Dimensions 53 Cambridge Road

We found the following examples of good practice.

The provider had acted to make sure people could have visitors safely. Procedures for visitors included, temperature and symptom checks prior to entry. Personal protective equipment (PPE) and hand sanitisation were also required. Family visits were facilitated for people in the garden during the summer. Those unable to visit used video or telephone calls.

Staff had spent time with people to help them to understand the changes related to the COVID-19 pandemic and need for the use of PPE. People made good use of outside space during better weather, supported by staff.

The provider followed government PPE guidance and practice. The provider found Public Health England very supportive with help and guidance during the outbreak.

The provider had been testing people and staff for COVID-19.

Staff changed their clothes at the start and end of their shift to reduce the risk of transmission of infection. The staff team had responded positively to the new infection prevention and control procedures. Staff felt well supported by the provider.

The provider had good support from the local authority teams including training in use of PPE.

Staff and people had taken up the flu vaccination. The provider had paid for staff to have the flu vaccination.

The registered manager had carried out risk assessments in relation to risks relating to the pandemic. These helped to keep people and staff safe.

Dimensions 53 Cambridge Road is a residential care home providing personal care to five people living with a learning disability and/or autistic spectrum disorder. Accommodation was provided over two floors of a converted residential building.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support 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 home was near to local amenities and fit with local residential buildings.

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

Some improvements had been made since the last inspection, however we found the service still did not consistently assess risks to people and implement management plans to manage those risks. Fire management actions were not always carried out or evidenced in line with requirements. Medicines were now stored securely, and the stocks were managed effectively.

There had been another change in registered manager since the last inspection, and the current registered manager had come into post shortly before this inspection. Though there was a service improvement plan in place, this had not identified all issues we identified in risk management and documentation and had not ensured action was taken in a timely way.

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. Improvements were required in evidencing assessments for specific decisions.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting 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.

Staff were caring and kind. We received positive feedback from a relative and visiting professional about the approach staff took and about positive interactions staff had with them. Staff fed back positively about the management of the service and improvements made since the last inspection.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 December 2018) and there were multiple breaches of regulation. 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 some improvements had been made, however we identified that systems had not been embedded which meant there were some continued breaches of regulation.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified continued breaches in relation to safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dimensions 53 Cambridge Road is a care home for up to six people with a learning disability. The building was purpose built, has six bedrooms across two floors, a shared living room and a kitchen dining area. There were five people living in the home at the time of the inspection.

The care service has been developed and designed to meet the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion to help ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Since our last inspection, there had been a change of management at the service. The previous manager had left and a new manager had been appointed. The new manager had submitted an application to CQC to register as manager for the service. At the time of inspection, this application was still in progress. 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.’

At this inspection we rated the service ‘requires improvement’. We found that the service was in breach of four regulations. You can see what action we told the provider to take at the back of the full version of the report.

People’s risks were not fully assessed and managed in the least restrictive way. One person was put at risk of serious harm from the inappropriate use of bed rails. Medicines were not stored securely and people did not always have guidance for the use of their medication.

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. People’s capacity to make decisions was not always assessed when decisions were made on people’s behalf. The provider had not always applied the principles of the Mental Capacity Act, resulting in people being deprived of their liberty.

Records were not kept accurately and were not always up to date. We found that the provider did not have sufficient quality assurance processes in place to identify quality and safety issues and take action to rectify these.

People were protected from the risk of abuse or neglect by staff who knew what signs to look for and how to report issues. Staff openly reported incidents and the service took action to prevent re-occurrence.

There were sufficient staff during the day to meet people’s needs and enable people to take part in social activities as they wished. However, staff reported there was not sufficient staffing levels at night to safely support people.

Staff had access to training, and had the appropriate skills, knowledge and experience to support people. The service referred people to other professionals as required and enabled people to access health services, such as their GP and dentist.

The premises were adapted to meet people’s needs and preferences. People had a choice of food to meet their dietary needs and preferences.

Staff used different methods of communication to meet people’s needs and ensure they were able to express their views and be involved in conversation.

Staff respected people’s dignity and privacy. Staff valued people’s individuality and enjoyed working in the home.

Staff ensured people had access to social activities which they enjoyed. People were encouraged to maintain relationships with people who were important to them.

Further information is in the detailed findings below.

Dimensions 53 Cambridge Road is a small service providing accommodation and support with personal care to a maximum of six people with a learning disability. At the time of our inspection, six people were living at 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.

People were well cared for and there were enough staff to support them effectively. The staff were knowledgeable about the complex needs of the people and knew how to spot signs of abuse. People felt safe and were supported by the care staff and registered manager. There were robust recruitment checks in place prior to staff commencing work. Medicines were administered as prescribed and stored safely within the service.

Care records and risk assessments were personalised, up to date and were an accurate reflection of the person’s care and support needs. The care plans were written with the person, who was fully involved in the planning and identifying of their support needs. The care plans included the person’s likes and preferences and were reviewed regularly to reflect changes to the person’s needs.

Staff had completed training appropriate to their role. There was an on-going training plan in place as well as additional group training sessions. Staff were observed being kind and caring and treated people with dignity and respect. They spoke to people in a kind, respectful and caring manner. There was an open, trusting relationship between them, which showed that staff and managers knew people well.

People were asked for their consent before care and support was given. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully.

People were supported to be part of the local community and were able to attend activities both within the home, as well as in the local community. They made choices about how they spent their time and where they went each day.

People and their relatives were asked for feedback about the service they received and any concerns were addressed promptly. Staff worked well as a team and said the manager provided support and guidance as they needed it. There was an open and transparent culture which was promoted amongst the staff team.

Staff felt the service was well-led and they were supported in their roles. Procedures were in place to learn from any r incidents and there were clear actions recorded.

We spoke with three people using the service, three members of staff and the newly appointed manager. We observed support given to people using the service. The people spoken with were positive about the support they received from the service. One person told us everything was 'alright,' and another person told us they were 'happy.' Care and support were observed to be respectful and responsive to individuals' needs.

People supported by the service and staff knew and got on well with each other. Staff ensured people were enabled to give their consent to care and support whenever possible. Where people did not have capacity to consent, effective systems ensured their rights and well-being were protected in line with legal requirements.

The provider's recruitment and selection processes ensured staff were suitable and sufficiently skilled to provide effective care and support to vulnerable people.

People were given opportunities to feedback about the service, and their complaints and comments were taken account of to improve the service. Regular audits helped maintain standards as part of an ongoing quality assurance programme.

We reviewed care plans for three of the five people using the service and they were detailed, up-to-date and person-centred. People living at the service and staff knew and got on well with each other. Support was observed to be person-centred, respectful and responsive to individual needs.

The service had identified a need for additional staff, but the staffing level did not compromise people's health and welfare and plans were in place for recruitment. There were adequate systems for recording and responding to complaints, and an easy-read guide to the process was available to all people using the service. The service had effective procedures in place for safeguarding vulnerable adults and staff followed the appropriate local safeguarding process.