Dimensions Bracknell & Surrey Domiciliary Care Office

Updated 21 December 2022

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 one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency which supports people living in 18 ‘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 four registered managers in post, who were responsible for several settings referred together as localities. Another locality manager had been in post for two months and had applied to become the fifth registered manager.

Notice of Inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a domiciliary care service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 17 October 2022 and ended on 31 October 2022. We visited the location’s office on 19 and 20 October 2022 and carried out visits at two supported living settings where seven people lived.

What we did before the inspection

We 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 reviewed notifications and information we had received about the service since the last inspection. We sought feedback from the local authority quality assurance and safeguarding team, and other professionals who work with the service. We checked information held by Companies House and the Information Commissioner’s Office. We checked for any online reviews and relevant social media, and we looked at the content of the provider’s website. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection

We spoke with eight people who use the service and six relatives of different people. We spoke with 28 staff including the operations director (East Berkshire & Surrey), four registered managers, a locality manager awaiting their CQC registration, three assistant locality managers and 18 support workers. We also spoke with the regional managing director.

We reviewed a range of documents, including eight people’s care records, multiple medicine records and daily notes in three different records systems. We looked at 13 staff files in relation to recruitment, staff training and supervision. These included the most recently appointed staff from each of the five localities within the service. A variety of records relating to the management of the service were reviewed, including the provider’s policies, procedures, accidents and incidents and quality assurance audits.

After the inspection

After the site and home visits we continued to seek clar

Updated 21 December 2022

About the service

Dimensions Bracknell & Surrey Domiciliary Care Office is a domiciliary care agency. The service provides support to older people, young adults, autistic people and people living with learning disability. Staff provide personal care to people living in their own homes and supported living settings. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection 49 people using the service were receiving personal care.

People’s experience of using this service and what we found

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.

The provider was able to demonstrate how they were meeting most of the underpinning principles of Right support, right care, right culture.

Right Support:

Procedures did not always ensure suitable staff of good character were recruited to safely support autistic people or people living with learning disabilities. Risk assessments did not always assure risks to people had been mitigated.

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.

People experienced good continuity and quality of care from staff they knew well, which consistently achieved successful outcomes. There were enough staff to meet people's care and support needs. Staff had training in relation to safeguarding and knew how to report any concerns.

Staff were focused on people's strengths and promoted their independence, which meant people enjoyed an enriched and fulfilling life. People's needs were assessed, and care plans were developed with them, and their relatives where required. Where people had specialist diets, this was understood, and staff knew how to support people safely in accordance with linked positive behaviour strategies. Staff enabled people to access specialist health and social care support in the community.

Right Care:

People received kind and compassionate care from staff who protected and respected people's privacy and dignity. Staff knew people well and responded to their individual needs, promoting equality and diversity in their daily support for people. We observed warm and caring interactions between people and staff. People's communication needs were clearly explored and documented. People were supported to maintain contact with people who mattered to them and to take part in activities that were meaningful to them.

Staff engaged well with other agencies to ensure people had access to the support they needed for their healthcare and wellbeing needs. The service made referrals and liaised with other healthcare professionals when required. Staff treated people with dignity and respect.

Right Culture:

People were empowered live fulfilled and enriched lives due to the values, attitudes and behaviours of the management and staff. People experienced good quality care and support in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. People's care plans were person centred and reflected how people wanted to receive their care. Effective training and supervision enabled staff to provide compassionate and empowering care that was tailored to meet people’s individual needs. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. People's wishes, needs and rights were at the heart of everything staff did to support people. People and those important to them were involved in planning their care. Registered managers valued and acted upon people's views. The registered managers had developed an open culture based on mutual trust and respect, inclusivity and improvement, which enhanced the quality of people’s lives. The service ethos built on transparency, respect for equality and diversity ensured the risks of a closed culture developing were minimised.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (report published 20 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We identified breaches in relation to recruitment, risk management and quality assurance of the service.

Please see the action we have told the provider to take at the end of this report.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

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.