Dimensions 40 Cody Road

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’s experience of using this service and what we found

Right Support: People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: The service was close to small local shops, there was a lack of easily accessible close public transport. The service had a minibus; however, people did not go out regularly and there was a lack of engagement and meaningful activity taking place. People were at risk of harm because staff did not always have the information they needed to support people safely.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive, and empowered lives.

Support plans and risk assessments were not regularly reviewed or updated.

Infection prevention and control was not managed in line with the provider's policy.

Medicines and recruitment were managed safely.

The provider’s quality and risk monitoring systems were not always effective in identifying and action on shortfalls to ensure people received safe and high-quality care.

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 (published 4 January 2018).

Why we inspected

The inspection was prompted in part due to concerns received about infection control, lack of activities and person centred care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dimensions 40 Cody Road on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to managing risk, infection control, person centred care, consent to care and treatment and governance.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The service had a registered manager. 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 who used the service were safe. The service had suitable policies and procedures about safeguarding. Staff had received suitable training about how to recognise and deal with any incidences of suspected abuse.

People had suitable risk assessments to assist in protecting them from harm. These were reviewed regularly. Restrictions at the service were kept to a minimum. The staff team had satisfactory understanding of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. Where necessary suitable action had been taken to safeguard people’s rights so they were not inappropriately restricted.

Overall we judged there were enough staff on duty. However we have made a recommendation that staffing levels are reviewed to enable people to have more one to one support and activities.

Suitable staff recruitment procedures were in place. Satisfactory checks such as references were obtained for new staff. Staff received appropriate training such as about health and safety, medicines management, and infection control.

The service had suitable medicines management systems, and these were operated appropriately. For example administration records were suitably kept, and medicines were stored securely.

The home was kept clean, and was well maintained. The building was appropriately adapted to meet people’s needs. Health and safety checks (for example to check the fire system was working) were regularly completed and suitable records were kept.

There were suitable policies and procedures to assess people before they moved into the service. Comprehensive care planning systems were also in place and care plans were reviewed regularly.

People had enough food to eat, and were involved in shopping and preparing food. When people needed assistance with eating, or help with special diets, staff provided appropriate support.

The service had good links with external professionals such as GP’s, social workers, and speech and language therapists. People received necessary support from these services when they needed help. Appropriate records were kept of any appointments people attended.

Staff were seen as caring and respectful. The care we observed was professional and supportive. Staff did not appear overly rushed, responded to people quickly if they needed support, and seemed kind and friendly.

People had the opportunity to participate in activities such as music, and going on social outings. People also had access to day services.

The service had a suitable complaints procedure. Relatives we spoke with said they felt staff and management were approachable, would deal with any concerns appropriately, and did not feel they would face any repercussions if they made a complaint.

Management were viewed positively. The organisation had a clear management structure and there were clear lines of accountability. Staff said they worked well as a team. There were regular staff meetings, and senior staff were regularly present to give guidance and support. There were suitable policies and procedures to measure and where necessary improve the quality of the service.

The service had a registered manager. 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.

The service is a large bungalow which accommodates up to five people with learning disabilities, physical disabilities or both. All rooms and facilities are on the ground floor and all areas are spacious, level and accessible to wheelchair users. The service has a garden on two sides, a driveway and parking for the service vehicle. The service has a registered manager who also manages two other services locally which are operated by the same provider.

People were kept safe because staff understood their responsibilities in protecting people and knew how to report any concerns. Staff put people first and were respectful in their interactions with people.

Risks to people were identified, assessed and measures were put in place to minimise risks. Staff were seen to carry out these measures.

There were enough staff at the service to ensure people’s needs were met. We saw copies of the staff rota and noted that when there were times the staffing level was not sufficient, arrangements had been made to cover these gaps. The registered manager told us of the contingency arrangements in place to cover gaps in the staff rota, both planned and unexpected. These included staff working overtime shifts, the utilisation of staff from two other local services run by the registered manager or agency staff. We saw these arrangements were in place when we visited.

People’s needs had been assessed before they moved into the service and were kept under regular review to ensure they were met. The service was well equipped to meet the varying needs of people using the service.

Effective recruitment procedures had been followed and the required checks on people applying to work at the service had been carried out. This helped the provider to ensure only those who were suitable to work with people were employed.

Staff told us they had received an induction into their role to ensure they understood people’s needs and how to meet them. Staff understood the responsibilities of their role and the provider’s values in supporting people to live the life they wished. We saw staff put people first during our visit.

Staff had completed training to ensure they had the skills and experience to support people effectively. This included training such as fire safety, first aid, safeguarding people at risk and moving and handling people for example. Other training to meet people’s individual needs or newly identified needs had also been provided.

Staff told us they received regular supervision from their line manager in order to discuss their role, any development needs and any other aspect of working in the service they wished to discuss. Staff received supervision six times a year and an annual appraisal.

Medicines were managed safely to ensure people received their medicines as prescribed. Staff had been trained to administer medicines and people received their medicines in the way they preferred.

People using the service had varying methods of communication which were understood by staff, were clearly recorded and updated. Staff understood when people were giving their consent for support and when they were not. Staff understood the principles of the Mental Capacity Act 2005 and supported people to make their own decisions. Where people were unable to make specific decisions appropriate action had been taken in the person’s best interest as legally required.

Where people’s liberty was deprived, applications had been made to ensure that this was lawful and carried out in the least restrictive way.

People were supported to have enough to eat and drink and to maintain a balanced diet. Where additional guidance was needed this had been sought from appropriate healthcare professionals such as a dietician or a Speech and Language Therapist (SALT).

Support to maintain good health and to access healthcare services was provided to people as and when required. People were supported to prevent illness by having flu vaccinations for example. They were also supported to access healthcare services promptly if they developed an illness such as a cold. A number of healthcare professionals were involved in the support of people including a GP, dentist services, opticians and a chiropodist.

People were supported by caring staff who treated them with dignity and respect in a relaxed and friendly way. Staff knew each person well and were able to describe their individual needs. Staff involved people in the daily activities of the service such as cooking or cleaning their own room where possible and in decision making about their day to day lives. Advocacy services had been obtained when needed to support people’s decision making.

Staff were aware of the need to provide people with privacy when they wished it and to provide support and care in a discreet way. Support plans were seen to provide clear guidance to staff about respecting people’s privacy.

The service was responsive to people’s needs. Staff recorded what worked well for people, what did not work so well and what could be learnt from things not working well. This was to ensure changes were made to improve the experience for people..

Although people were not able to complain in a direct, verbal manner, they were able to make their feelings known. Staff understood each person’s ways of communicating and what that meant. One person would let staff know that they did not want to do something by pushing themselves away from the person or meal for example. Another person would communicate to staff that they had enough to eat by closing their mouth firmly.

People were provided with an opportunity to give their views about the service each year in an annual survey, which was completed with the support of their relatives or staff.

The service was well-led and had a clear management and staffing structure. This consisted of a registered manager, deputy manager, a team leader and a team of support staff.

The registered manager and staff promoted an open, person centred service with a focus on putting people first. Accidents and incidents were reported and managed appropriately in order to prevent them reoccurring and to promote people’s safety.

The quality of the service provided was kept under review and was monitored by the registered manager and the provider.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. Observation during the inspection showed

staff supporting people to make their own choices about what they had for lunch and what activities they took part in. Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis.

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas watching television and interacting with staff. During our inspection we observed staff spending time with one person supporting them to participate in music therapy in the sensory room. We observed staff spending the majority of their time with people who used the service, going shopping, listening to music and attending art class. They frequently checked on them to ensure they were alright when spending time on their own.

During the inspection we observed staff spending the majority of their time with people who used the service. They frequently checked on them to ensure they were alright when spending time on their own.

We observed that the staff treated people with respect and dignity. They used appropriate physical affection and touch and responded to people's needs. The staff told us that all the training they completed included how to treat people with dignity and most staff had worked at the service for a number of years so they understood people's communication.

The one person and one relative we spoke with said the staff listened to them and responded quickly if things needed to improve. They said they felt their relative felt safe at the service and they did not have any complaints.

The one person we spoke with and one relative said they had been asked their opinion of the service and there had been opportunities to attend meetings. We saw minutes of these meetings which demonstrated people had an opportunity to contribute to the running of their home.