Archived: Dimensions 2 Buckby Lane

This comprehensive inspection took place on 22 February 2018. The inspection was unannounced, which meant the staff and provider did not know we would be visiting.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going 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.

People were kept safe from harm and staff knew what to do in order to maintain their safety. Risks to people were assessed and action was taken to minimise potential risks. Medicines were managed safely by trained staff and administered as prescribed. There were always enough staff deployed with the right mix of skills to make sure that care practice was delivered safely and to respond to unforeseen events. Staff underwent relevant pre- employment checks to ensure they were suitable to support people living with a learning disability.

Staff received training and supervision to maintain and develop their skills and knowledge, which enabled them to support people and meet their needs effectively. Staff applied the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards in their day to day care practice. This ensured people’s rights were protected. People were supported to have a healthy balanced diet and had access to the food and drink of their choice, when they wanted it. The environment was personalised to meet people's individual needs and the provider ensured all required specialist adaptive equipment needed to support people effectively was available.

People experienced positive caring relationships with staff who consistently treated them with kindness and compassion in their day-to-day care. Staff supervisions and competency assessments ensured that people experienced care which respected their privacy and dignity, whilst protecting their human rights. Meaningful relationships developed within the home had a positive impact on people’s wellbeing. Staff encouraged people to do as much for themselves as possible and to experience new things to promote their independence.

People experienced care that was flexible and responsive to their individual needs and preferences. People’s care plans were person centred and detailed how their assessed needs were to be supported by staff.

Staff made sure that people could maintain relationships that mattered to them and encouraged social contact and companionship which protected people from the risk of social isolation and loneliness.

People and their relatives were given the opportunity to give feedback on the service during care reviews, meetings and feedback surveys. The service used the learning from feedback and complaints as an opportunity to drive improvement in the quality of care provided.

The service was well led. Quality assurance systems monitored the quality of service being delivered and action plans drove continuous improvement in the service.

The service provides accommodation and support for up to four people who have learning disabilities or autism. Dimensions 2 Buckby Lane aims to support people to lead a full and active life within their local community and continue with life-long learning and personal development. The service is a converted house, within a residential area, which has been furnished to meet individual needs.

The service had a registered manager in place. 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 service is required by a condition of its registration to have a registered manager.

People living at Dimensions 2 Buckby Lane received care and support from knowledgeable and experienced support workers. Many of the support workers had supported people living at the service for some years and demonstrated an in-depth knowledge of people’s needs and aspirations. Support workers were supported to undertake training to support them in their role, including nationally recognised qualifications. They received regular supervision and appraisal to support them to develop their understanding of good practice and to fulfil their roles effectively.

Support workers sought people’s consent before they provided their care and support. Where some people were unable to make certain decisions about their care the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. Where people had restrictions placed upon them to keep them safe, the staff continued to ensure people’s care preferences were respected and met in the least restrictive way.

People were supported to have their health needs met by health and social care professionals including their GP and dentist. People were offered a healthy balanced diet and when people required support to eat and drink this was provided in line with professional’s guidance.

The service responded to people’s needs and supported people to develop their skills and independence. We heard many examples of how people had been supported to develop their communication skills, self-care abilities and to have increased enjoyment in the community.

Support workers understood how to keep people safe. They had received training in safeguarding and were able to demonstrate an awareness of abuse and how concerns should be reported. People’s safety risks were identified, managed and reviewed and the staff understood how to keep people safe. Systems were in place to protect people from the risks associated with medicines.

There were enough support workers to keep people safe and support people to do the things they liked. The provider’s recruitment process had been effective at identifying applicants who were suitable to work with people.

Support workers were able to demonstrate their understanding of the risks to people’s health and welfare, and followed guidance to manage them safely. Risks associated with people’s care and support needs were identified and addressed to protect them from harm. Environmental risks were managed safely through regular servicing and audits.

Support workers supported people to identify their individual wishes and needs by using their individual methods of communication. People were encouraged to make their own decisions and to be as independent as they were able to be.

Relatives told us people were happy and content in the home. We observed people appeared relaxed and calm in the company of staff who they readily approached for support when required.

Support workers promoted people’s independence, and praised people when they undertook or completed household tasks or activities.

Relatives told us they had no reason to complain but knew how to do so if required and that the staff. The registered manager listened to people’s comments and implemented identified learning from incidents and accidents.

The senior staff provided clear and direct leadership and effectively operated systems to assure the quality of the home and drive improvements.

On the day of the inspection three people were living in 2, Buckby Lane. We spoke with two people who use the service. One person had complex needs and was not able to communicate with us verbally. However, we were able to find out about their experience of the service by observing care and talking with their family and staff. During our inspection we also spoke with the registered manager, a lead support worker, four care workers, a visiting health professional and a financial appointee. We also spoke with the parents of the three people who use the service.

This is a summary of what we found;

Is the service safe?

Relatives of people told us that they trusted the manager and staff to 'keep their relatives safe and well.' One relative told us, 'I couldn't do any better. I am so pleased they are there because the staff are always quick to realise if they are poorly and do something about it.'

People were protected from the risk of inappropriate or unsafe care because the provider had an effective system to identify, assess and manage risks to their health, safety and welfare. We found that the provider had reviewed people's risk assessments to reflect changes in their needs.

Two people had appointees to ensure their finances were managed properly and to protect them from financial abuse. We spoke with one of the financial appointees who told us that they had reviewed the person's finances with the person's key worker in September 2013. We saw this review had been recorded within the person's support plan,

The provider had an effective process to manage medicines safely. During our inspection we observed two care workers administer medicines appropriately, in the way people preferred, detailed within their medication plan.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the location to be meeting the requirements of the DoLS. Whilst no applications had been submitted, the manager was reviewing whether any applications needed to be made in response to the recent Supreme Court judgement in relation to DoLS.

Is the service effective?

We found that the provider had an effective system to ensure staff received appropriate learning and development. We reviewed staff records which showed the provider supported staff with an effective system of training, supervision and appraisal.

We found that the service had effectively managed people's nutritional and hydration requirements. Where necessary people had assessments and plans completed by speech and language therapists. We saw people were supported to eat a healthy balanced diet by staff who had been trained regarding nutrition and food safety.

Care practices we observed demonstrated that staff knew the needs of people and how to communicate with them.

Where people lacked the capacity to make specific decisions the provider had assessed this and had followed the correct legal processes to make decisions in peoples' best interests.

Is the service caring?

People were supported by kind and compassionate staff, who spoke with people in a caring manner. We saw that care workers gave encouragement to support people who were able to do things at their own pace.

One person told us the staff, 'Are are nice, they are my friends'. One person's relatives told us, 'The staff are excellent. You can feel that they really care for the people in the home and it is not just a job.' Another relative told us, 'Their key worker is always looking to do things which improve the quality of their life.'

Is the service responsive?

We saw evidence that when people's care needs had changed the service had been responsive to this. They had recognised changes in people's needs and engaged other services to ensure appropriate actions were taken to meet these.

The service had a complaints system which was readily accessible to people. This ensured staff listened to their concerns and responded to them effectively.

On the day of our inspection we saw the service had arranged appointments for people with different health professionals in swift response to health issues identified whilst providing personal care.

Is the service well-led?

The service had a registered manager in place and staff told us that the service was well led. We found there were processes and systems in place to monitor the quality of the service provided.

One care worker told us, 'Things have definitely improved since the new manager and team leader arrived. Now there is always someone to discuss problems with and things get done about them.'

We read the provider's business improvement plan for the service. We noted that identified actions in relation to required improvements had been allocated to specific people, together with relevant target dates to achieve them. We found the registered manager had monitored progress of these actions.

We saw staff engaging positively with the people they supported. People had opportunities for activities in the home and within the community. They were also supported to take part in their care and the day-to-day routines according to their wishes.

Care plans, supported by risk assessments and other documents, gave detailed information about how to provide people's support. Appropriate support had been sought from external healthcare professionals. Staff understood their role in safeguarding people from abuse and had access to information about this.

Staff recruitment records were not as comprehensive as required and were not consistently documented.

Within the home, some of the recording was inconsistent and incomplete. The management team also had management responsibility for another service, which may have contributed to this. The provider had systems in place to monitor the performance of the service. Although a national survey of people's views about the provider's care had been carried out in May 2013, feedback information specific to this home was not available.