Archived: Dimensions - 209 & 211 Burncross Road

Since our last inspection in December 2010 all of the day staff had received `Active Support' training and coaching and this had resulted in staff working with people in a person centred manner. This had had a positive effect on people's outcomes and their opportunities to lead meaningful lifestyles. People had access to daily activities in their home, to regular community activities and were supported to make everyday choices about how and with whom they spent their time.

Overall, people's care and welfare was protected by the support planning systems and risk assessments in place and staff knowledge of people's preferences was really positive to see. Some concerns were identified about the staff's understanding of the different recording systems in place and this has been brought to the Regional Operations Director to address and an improvement action has been made to address this.

Overall, we found that people were happy living at Burncross Rd and were supported by adequate numbers of suitably skilled and committed staff.

Relatives told us;

'The house seems a lot cleaner, they have done a lot of decorating but there have been a lot of changes with the staff team and the managers keep coming and going'.

'My relative always has received excellent care, but there are a lot of agency staff in the home and that makes the permanent staff's job much harder as they have to look after them as well'.

'Overall, I think (people) are adequately looked after by good staff, but there are too many agency staff working there and they don't know people or how to manage them'.

'There are not enough activities for people. Would you like to sit there, all day in a chair, because that's what happens'?

We spoke to two professionals who told us;

One professional told us they had concerns about the staff culture in the home. They said they visited regularly and very rarely saw people doing any meaningful activities. They thought the staff approach appeared task orientated, was not person centred and felt the staff practices were 'quite institutional'. This professional said they thought staff meant well, but lacked the necessary skills to support people appropriately.

Another professional told us that they had recently withdrawn Speech & Language support for a person who lived at the home. They said the staff had not been able to implement the communication support plan for the person, as there were so many staff changes.

These practices placed people at risk of their care and welfare needs not being adequately met.

Although the provider had taken steps to better safeguard people, for example staff had been offered training and their awareness of adult safeguarding procedures had improved since our last visit. We had concerns about some of the staff practices we had observed and other stakeholders had told us about. We were concerned about the staff teams' level of understanding in preventing the risk of abuse and or neglect of people. In that they showed little understanding of the value of providing people with a stimulating environment, meaningful activities, and effective communication in preventing behaviour that presents a risk. We also had concerns about some of the staff teams' ability to engage with and respond to people in an appropriately person-centred way. This placed people at risk of experiencing abusive practices.

During our visit we saw evidence that the provider had ensured that staff had received adequate training to administer medication to people who lived at the home. They had also assessed the staff prior to them carrying out this duty. And some of the medication records we checked had been completed adequately. However, we also saw evidence of other medication records that had not been completed adequately, therefore we had concerns about whether people had received medication at the times and in the way they had been prescribed. This could place people's health at risk.

Since our last visit in June 2010 the provider had agreed to increase the staffing levels and a person who required 1-1 staff support was receiving this on a regular basis. From the staff rotas we checked there was evidence of this staffing level increase but there was also evidence that 9 shifts had not been adequately staffed over a two week period in late November 2010. This did not ensure that people's safety and welfare needs were being met by sufficient numbers of suitably skilled and experienced staff.

The provider had greatly improved the mandatory and specialist training opportunities available to staff and the staff confirmed this. Staff had also received some formal supervision; however, at the point at which care was being delivered to people, the system had failed to identify some staff practices which did not protect people's dignity or rights.

There was evidence that the support staff had been offered advice and support from the team leaders, but there was very little evidence that the team leaders had been offered adequate support during the two weeks since the previous manager had been absent from the home. This meant that the senior staff were struggling to manage the service and the staff team during this time. This arrangement did not ensure that staff were adequately supported people or supervised to deliver care and support safely and to an appropriate standard.

Since our last visit the provider had significantly improved many of the quality monitoring systems within the home however, they now need to be developed to ensure that care delivery is offered to an adequate standard to ensure people's care and welfare needs are protected.