Dimensions 149 Ash Street

Updated 7 September 2019

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 Care Act 2014.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Dimensions 149 Ash Street is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.

During the inspection

We met all five people who used the service and talked with two of them about their experience of the care provided. As some people did not have verbal communication skills, we spent time observing the care people received. We spoke with five members of staff including the deputy manager, a senior manager who was visiting the service and three care workers.

After the inspection, we had follow-up telephone calls with the deputy manager and received additional information including details of family and professional contacts.

We reviewed a range of records. This included two people’s care records and multiple medication records. We looked at staff records in relation to recruitment, training and staff supervision. We also looked at records relating to the management of the service, including staff rotas, audits and checks of the service and care provided as well as provider newsletters.

After the inspection

We contacted relatives of three people as well as health and social care professionals who support people at the service. This included a GP surgery, the community learning disability team staff, specialist health workers and an advocate. We received feedback from three relatives and one professional.

Updated 7 September 2019

About the service

Dimensions 149 Ash Street is a residential care home providing personal care and accommodation for up to five adults living with a learning disability and/or autism.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support (RRS) and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service is a large home in a suburban street, similar to other large residential properties in the area. Five people were using the service, all of them had lived there for between five and twenty-five years.

The outcomes for people using the service reflected the principles and values of RRS by promoting their choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. They were encouraged to do activities both in the home and in the community. This included following hobbies and interests, social activities and activities associated with daily living including personal care and housework.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff did not wear anything that suggested they were care staff when coming and going with people.

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.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the deputy manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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

The five people at Dimensions 149 Ash Street had all lived there for over five years and were clearly happy and comfortable in the service. Families said their relatives were well cared for. Relatives said they were very happy they were involved by staff whenever necessary and were free to visit when they wanted. Relatives said they were always welcomed by staff, most of whom they knew well. They also said they had never had to complain but would feel able to talk to the registered manager or senior staff if they had a concern. Comments from relatives included “The staff at 149 are brilliant…. we could not ask for more” and “They support her very well and are very caring… would hate [person] to move, they know [person] so well and manage [long-term condition] well.”

People were supported by caring and compassionate staff, who knew them well and supported each person to do things they wanted in the home and in the local community. Care plans contained up-to-date assessments of people’s risks, needs and preferences. They guided staff on how the person’s care should be delivered and how they should be supported. Care records contained detailed information about how each person communicated and how to communicate with them, using both verbal and non-verbal methods. People’s care plans were being followed in practice. A relative commented “[Person] can't talk and is a bit of a loner, but they help [person] do what [person] wants.”

People received their medicines as prescribed, and there were safe systems in place to manage the storage, administration and disposal of medicines. A senior member of staff took immediate action to remedy a problem with the thermometer in the medicines refrigerator when this was identified during the inspection.

There was an established management team, who worked alongside care staff each day. The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

They were also supported by senior managers from the provider organisation. Quality assurance systems and regular audits were in place to assess, monitor and improve the quality and safety of the service provided.

Systems to safeguard people from abuse were in place. The service responded to concerns or complaints about people’s wellbeing and learned from incidents to prevent a reoccurrence. People’s rights to privacy and dignity were respected. Decisions had been made and recorded in people’s best interests where they were not able to make these decisions themselves. The service respected and supported people’s equality and diversity.

There were enough staff to meet people’s needs. Staff received training and the support needed to carry out their role. Staff were encouraged to share ideas about how the service could be improved for people. The recruitment process helped ensure potential staff were safe to work with people who may be vulnerable.

Rating at last inspection

The last rating for this service was Good (published 10 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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