Archived: Dimensions Woodmere Lower Wokingham Road

Dimensions Woodmere Lower Wokingham Road is a care home (without nursing) which is registered to provide a service for up to six people with learning disabilities. There were five people living in the home on the day of the inspection. Dimensions Woodmere Lower Wokingham Road accommodates people in a large adapted building. Three people had their own flats and two people shared a flat.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting most parts of the underpinning principles of Right support, right care, right culture. However, some improvements are required. The model of care is satisfactory; it ensured that people could live their lives how they chose and as an individual member of society. The staff supported people to have choice and control in their life. The care was person-centred and promoted people's dignity, privacy and human rights. The staff and the registered manager worked in a positive way to ensure that people received good care.

Effective recruitment processes were not in place to ensure, as far as possible, that people were protected from staff being employed who were not suitable. The management of medicines and premises was not always safe. Not all staff were up to date with, or had received, their competency checks and mandatory training. Risks to people's personal safety had been assessed. However, action was not always taken to reduce the risks where possible and the plans were not always in place to minimise those risks.

Quality assurance systems in place were not effective in ensuring compliance with the fundamental standards and identifying when the fundamental standards were not met. When incidents or accidents happened, it was not always clear that it was investigated, and lessons were learnt. The registered person did not inform us about notifiable incidents in a timely manner. The registered person did not ensure that clear and consistent records were kept for people who use the service and the service management.

We have made a recommendation about seeking guidance from a reputable source to ensure the principles of the Accessible Information Standard were met.

Relatives felt their family members were kept safe in the service. Professionals also felt people who use the service were supported well. Relatives told us they felt they could approach the management and staff with any concerns and that communication was good. The staff members felt staffing levels were sufficient to do their job safely and effectively. The registered manager appreciated staff contributions to ensure people received the best care and support. Staff felt the registered manager was managing the service well, and they could approach the registered manager for any advice, help or support. The registered manager and staff understood their responsibilities to raise concerns. There was an emergency plan in place to respond to unexpected events and the premises and equipment were kept clean.

During the pandemic, the registered manager continued working with the staff team to ensure they provided caring and kind support consistently. Staff had ongoing support via regular supervision and appraisals. They felt supported and maintained great teamwork. The staff team recognised and responded to changes in people’s needs and ensured a timely response from different professionals. People received effective care and support from staff who knew them well. People enjoyed the food and could choose what they ate and where to eat. People had their healthcare needs identified and were able to access healthcare professionals such as their GP.

People, their families and other people that mattered were involved in the planning of their care. People were encouraged to live a fulfilling life with activities of their choosing as much as possible and were supported to keep in contact with their families.

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.

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 6 August 2018).

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to quality assurance; notification of incidents and management changes; record keeping; management of medicine; and staff training, supervision and recruitment. We have made a recommendation about meeting the Accessible Information Standard.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dimensions Woodmere is a care home (without nursing) which is registered to provide a service for up to six people with learning disabilities. There were five people living in the home on the day of the inspection. Some people had other associated difficulties such as being on the autistic spectrum.

People in care homes receive accommodation and nursing or personal care as a 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.

Dimensions Woodmere accommodates people in a large adapted building. Two people had their own flats and four people shared two flats. The service was run 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 can lead as ordinary a life as any citizen.

At the last inspection, on 24 May 2016, the service was rated as good in all domains. This meant that the service was rated as overall good. At this inspection we found that all domains remained good. Evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

People continued to be protected from all forms of abuse. Staff training in safeguarding people was refreshed regularly and staff continued to understand their responsibilities and what action to take if they identified any concerns. The service identified health and safety, safe working practices and individual risks to people. All aspects of safety were considered and actions were taken to assist people to remain as safe as possible.

People continued to be supported by appropriate staffing ratios. Staff met people’s specific needs, including any relating to diversity, safely. Recruitment systems ensured, that as far as possible, staff recruited were safe and suitable to work with people. People were supported to take their medicines, at the right times and in the right amounts by trained staff whose competency was assessed regularly.

A well-trained and knowledgeable staff team offered people effective care. They met people’s diverse needs including their current and changing health and emotional well-being needs. The service worked closely with health and other professionals to ensure they offered individuals the best care in the most effective and comfortable way.

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

The service was person centred and remained responsive to people’s diverse, individualised needs and aspirations. Activity programmes met people’s preferences and choices. Care planning was individualised and regularly reviewed which ensured people’s current needs were met and their equality and diversity was respected.

The staff team continued to be caring and were committed to meeting people’s needs with kindness and respect. They ensured they promoted people’s privacy and dignity and communicated with them effectively.

The registered manager was experienced, respected and highly thought of. She and the management team ensured the service continued to be well-led. The registered manager and the staff team offered people person-centred and responsive care. They did not tolerate any form of discrimination relating to staff or people who live in the service. The quality of care the service provided was assessed, reviewed and improved, as necessary.

Dimensions Woodmere is a residential care home which provides a service for people with learning and other disabilities, such as people on the autism spectrum. The service is registered to provide care for up to six people. There were six people living there on the day of the visit. People were provided with shared or single, self-contained flats. There were two shared and two single flats with communal facilities such as the garden and the laundry.

There is a registered manager running the service. 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.

People were kept safe from any form of abuse because staff were properly trained so they knew how to protect people. The service took people’s, staff’s and visitors’ health and safety seriously. Policies and procedures which staff understood were followed to keep people as safe as possible. Any risks were identified and action was taken to reduce them. There were high staff ratios to ensure people were looked after safely. The recruitment procedures were robust and made sure, that as far as possible, staff were safe and suitable to work with the people who live in the home. Medicines were given safely by properly trained staff.

People were supported to stay as healthy and happy as possible. The staff team sought advice from and worked closely with health and other professionals to meet people’s needs in the best way. People’s emotional needs were met to ensure people were able to enjoy their lives as much as they could.

Peoples’ rights were protected by the staff and registered manager of the service. The service understood how the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who may not have capacity to do so. People were helped to make decisions and choices so they could control as much of their daily lives as possible. People were encouraged to be involved in all aspects of the running of their home.

People were provided with care by a staff team who knew them well and who understood their individual needs. Staff were well trained, understanding and responsive to changes in people’s needs and wishes. People were treated with respect, kindness and dignity at all times. Staff understood what person centred (individualised) care meant and why it was important. They were non-discriminatory and met people’s equality and diversity needs. People were provided with a variety of activities, according to their needs, abilities and preferences.

The service was well-led by a respected registered manager and supportive management team. The service had a positive culture and open management style which encouraged people, staff and others to express their views and opinions. The quality of the care provided was maintained and enhanced as appropriate.

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?

This is a summary of what we found.

Is the service safe?

People who use the service had been cared for in an environment that was safe, clean and hygienic. One relative of a person who uses the service told us 'X is cared for in a safe environment.' Guidelines about infection prevention and control were available for staff to follow. All staff had received refresher training in infection prevention and control. A personal evacuation plan was present in each person's file we looked at. A member of the management team was available on call in case of emergencies.

Since our last inspection on 8 and 9 January 2014 we found the provider had put measures in place to strengthen the recruitment process for the employment of new staff. Existing staff recruitment files had been reviewed to ensure they contained all the information required by the Health and Social Care Act. This meant staff employed to work at the service were suitable and had the skills and experience needed to support people.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to this type of service. While no applications have needed to be submitted by the provider since 2010, proper policies and procedures were in place. Relevant staff were trained to understand when an application should be made, and how to submit one.

Since our last inspection on 8 and 9 January 2014 we found actions had been taken by the provider to ensure records for people and staff were accurate and fit for purpose. We saw people's records were stored securely and could be located promptly when requested.

People were protected from the risk of inappropriate or unsafe care. This was because the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to incidents.

Is the service effective?

We spoke with two people and two relatives of people who use the service. They were complimentary about the care received. One person we spoke with said 'I am happy here.' It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One relative told us. 'They are providing good care that meets X's needs.'

Staff had received training to meet the specific needs of the people living at the home. Examples of training included, management of epilepsy. People's health and care needs were assessed with them. Care to meet these needs was recorded in support plans. Relatives we spoke with told us the support plans reflected their family member's current needs. We noted people's involvement in annual reviews of their care.

Is the service caring?

People were supported by kind and supportive staff. All interactions we observed between the staff and people were open, respectful and courteous. We saw that care workers gave encouragement when supporting people. People were able to do things at their own pace and were not rushed. A relative told us "I have no concerns about the care here.' People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded in their support plans. Care and support had been provided in accordance with people's wishes for example arranging preferred activities, holidays and colour schemes in bedrooms.

Is the service responsive?

People's needs had been assessed before they moved into the home. People told us they met with their key workers once a week to discuss what was important to them. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is he service well-led?

The provider had systems in place to regularly assess and monitor the quality of service that people received. The provider carried out quarterly quality audits of the service. The home manager told us a survey went out to staff, people and their relatives annually. This survey asked people what they thought about the quality of support provided. We saw the outcome of the last survey for 2013-14 was available to people in an accessible format. Records seen by us showed people were complementary about the service and any identified shortfalls were addressed promptly. Relatives we spoke with confirmed they had been listened to and provided examples of improvements made to the service following their feedback. As a result the quality of the service was continuingly improving. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. One relative told us 'They provide a very good service for X.'

The home was clean and well maintained. We saw that bedrooms were personalised to people's preferences and equipped with appropriate furniture like beds, wardrobes, chest of drawers. We looked at certificates relating to health and safety. We saw that gas, electrical and fire safety certificates were in place and renewed as required to ensure the premises remained safe for staff and people using the service. However, there had not been a fire drill recorded for the home for nine months.

Staff recruitment processes were not effective and did not always ensure that staff were suitable to work with vulnerable people. Recruitment files we looked at did not hold sufficient and appropriate information about staff according the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Schedule 3.

There was a process and written complaints procedure, including an easy read version. The family members we spoke with told us they were aware of who to speak to if they had any complaints or concerns. There was an effective complaints management system in place. The complaints procedure was accessible and clearly displayed in the home.

The provider had a policy for record keeping. All records relevant to people using the service and the management of the service were stored securely in the office and easily accessible to staff. However, some health and social care and support records were not always accurate, up to date and/or fit for purpose.

We observed staff communicating and listening to people in a respectful and meaningful way. We spoke with staff and looked at people's support plans and supporting documents and found that peoples' needs were assessed, and care and support was planned and delivered in line with their individual support plans and communications passport.

People who live at Woodmere were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People living at the home told us they felt safe. Relatives felt that they would be comfortable to raise concerns with the manager.

Staff were supported to deliver care safely and to an appropriate standard. They had attended appropriate training and supervision.The provider had a system of quality monitoring and processes in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.