Archived: Dimensions Luton Domiciliary Care Office

Dimensions Luton supports people who live in supported living services located in Bedfordshire, Hertfordshire, Cambridge, and Buckinghamshire. The service was supporting 76 people with the regulated activity of personal care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

We found some shortfalls with how the service was being monitored and assessed by the registered manager and the provider.

People’s relatives felt confident that people were safe in the care of staff and the service. There were good processes and systems in place to protect people from the potential risk of abuse and respond to incidents. People had risk assessments and care plans which guided staff about how to meet people’s needs. There were sufficient staff to support people and respond to their needs. People received their medicines. People’s mood controlling medicines were being managed in a way to reduce the use of these. Staff knew how to promote good hygiene in people’s homes.

Professionals spoke highly of the staff in terms of their knowledge and motivation to keep people healthy. Relatives were confident that people’s health was monitored carefully, and GP’s and other health professionals were contacted when it was needed. There were good plans to enable staff to support people who had complex needs when eating and drinking. Staff were knowledgeable about what people liked to eat and drink.

Staff were satisfied about the training they received. They felt supported by their line managers and felt comfortable about seeking direction and raising issues with them. Specialist training was proved when this was needed. Staff knew how to promote choices for people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Relatives felt staff were caring and respectful with people. Staff had a good understanding about the importance of forming caring relationships with people and to involve them in their day to day care.

Care was arranged so people’s needs were met by a regular group of staff who knew them well. People saw regular staff to promote people’s wellbeing and their need for routine. Staff supported people to fulfil their interests.

The service was making plans with people in regard to some aspects of their end of life needs, but these did not always include people’s wishes and wants at this part of their lives. We made a recommendation about this.

People would be asked their views in their yearly reviews. However, these were often late, and the service had not considered other ways of gaining people’s views of their care. Reviews often lacked details about people’s experiences or future goals. We made a recommendation about this.

There was a good culture in the staff team who spoke about putting people first and supporting them to live happy lives.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 20 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dimensions Luton Domiciliary Care office provides personal care and support services to adults and younger people with a learning disability living in their own homes, and within shared premises in the Bedfordshire area. At the time of our inspection the provider was supporting up to 65 people.

The service has a Registered Manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service took safeguarding concerns seriously and followed the local authority policy and guidance when dealing with safeguarding people from harm and the staff we spoke with demonstrated a good understanding of safeguarding issues.

There was a robust recruitment procedure to help ensure the staff recruited were suitable to work with the people using the service. People who used the service were encouraged to participate in the interviewing process for potential employees. This demonstrated the service’s commitment to the culture of inclusion and participation within the service.

Staffing levels were sufficient to provide the level of care required. Arrangements were in place to cover any sickness or absences. Flexible working was encouraged and supported and this helped provide a good work/life balance for staff. It also helped the service to meet the needs of every person who used the service.

Risk assessments were in place and were regularly reviewed and updated. The service endeavoured to balance risks so people could maintain their independence and lead an active life. Staff were trained to administer medicines safely and had undertaken further training to ensure they could deal with a number of health issues. Regular checks were undertaken to help ensure on-going competence in this area.

Staff demonstrated a good understanding of their roles and responsibilities. The service demonstrated a commitment to staff training, which was on-going and regular refreshers were undertaken.

Staff were given positive encouragement to undertake further, more specialised training appropriate to the work, including working towards Qualifications and Credit Framework (QCF), which is a nationally recognised diploma in health and social care.

Supervisions were undertaken regularly and considered important in offering an opportunity for discussion between staff and management about on-going work issues. Professional Development Reviews (PDR) were held annually to ensure learning was reviewed and training needs were met.

Care files were clear and comprehensive and contained relevant health and personal information. They were person-centred and included individuals’ goals, wishes and achievements. The service was flexible and responsive to changing needs, desires and circumstances. Positive outcomes were personal to each individual and were celebrated within care files.

Confidentiality was respected and independence was promoted. Communication with relatives was on-going throughout the duration of their relative’s involvement in the service.

People who used the service were encouraged to pursue their interests. Staff ensured that they treated each person as an individual and tailored activities and support to them.

Comments were encouraged formally and informally and there was a complaints policy in place. Literature given out to families gave the information and opportunity for people to raise concerns or make suggestions.

Best practice guidelines were followed and the service was innovative and creative in its approach to support. The management and staff were not afraid to challenge decisions and advocate fully on behalf of the people they supported in order to further improve people’s lives.

Feedback was regularly sought from families and users of the service. The service listened and took action to address any concerns and suggestions put forward by people who used the service and their families.

Team meetings were regularly undertaken, giving staff the opportunity to discuss any issues and to share good practice examples. The meetings were used as a forum to share current best practice guidance and keep staff up to date with new methods and innovation.

A number of audits were undertaken, results analysed and lessons learned from these to drive continual improvement in service delivery.