Dimensions 1 Middlefield Close

We found the following examples of good practice.

People’s wellbeing was protected. Staff took steps to minimise any negative impact the COVID-19 pandemic had on their lives. For example, people maintained contact with their loved ones via regular phone calls and were supported to understand the changes in their day to day lives related to COVID-19. The spacious communal garden and outside care park area were used to facilitate socially distanced family visits.

The registered manager ensured appropriate clinical support around aerosol generating procedures (AGPs) was in place for those who required that kind of support. The required training was provided to staff by specialist infection prevention and control (IPC) nurse. There was appropriate stock of high-level PPE available for staff and clear guidance on other precautions which had to be observed, such as ensuring thorough ventilation of the room following the AGP. The registered manager worked closely with the specialist nurse who supported with IPC audits and regular refresher training for staff.

People who were extremely vulnerable and received communication from NHS around shielding were supported to do so. The registered manager reviewed risks to these people early in the pandemic and implemented increased IPC precautions to minimise the risk as far as possible. Staff we talked with were dedicated to protecting people and each other and aware of people’s vulnerability. One staff member explained they always had clean PPE on when supporting the person even if social distancing was possible, so they were ready to provide immediate emergency assistance to people who might need it due to their health needs. When equipment at the serviced needed repairs, some of the work was completed by contractors in the car park and items were disinfected by staff before entering the home to protect people.

Staff told us they felt supported by the management and the provider and worked well as a team. This meant people received consistent support. Staff who could be more vulnerable to COVID-19 were supported by the registered manager to assess their individual circumstances, so they told us they felt safe and confident when at work. The service also accessed the national vaccination program.

Dimensions 1 Middlefield Close is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

People’s experience of using this service:

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People appeared relaxed and happy in the company of the staff. People who verbally communicated told us they enjoyed living at the home. A relative said, “The staff are brilliant, nothing they need to do better and X is very relaxed, he has his freedom and is well cared for”. People were involved in their own home as much as possible. People were vacuuming and sweeping and making drinks. The home had a relaxed, comfortable atmosphere and people were care for by a dedicated team of staff.

People received safe care because any risks had been assessed and staff knew what action to take to minimise these risks. For examples, they knew to monitor closely people who had epilepsy and they responded with appropriate care or by calling the emergency services.

Staff knew how to prevent the spread of infections and how to respond to any emergencies. People received their medicines in a safe way and medicines were stored safely and accurate records were kept.

Accidents and incidents were recorded and investigated appropriately.

Staff had been recruited safely and there were enough staff to support people with their care and their activities. The staff were trained to deliver effective care that met each person’s needs and they received supervision to make sure their training was put into practice.

People had access to health care and regular health checks. People were supported to have a healthy diet which took account of their needs. People ate different meals at different times to suit their own preferences. Staff made sure they served people food in a way that was safe, such as cut up into small pieces if people were at risk of choking.

Staff understood the requirements of the Mental Capacity Act and gave people choices and sought their consent. Where people lacked consent for some decisions the correct legal processes had been followed.

The home was suitable for people and there was specialist equipment as needed. All the accommodation is on the ground floor which allowed people, including those who use a wheelchair, to have full access. A new bed had just arrived to make someone more comfortable and one person had a tailor made chair to help their posture and comfort. The home showed wear and tear and although the housing association had been slow in responding to requests for repairs the registered manager had a redecoration plan in place.

The staff cared about every person and showed this by appropriate affection and humour. Close relationships had been built up over a long time and staff knew each person’s needs very well.

People were encouraged and supported to maintain important relationships and families were always welcomed and included.

People were supported to take part in a wide range of activities and hobbies that suited their personalities and preferences. These included, visiting historic places, art and music groups as well as one to one time having meals out in town or shopping. The routines were set by people and not by staff. There were detailed plans in place for each person which staff followed, and these were regularly updated as changes occurred. Complaints had been recorded and investigated.

The registered manager also managed one of the provider's other services and divided their time between the two homes. There was a clear management structure in place which meant that there was enough support in place for staff at all times.

There was an open culture and staff understood the providers aim of providing people with a fulfilling life with as few barriers as possible. Regular quality checks were made by the registered manager and the provider and action was taken to improve when needed.

The registered manager had informed CQC of any serious incidents as they are required to do. When incidents had taken place, they had been reviewed to learn any lessons to try to prevent them happening again.

Rating at last inspection

The last inspection was carried out on the 8 September 2016 and the rating was Good.

Why we inspected

This inspection was carried out as part of our routine schedule of inspection based on the previous rating.

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

The inspection took place on 08 September 2016 and was unannounced.

1 Middlefield Close is registered to provide accommodation for a maximum of five people. It specialises in care for people with learning disabilities and autistic spectrum disorder. At the time of the inspection there were five people living at the service.

There was a registered manager in post. 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 registered manager was unavailable during the inspection, support was provided by the deputy manager to access records and information.

People and staff spoke highly of the management of the home. Staff told us that they felt supported and knew that there was always someone available to help them when needed. We received positive feedback regarding the care staff from relatives of people living at Middlefield Close.

Care plans and risk assessments had been completed to ensure people received appropriate care. Staff involved in developing care plans knew what was important to people and their communication needs. This meant information was personalised and reflected people's personal choices and preferences.

People were encouraged to take part in daily living tasks and supported to participate in daily activities. Staff demonstrated an understanding of how to recognise and report abuse and treated people with respect and dignity. People were given choices and involved in day to day decisions about how they spent their time. People had a choice of meals provided and staff knew people's likes and dislikes.

People’s rights were protected as systems were in place to assess people’s capacity to make decisions and guidance was followed when making decisions in people’s best interests. There was complaints procedure in place and relatives told us they would felt any concerns raised would be addressed promptly.

Medicines documentation and relevant policies were in place. These followed best practice guidelines to ensure people received their medicines safely. Regular auditing and checks were carried out and accurate records were maintained. People had access to healthcare professionals and their health needs were assessed and monitored. Where people’s behaviours and anxiety impacted on their day to day lives guidance was available to staff as to how to support people in managing their anxiety.

People were supported by sufficient numbers of skilled staff. Staff felt that training provided was effective and ensured they were able to provide the best care for people. Staff received regular supervision and training which they felt was effective and supported them in providing safe care for people. Recruitment checks were completed before staff started work to ensure they were suitable to be employed in the service.

Systems were in place to assess the quality of the service people received. Maintenance and servicing of equipment was completed regularly and fire evacuation plans and procedures were in place. There was a business continuity plan in place to ensure people would continue to receive safe care in an emergency. Notifications had been completed to inform CQC and other outside organisations when significant events occurred.

If you wish to see the detailed evidence supporting our summary please read our full report.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Is the service safe?

People were protected from the risk of inappropriate or unsafe care. This was because the provider had effective systems in place to assess, plan, review and monitor the care and support provided to people who used the service. In addition the procedures to identify, assess and manage risks to the health, safety and welfare of people and care workers in relation to activities had been used effectively.

One relative said, "They look after X well he has everything he needs here and he is safe."

Staff understood how to manage emergency situations and they had the training and equipment to do so safely.

Staff had been recruited using an effective system which ensured that all the required checks had been carried out prior to them starting to work with people at the service.

Is the service effective?

People's care needs had been assessed and planned for effectively. The staff were aware of people's assessed needs and this meant that appropriate care and support was delivered.

All staff had received training to meet the needs of the people who use the service. Examples of training included infection control, the safeguarding of vulnerable adults (SOVA), safe moving and handling and fire safety.

The staff were aware of people's health needs including what support people needed in relation to attending medical appointments. The health information staff required had been recorded but needed more frequent review to ensure it was up to date.

Is the service caring?

People were supported by kind staff who knew them well. We observed kind and caring interactions between staff and people who used the service. People who were not able to verbally express their views were cared for by staff who knew them well enough to seek their views and interpret their needs and wishes.

There were systems in place to ensure relatives could provide feedback to the provider about the quality of the service provided for their family members. There was also a system through which staff were enabled to share their experiences and views about the service.

Is the service responsive?

The service was responsive to people's needs because there were enough staff with appropriate knowledge, skills and training to meet people's assessed needs.

Is the service well-led?

The registered manager and the provider's representatives had an effective system for assessing and monitoring the quality and safety of the service. This meant they were identifying shortfalls and taking appropriate action to ensure people received a safe, effective, caring, responsive and well led service.

You can see our judgements on the front page of this report.

During our visit we saw that people were being treated with dignity and respect and people's independence was encouraged. People were spoken to in a respectful way. We spoke with a family member and they felt that their relative was very well cared for and that they were involved in making decisions about their relative's care and treatment.

One person that we spoke to told us that they enjoyed going to art classes and castles. During our visit we saw that this person attended the art class and that they had a poster displayed in their bedroom of all the castles that they had visited and pictures of the castles that they had visited.

People's bedrooms were personalised and met the individual needs of people using the service. We saw that people's likes and preferences were reflected in their individual bedrooms. People had pictures and art work displayed as well as musical instruments that they enjoyed playing and listening to.

We saw staff supporting people to make their own choices about what they had to eat and drink and what activities they took part in. Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

Staff that we spoke to felt very valued and supported and were passionate about the work that they did.

We found that people were involved in making decisions about their care and support, and their privacy and dignity were respected. Support plans were based on thorough assessments and support was delivered according to the plans. People using the service were protected against the risks of abuse. The provider had recruitment processes in place to ensure that people's support was delivered by staff who were suitable and had the right skills and knowledge. The quality of the service provided was monitored and assessed regularly.