Background to this inspection
Updated
9 May 2018
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.
Inspection site visit activity started on 5 March and ended on 6 March 2018. It included visits to five people in their own homes and the office. We visited the central office on the morning of 5 March and all day on 6 March to see the registered manager and staff; and to review staff records, care records, policies and procedures.
The care service has been developed and designed 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 using the service can live as ordinary a life as any citizen.
The provider was given 48 hours’ notice. This was so that we could be sure the registered manager was available when we visited and that consent could be sought from people to home visits from the inspector. The inspection was carried out by a single inspector on day one and an inspector and expert by experience on day two. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their experience related to supporting people with learning disabilities and autism.
Before the inspection we reviewed all the information we held about the service. This included notifications the home had sent us. A notification is the means by which providers tell us important information that affects the running of the service and the care people receive.
We had received a Provider Information Return (PIR) from the service. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
We spoke with one person who used the service, one social care professional and seven staff. We had telephone conversations with 12 relatives and four professionals who had experience of working with the home.
We met with the registered manager and five locality managers. We reviewed five people’s care files, policies, risk assessments, health and safety records, consent to care and treatment, quality audits and the 2017/18 feedback questionnaire results. We looked at three staff files, the recruitment process, complaints, incidents and accident recording, training, supervision and appraisal records.
We visited five people in their own homes and observed care being delivered to people some of whom were non-verbal.
We asked the registered manager to send us information after the visit. This included policies and the staff training record. The registered manager agreed to submit this by Thursday 8 March 2018 and did so.
Updated
9 May 2018
The inspection took place on 5 March and was announced. The inspection continued on 6 March 2018 and was again announced.
Dimensions Dorset provides care and support to people with learning disabilities who live in their own homes. It is registered to provide personal care. At the time of the inspection the service was delivering personal care to 56 people.
This service provides care and support to people living in 62 ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
The service also provides personal care to people living in their own houses and flats in the community. It provides a service to adults with learning disability and autism.
Not everyone using Dimensions Dorset receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
There was a registered manager in post. 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 receiving support from Dimensions Dorset received highly individualised person centred care. Support plans contained detailed and personalised care plans and we saw that people had been supported to have a full and meaningful life enjoying interests, taking part in new experiences and being active members of the local community. There was an emphasis on the need for good communication with a range of documentation being provided in way to assist people in accessing information.
People, relatives, professionals and staff felt that the service was extremely well led. The provider, registered manager and staff actively promoted a positive, inclusive and open culture; this approach had a positive impact on the quality of the service people received. The structure of the service worked for people, so that locality managers were always available to support staff and people when needed. The service worked in conjunction with other organisations to improve care for people with a learning disability. There were robust quality assurance systems in place which monitored the service, identifying potential areas for improvement, and actions were taken to improve these.
Staff were highly motivated, worked well as a team and shared a common ethos of providing high quality, compassionate care with regard to people's individual wishes and support needs. Staff were valued, well supported and supervised by the management team.
Feedback from people, relatives and professionals described the service as excellent, one which exceeds expectations, outstanding and the best in the local Area.
There was a people council and the local representative worked in the local office. The Council was an elected body of people Dimensions supported that met four times a year on its own and twice with the Dimensions Board. Feedback from a local level had influenced changes at an organisational and national level which had led to positive impacts on people’s lives.
Family charters were in place. These outlined a commitment to involve people’s families in exactly what they wished to be involved in. The registered manager sat down with families and reviewed these on an annual basis to determine how much contact families wished to have with staff, the management, the organisation and what they may wish to be updated on.
People were supported by staff who received regular training specific to their needs. An inclusive and innovative appraisal system was used. These gathered feedback from people and the families about staff performance and the delivery of care which was then shared with staff and used to celebrate successes, develop and improve performance.
People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received safeguarding training. People were provided with information about how to keep safe and were asked their desired outcomes following any alert made.
Risks to people were identified promptly and effective and robust plans were put in place to minimise these risks, involving relevant people, such as people's family members and other professionals. Effective positive behaviour support plans had been completed and were up to date. These gave staff clear guidance on how best to support people which had led to positive outcomes.
Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. People’s records contained assessments of their capacity and where decisions had been made in people’s best interests around their care and treatment these were recorded.
Medicines were managed safely, securely stored in people’s homes, correctly recorded and only administered by staff that were trained to give medicines. Medicine Administration Records reviewed showed no gaps. This told us that people were receiving their medicines.
There was an infection control policy in place which staff were aware of to minimise the risk of infection.
People were supported with shopping, cooking and preparation of meals they chose in their home. The training record showed that staff had received food hygiene training.
People, relatives and professionals told us that staff were caring. During visits to people’s homes we observed positive interactions between staff and people. This showed us that people felt comfortable with staff supporting them.
People, staff and relatives were encouraged to feedback. We reviewed the findings from quality feedback questionnaires which had been sent to people and noted that it contained positive feedback.
Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.