Background to this inspection
Updated
20 June 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by 1 inspector.
Service and service type
This service provides care and support to people living in 14 'supported living' settings, so that they can live 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.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there were 6 registered managers in post. In addition to the 6 registered managers, there were 2 new managers in post who had submitted applications to register. We are currently assessing these applications. Throughout the report, they will be referred to as “managers.”
Notice of inspection
We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.
Inspection activity started on 16 May 2023 and ended on 26 May 2023. We visited the location’s services on 18 May 2023, 19 May 2023 and 24 May 2023.
What we did before the inspection
We sought feedback from the local authority and used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 5 people and 3 relatives about their experience of the care provided. We received feedback from 41 members of staff including the registered managers and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We received written responses from 7 health and social care professionals.
We reviewed a range of records. This included 5 people's care and support records and 9 people’s medicine administration records. We looked at 2 staff files in relation to recruitment and training. We also reviewed a variety of records relating to the management of the service, including policies and procedures, staffing rotas, accident and incident records, safeguarding records and quality assurance reports.
Updated
20 June 2023
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
About the service
Dimensions Somerset Yeovil Domiciliary Care Office is a domiciliary care agency providing personal care to 57 people with learning disabilities and/or autism in their own homes or flats in the community.
Most people had limited verbal communication so were unable to feedback their views. Other ways of collecting their views were used, such as observations during visits and speaking with those important to them.
People receiving support from Dimensions Somerset Yeovil Domiciliary Care Office lived in 1 of the 14 supported living services, shared accommodation or individual homes and flats. Many of the households had multiple occupancy of over 3 people with shared living spaces and 24-hour care and support on site.
People’s experience of using this service and what we found
Right Culture:
Quality assurance processes were not always effective. Whilst medicines were generally managed safely, audit checks of medicine administration records were not always completed in line with the provider’s policy or best practice. There were inconsistencies in recruitment files and staff did not always have access to the most current information relating to people’s care needs, the provider took action to address these shortfalls during inspection. Record keeping varied across the service’s locations.
The registered managers demonstrated joint working with people and professionals, who provided specialist support to meet people’s health needs. The service involved people’s families and advocates as appropriate.
Right Support:
The provider had made improvements to the service following our previous inspection, to ensure it was safe for people. Where possible, the same staff supported people and so understood their individual communication needs. One registered manager explained to us, “I monitor the rotas to make sure that all staff have an opportunity to work with each person we support. It increases their confidence when working with people who may show behaviours of distress and helps them get to know people which then makes them more confident about how to safely support that person and take positive risks.”
A number of regular agency staff had applied to work for the service on a permanent basis.
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.
Right Care:
Support plans and risk assessments were person centred. People and relatives told us staff knew them well. Staff supported people in a kind and compassionate way, considering their dignity and privacy, one person told us, “I can lock my door, why not? It’s my space.” Another person put their thumbs up and answered “Yes” when asked if staff were kind.
People were supported to live full, active lives and encouraged to increase their independence.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.
Rating at last inspection and update
The last rating for this service was requires improvement (published 17 June 2021).
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
Why we inspected
We carried out an announced focussed inspection of this service on 17 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At our last inspection we found breaches in relation to safe care and treatment, keeping people safe from abuse and systems to manage the service.
We undertook this focused inspection to check the service had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dimensions Somerset Yeovil Domiciliary Care on our website at www.cqc.org.uk.
Enforcement
We have identified a continued breach in relation to good governance at this inspection. We have made a recommendation about the recruitment of staff.
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.