Dimensions Somerset The Brambles

Updated 5 February 2022

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two adult social care inspectors, one pharmacy inspector and an Expert by Experience. This is a person who has personal experience of using or caring for someone who uses this type of care service. Two adult social care inspectors visited on both days of the inspection and were joined by the pharmacy inspector on the first day. The Expert by Experience made phone calls to relatives of people who lived at the home to ask their views. They spoke with four relatives.

Service and service type

The Brambles is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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

The first day of this inspection was unannounced. We arranged to visit for a second day as the registered manager was not working in the home on the first day we visited.

What we did before the inspection

We met remotely with the provider’s nominated individual (the person legally responsible for the safety and quality of the service) and with staff from the local authority safeguarding team. The provider completed a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed all the other information we had received about the service since the last inspection. We used all this information to plan our inspection.

During the inspection

We met six people who lived at the home and had limited conversations and interaction with four people. We spent time observing how staff supported, interacted and communicated with people. We spoke with five members of care staff (including agency staff), the registered manager and with the provider’s performance coach who was supporting developments in the home.

We reviewed some records. This included five medication records, five people’s care plans and risk assessments, staff rotas and some health and safety checks.

After the inspection

We asked the registered manager to send us further information. This included the most recent quality assurance audit, the current improvement plan for the service, staff training and supervision information, staff meeting minutes, health and safety reports and an analysis of accidents and incidents which had occurred in the home.

Updated 5 February 2022

About the service

Dimensions Somerset The Brambles is a residential care home providing personal care for up to seven people who have a learning disability, physical disability or autism. There were seven people living at the home when we visited.

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.

People were supported by enough staff to ensure their safety. When staffing levels were reduced, people were safe but their care and/or activities could be affected. Relatives did express some concern about the impact lower staffing levels had and the use of temporary staff. Staff recruitment was ongoing.

People were safe at the home. They were comfortable and relaxed with the staff who supported them. Relatives thought the home was a safe place for their family members to live. Staff knew how to recognise and report concerns about possible abuse.

People were supported to have meals of their choice. We observed very good mealtime interaction and support provided by staff.

Risk assessments were used to ensure people received safe care and support according to their individual needs. Risks to people’s physical health had been considered and planned for.

People received their medicines safely and at the right time. People were protected from catching and spreading infections.

People lived in a home which was well-organised, with clear lines of responsibility and accountability. There was honesty and accountability when things went wrong.

There was a clear structure within the staff team ensuring staff understood their own roles and responsibilities. Relatives and staff had high confidence in the management team.

Audits, surveys and observations were used to try to improve the care and facilities for people; where shortfalls were identified action was taken to make sure improvements were made. There was a clear, up to date improvement plan for the service. There was good support from senior staff within the organisation to help improve the service and develop new initiatives.

Staff training, support and teamwork were good. We saw staff were positive and engaged with people, treating them with kindness, dignity and respect.

Staff worked in partnership with other professionals, such as speech and language therapists and GPs to make sure people’s individual needs were met.

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 service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were seen as individuals and were well supported so they could lead fulfilling lives. Staff treated each person with dignity, respect and respected their abilities, choices and human rights.

Right Support: The Brambles is a small care home, based in the community. People had their own rooms but also shared communal areas so people could spend time together. Most people had lived at the service for many years and saw the service as their home. People were supported to make choices, be involved in ‘home life’ and to take risks.

Right Care: People received personalised care, although staffing shortages could impact on the choices people had and in quality and consistency of care. There was a reliance on temporary staff, although staff recruitment was ongoing.

Right culture: The registered manager led by example. There was a positive culture at the service. Staff were committed to the provider's values, aims and objectives. People, staff and relatives were involved in the running of the home. Ideas for improvement were welcomed and incorporated in the home’s development plan. There was an honesty and openness about things which needed to improve.

Rating at last inspection

The last rating for this service was good (published 2 August 2018).

Why we inspected

This inspection was in response to a serious safeguarding incident, to examine the learning from the incident and to check people were currently safe. As a result, we undertook a focused inspection to review the key questions of ‘Safe’, ‘Effective’ and ‘Well-Led’ only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has not changed and remains good.

We found no evidence during this inspection that people were at risk of harm from these concerns. However, it was evident that it was a very difficult time for people and staff as the investigation into the serious safeguarding incident was still ongoing, so learning from the incident was not yet complete.

We looked at infection prevention and control measures under the ‘Safe’ key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dimensions Somerset The Brambles on our website at www.cqc.org.uk.

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.