Background to this inspection
Updated
23 October 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’
The inspection took place on the 16 September 2015 and was unannounced. The inspection team consisted of one inspector.
Before the inspection, we reviewed all the information we held about the service including previous inspection reports and notifications received by the Care Quality Commission (CQC). A notification is used by registered managers to tell us about important issues and events which have happened within the service. Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, such as what the service does well and improvements they plan to make. We used this information to help us decide what areas to focus on during our inspection.
Due to nature of the needs of some of the people using the service, we were not able to seek each person views about the care and support they received. We were however, able to speak with two people and also spent time observing interactions between people and the staff supporting them. We also spoke a relative, the registered manager, assistant manager and three support workers. We reviewed the care records of two people in detail. Other records relating the management of the service such as audits and policies and procedures were also viewed.
Following the inspection we sought feedback from five health and social professionals about the quality of care people received.
The last full inspection of this service was in September 2013, when we identified some concerns in relation to how medicines were being managed. We went back to the service in December 2013 and found that the required improvements had been made.
Updated
23 October 2015
The inspection took place on the 16 September 2015. The inspection was unannounced.
Dimensions are a specialist provider of a wide range of services for people with learning disabilities and people who experience autism. This service provides care and support for up to six people with a learning disability. The home consists of two adjoining bungalows with an office in the middle. Each bungalow has three bedrooms, a lounge, bathroom, laundry room and a large kitchen /diner. The home has a large 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 manager was also the registered manager for another Dimensions service nearby and was supported in these roles by an assistant locality manager.
Some areas required improvement. Where people were at risk of their health deteriorating quickly, escalation plans were in place, but these were not always being followed and had not been updated in light of revised guidance from healthcare professionals.
Staff had received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards. Staff acted in accordance with people’s wishes and choices. Systems were being implemented to support staff to assess and record mental capacity assessments and best interests decisions.
Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team.
Safe recruitment practices were followed and appropriate checks had been undertaken which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.
Staff received a comprehensive induction which involved learning about the values of the service, the needs of people using the service and key policies and procedures. Staff were supported to provide appropriate care to people because they were trained, supervised and appraised.
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 either in place or had been applied for.
People were supported to have enough to eat and drink and their care plans included information about their dietary needs and risks in relation to nutrition and hydration.
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 were supported to follow their interests and make choices about how they spent their time.
There was an open and transparent culture within the service and the engagement and involvement of people and staff was encouraged and their feedback was used to drive improvements. 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.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.