Archived: Dimensions 61 New Road

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The registered manager was also the registered manager of another Dimensions service and provided management oversight to two single dwelling supported living settings. The registered manager was not available during the inspection due to being on leave, but we spoke with them upon their return to discuss our inspection findings.

At the last inspection in June 2016 the service was rated as requires improvement. This was because improvements were needed to ensure that the premises were kept in good decorative order and to ensure that staff received adequate supervision. This inspection found that the required improvements had been made. Staff had ensured the premises were more homely and comfortable for people to live in and the registered manager had taken action to ensure that staff were receiving more regular supervision.

Regular checks were undertaken to help maintain a safe environment for people to live in. We have made a recommendation that the provider ensure that the window restrictors meet relevant guidance.

Staff had a good understanding of people’s risks and how to support them to maintain good health and stay safe. Staff understood how to support people to take positive risks and the importance of not restricting their interests.

Accidents and incidents were investigated to make sure that any causes were identified and action was taken to minimise any risk of reoccurrence. People’s medicines were managed safely.

Staff understood how to recognise and respond to abuse. People were encouraged to express their choices and these were respected. The leadership team understood the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were supported to have enough to eat and drink and their dietary needs were met. Staff worked effectively with a range of other healthcare professionals to help ensure people’s health care needs were met.

People were supported by staff that were kind and caring. Staff and people had a good relationship and that staff showed people kindness and patience and provided care in a calm and quiet manner. Staff listened to people and respected their choices and wishes, encouraging them to be involved in making decisions about the care and support provided.

The service and people living there continued to be part of their local community. People were supported to stay in contact with their friends and relatives.

People were cared for with dignity and respect and that staff were mindful of their need for privacy.

Staff understood the needs of the people they supported and cared for them in a person centred manner that was responsive to their individual needs.

People were able and encouraged to take part in a range of leisure activities and follow their own interests.

The provider had a complaints procedure in place that was accessible to people. Records showed that the provider had not had any complaints since our last inspection.

Feedback from staff about the registered manager and the assistant locality manager was positive. Staff felt well supported and confident going to the registered manager or assistant locality manager with any concerns or ideas.

The registered manager fostered a positive and person centred culture within the home and helped staff provide care which was in keeping with people’s needs and wishes.

Dimensions are a specialist provider of a wide range of services for people with learning disabilities and people who experience autism. This service provided care and support for up to six people with a learning disability. At the time of our inspection there were five people using the service some of whom were also living with physical disabilities. The home was arranged over two floors. The ground floor consisted of two bedrooms with a shared adapted bathroom, a dining and kitchen area, a laundry room and a communal lounge. This floor was fully accessible to wheelchair users. Four further bedrooms and the office were located on the first floor which was accessed by stairs only. The home had a large accessible garden to the rear and parking to the front.

The service had a registered manager. 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 and associated Regulations about how the service is run. The registered manager also managed another Dimensions service and was supported in these roles by an assistant locality manager.

Improvements were needed to ensure that repairs and improvements to the environment were completed in a timely manner so that the service was kept in good decorative order and was homely and comfortable for people to live in.

Improvements were needed to ensure that the registered manager had sufficient time to perform their duties effectively and provide support, such as regular supervision, to the staff team.

There were systems and processes in place to identify and manage risks to people’s wellbeing. When new or increased risks were identified, action was taken to address these.

Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team and external agencies.

Appropriate arrangements were in place to manage people’s medicines. Medicines were only administered by staff who had been trained to do this.

There were sufficient staff to meet people’s needs and safe recruitment practices were followed. Appropriate checks had been undertaken which made sure only suitable staff were employed to care for people in the home.

Staff were acting in accordance with the principles of the Mental Capacity Act 2005. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were in place.

People were supported to have enough to eat and drink. They were involved in decisions about what they ate and were assisted to remain as independent as possible with eating and drinking.

Staff showed people kindness, patience and respect and we observed positive interactions between people and their support workers. People were encouraged to maintain relationships with their family and to make new friends within the local community.

Staff had a good knowledge and understanding of the people they were supporting. Staff were able to give us detailed examples of people’s likes and dislikes which demonstrated they knew them well. People took part in a range of activities that were tailored to their individual interests.

People and staff spoke positively about the registered manager who they said was committed to providing a strong person centred culture and to advocating and championing the rights of people living at the service. Staff told us that the registered manager was really focused on the people using the service and had made improvements at the service.

There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving the best possible support.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

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

Is the service safe?

People's care records contained assessments which covered the risks associated with staff providing the care and support they needed. This helped to ensure that people who used the service were safe because staff had taken action to identify and assess the risks to their health and wellbeing. We did however find some examples where the risks to people had not been fully recorded and planned for.

Systems were in place to receive, store and administer medicines. Supporting information to ensure staff administered medicines safely was available. The service ensured people received their medicines safely as prescribed.

The registered manager took people's needs into account and ensured that care workers with the relevant knowledge, skills and experience were scheduled to care for people. This helped to ensure that people's needs were met.

The service had taken action to assess and mitigate the potential risks associated with the night-time staffing levels by making arrangements to ensure that people had detailed night time support plans and personal evacuation plans in place.

Is the service effective?

The provider had taken action to ensure that there were effective systems in place to reduce the risk, and spread of infection. We observed that the home was clean and hygienic.

Staff we spoke with were informed about people's needs and were able to tell us about the care they provided. This information was consistent with that recorded in people's records.

The service worked effectively with other providers to ensure that people received co-ordinated care, treatment and support.

Is the service caring?

People were supported by kind and attentive staff. Staff treated people with dignity and respect.

The service had taken action to ensure that care and support was provided in accordance with peoples wishes.

People told us they were well cared for. One person told us, 'We're all looked after here very well'. Another told us they were 'Very Happy'. A relative told us; 'There is always a nice atmosphere at the home'.

Is the service responsive?

We found that the service had ensured people were aware of the complaints system by providing this in a format that met their needs. People told us that they would share any concerns they had with the registered manager. One person said, 'If I was worried about something I would tell the boss'. A relative told us that they felt confident that complaints would be taken seriously, they said, 'Anything you say they [the registered manager] takes it on board.

Is the service well led?

The service had a consistent management structure that maintained oversight of the home and provided leadership to the staff team. One staff member told us '[the manager] does something about your concerns and gives you feedback'.they have made the team cohesive'they have worked wonders'.

The registered manager was able to demonstrate a good knowledge of the needs of people who used the service and their care and support needs.

People knew how to complain and told us that they were confident that action would be taken where necessary. A relative told us they felt confident that complaints would be taken seriously, they said; 'Anything you say they [the registered manager] takes it on board'.

The service had taken action to ensure that it had appropriate quality assurance systems in place to monitor the quality of the service and identify where improvements could be made.

People were enabled to give their consent to care and support whenever possible. Where people did not have capacity to consent, effective systems ensured their rights and well-being were protected in line with legal requirements.

People living at the service and staff knew and got on well with each other. We reviewed plans and records of care for three of the six people at the service, and found they were person-centred but needed updating in parts.

We found issues with the standard of cleanliness of a number of communal rooms and personal spaces, which put people at risk of infection. The service's systems for the management, storage and disposal of medicines were not effective. This resulted in the risk that people did not receive all medicines in line with their specific health needs.

There were sufficient numbers of staff working to meet people's fundamental care and welfare needs during the day time. We found there was insufficient staff to support all people's choices and meet all their potential care needs in the evenings and during the night time.

Regular internal audits did not effectively highlight all issues that needed to be addressed as part of the provider's quality assurance programme.

We reviewed care plans for four of the six people using the service. Although they were in different states of completion, they all contained essential details about people's care and support and were person-centred. People living at the service and staff knew and got on well with each other, and support was observed to be person-centred, respectful and responsive to individual needs.

The service had robust recruitment and selection procedures, and necessary checks were carried out on all staff before they started working at the service. The service had adequate systems for recording and responding to complaints, and an easy-read guide to the complaints process was available to all people using the service. There were effective procedures in place for safeguarding vulnerable adults and staff followed the appropriate local safeguarding process.