The inspection took place on 7 and 8 November 2016 and was announced. Dimensions Kent Limited provides supported living services to people living in their own homes. At the time of this inspection fourteen people were being supported who had high complex needs and required a one to one bespoke service. It is a specialist service for people that have anxious or emotional behaviour that has limited their quality of life and experiences. .Each person had a tenancy agreement for their property and received 24 hour support in all aspects of their care to enable them to remain as independent as possible. People lived in several properties in the East Kent area in their own flats, with communal areas. The care and support people received was overseen by a manager (who was applying to be registered), and two locality managers, who were in day to day charge of the service.
The previous registered manager had left the service on 31 October 2016. The organisation had taken prompt action and appointed a new manager who had experience in covering these types of services in other areas of the same organisation. They commenced their duties on 1 November 2016 and their application to become the registered manager was currently being processed by the Care Quality Commission. If a service does not have a registered manager in post at the time of the inspection the rating in the well led domain is restricted to being judged as requires improvement. At this inspection as the registered manager’s application was being processed by CQC and the evidence in well led was positive we having taken a proportional and balanced view to rate the domain as good. A registered manager is a person who has registered with 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 2008 and associated Regulations about how the service is run.
People, staff and relatives spoke highly of the management and staff. They told us that it was an excellent service where people were supported to enjoy their lives to the full. The management team and staff were passionate and committed to supporting people with person centred care to have meaningful lives, and reach their full potential. The management team visions and values were imaginative and person-centred, and made sure people were at the heart of the service. The culture of the service was extremely positive, with a clear vision of providing high quality care to people. The management team sustained high quality practice, with the ethos of development and continuous improvement of the service. Everyone we spoke with were highly motivated and actively involved in the service to ensure that people received consistent high quality care.
Staff understood the importance of making people feel safe and protected from harm. Staff treated people with respect at all times; they were patient and kind, and gently encouraged people to take their time to communicate their needs. Detailed plans about individual’s communication needs enabled people to express themselves in ways that were understood by staff. People showed affection towards staff who listened and acted on what they said or needed.
People were encouraged to live their lives to the full and risks were managed proactively. When activities did not go as planned the staff reviewed the risk assessments and made adjustments so people could continue with their chosen activity safely. When people’s behaviours impacted on their day to day lives, detailed guidance was available to staff to support them to manage their anxieties. People’s finances were protected and checked to make sure people could access their monies when they wanted to.
Systems were in place to record accidents or incidents, with a clear process to investigate, review and look for patterns and trends to reduce the risk of re-occurrence. The provider had a business continuity plan to make sure they could respond to emergency situations, such as adverse weather conditions. There was an out of office on call system to ensure that people and staff could access support and guidance at any time if needed.
Some people had equipment in place to aid their mobility, such as hoists. Staff were aware that the equipment needed to be serviced to remain safe, and systems were in place to confirm the equipment was being serviced according to the manufacturer’s guidelines.
People had all been assessed to receive one to one care and staffing levels were constantly reviewed to make sure additional staff were available if people needed two members of staff to help with their mobility or personal care. Staff were carefully matched to each person to ensure that they shared interests and hobbies and this helped to build strong caring relationships. People were supported by core team members to ensure they received consistent care from staff who knew them well.
Staff received regular training including specialist training to help people with their complex needs. All staff had received regular supervision from their line manager and an appraisal to discuss their training and development needs. Staff were recruited safely and people were involved in the process where possible. New staff were checked before they started work to ensure they were suitable to be employed in the service. As part of the induction programme new staff shadowed established staff until they got to know the people and how to care for their individual and specific needs.
People were receiving their medicines safely. Staff were trained in the safe administration of medicines and kept records that were accurate. People received medicine reviews to make sure their medicines were working effectively. People were supported with their health care needs, which were regularly assessed and monitored. Health care professionals were involved when required and their advice and recommendations were followed by staff.
People were supported with all their meals and drinks. Each person’s care plan provided guidance for staff about people’s preferences and any specific dietary requirements. People were able to choose their meals with the support of staff and their preferences were respected.
People’s rights were protected as the provider had clear systems in place to assess people’s capacity. People were supported by family and health care professionals to make decisions in their best interests, which were clearly recorded and followed by staff.
The management and staff team were very motivated and exceptional in enabling people to remain as independent as they were able. They were determined that people would receive the support and independence they needed to remain living in their homes. They had an in-depth understanding of people’s individual needs around all aspects of their care, including upholding their privacy and dignity. All interactions between staff and people were very caring and respectful.
Staff were very understanding and consistently patient, kind and compassionate. People smiled and turned around when staff entered their home and spoke with them. They welcomed staff into their home and showed affection and warmth when they communicated with each other. People were relaxed and very comfortable with staff who knew them well.
People were given choices and involved in day to day decisions about their care. They only received care from staff they had met before and were relaxed, and comfortable with them. This ensured that people's individuality and diversity was nurtured and they received care in a way that suited them best.
People had their own transport and were able to choose when they went out into the community with staff as they wished. They were supported to have very varied, interesting and personalised activity programmes of their choice. Staff encouraged people to enjoy new experiences to enable them to lead their lives to the full in line with their individual interests and abilities. People visited their favourite places, such as local cafes and attended church on Sunday.
People and their relatives were involved in planning their care. There was a strong emphasis on person centred care in all aspects of people’s daily routines. The care records were clear and continually reviewed to ensure that staff understood people’s changing needs. People, their relatives and outside agencies were consulted and involved in assessments and reviews to ensure people received the care they needed.
People who needed support with communication skills were supported by staff who knew them well. Care and support plans had information of how people would present if they were happy or when something was wrong. There had been no complaints this year and although the relatives told us that they did not have any complaints they said they would not hesitate to raise and discuss any issues with the locality managers if they had any concerns.
The leadership from the management team and support from the provider ensured that all staff were clear about their roles and responsibilities and what was expected of them. Staff sought advice and thought of different ways to ensure people received personalised care by working closely with relatives and health care professionals. Staff were proactive and recognised the importance of new concepts of care as a way to improve people’s standard of living.
Staff told us they were fully supported to do their jobs well and were very positive about working at the service. They felt valued and staff morale was high. They told us the support they received to do their jobs properly was excellent and there was always training and development opportunities available to enhance their skills.
Effective systems to continually monitor the quality of the service ensured that people received a high standard of care. The provider gathered information about the