Archived: Dimensions 11 Kilford Court

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

Some of the risks relating to people needs and the environment had not been effectively managed. Medicines were not being managed safely or in line with best practice frameworks. There were not always sufficient numbers of staff deployed to meet people’s needs. The home was clean. There were systems in place to learn from when things go wrong.

The systems in place had not been fully effective at improving the quality and safety of the service. Overall staff told us they had confidence in the way the service was managed, and they were clear about their role and responsibilities. There were some systems in place to actively seek the engagement and involvement of people and staff in developing the service and driving improvements. The leadership team were transparent and collaborative and demonstrated a commitment to improve the service. The manager took on board the feedback from our inspection and took immediate action to resolve the shortfalls identified.

Staff, including agency staff, demonstrated a good understanding of the individual personalities of the people they supported and were able to talk about people’s preferred routines. The support provided did not always empower people to have as much control and independence as possible. The service had taken steps to provide information to people in ways which they understood. Systems were in place to investigate and respond to complaints or concerns. End of life care plans were to be developed as part of the planned person-centred reviews of people’s care and support.

Staff and management had worked collaboratively with a number of mental health professionals to better understand and improve the support being provided to effectively meet people’s needs. There was evidence that capacity to consent to care and support was considered as part of the care planning process. However, this had not always been well documented. People continued to be supported to have enough to eat and drink and their dietary needs were met. The premises were suitable for people’s needs, but many of the fixtures or fittings were tired or worn and would benefit from being updated or replaced. A suitable training programme was in place.

Overall, people were supported by staff who were kind and caring and whom understood how to protect their dignity. However, some of the interactions we saw were neutral and could have been more person centred.

Rating at last inspection

The last rating for this service was ‘Good’ (published 17 March 2017).

Why we inspected

Follow up

We will 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

Dimensions are a specialist provider of a wide range of services for people with learning disabilities and people who experience autism. 11 Kilford Court provides care and support for up to six people with a learning disability. At the time of our inspection there were four people living at the home some of whom were also living with physical disabilities and with dementia. The home is arranged over two floors. The ground floor consists of four bedrooms, a dining and kitchen area, a laundry room and a communal lounge which also had a sensory area. There is also an adapted bathroom and a level access shower room on this floor. This floor is fully accessible to wheelchair users. Two further bedrooms and the office and staff sleep in room were located on the first floor which were accessed by stairs only. The home has a large accessible garden to the rear and parking to the front.

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 and associated Regulations about how the service is run. The registered manager also managed another Dimensions services and was supported in their roles by an assistant manager.

At the last inspection in January 2016, the service was rated “Requires Improvement” overall and there were breaches of Regulations associated with managing risk and ensuring staff had received appropriate support. At this inspection, we found that improvements had been made and the service was now “Good” overall with no breaches of legal requirements.

Since our last inspection, improvements had been made to ensure that risks to people’s health and wellbeing were adequately assessed and planned for. Staff were now receiving regular supervision and were being supported to undertake nationally recognised qualifications.

The registered manager was taking robust action to ensure the landlord took timely action to make improvements to the property.

Staff spoke positively about the leadership of the service. Morale was found to have significantly improved with staff telling us that the registered manager worked effectively with them and encouraged them to express their views about how the service might improve.

Improvements had been made which helped to ensure people's rights were protected. Staff had acted in accordance with the requirements of the mental capacity act and the Deprivation of Liberty Safeguards (DoLS). Where people were able to express choices, these were respected.

Whilst each person had an individualised weekly plan of activities, more could be done to enhance the quality of interactions with people and offer more varied and meaningful opportunities for active support.

Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team.

Appropriate arrangements were in place to manage people’s medicines. Medicines were only administered by staff who had been trained to do this.

There were sufficient staff to meet people’s needs and safe recruitment practices were followed.

Staff received a range of training which enabled them to provide people with appropriate care.

People were supported to have enough to eat and drink. Staff recognised when people’s physical health needs changed and ensured that relevant referrals were made to health care professionals.

Staff showed people kindness, patience and respect. Staff demonstrated a good knowledge and understanding of the people they were supporting. They were well informed about people’s communication needs and used this effectively to provide person centred care.

Staff demonstrated a good understanding of the meaning of dignity and how this encompassed all of the care provided to each person.

There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving the best possible support.

Dimensions are a specialist provider of a wide range of services for people with learning disabilities and people who experience autism. This service provided care and support for up to six people with a learning disability. At the time of our inspection there were five people using the service some of whom were also living with physical disabilities and with dementia. Their home is arranged over two floors. The ground floor consists of four bedrooms, a dining and kitchen area, a laundry room and a communal lounge which also had a sensory area. There is also an adapted bathroom and a level access shower room on this floor. This floor is fully accessible to wheelchair users. Two further bedrooms and the office and staff sleep in room were located on the first floor which were accessed by stairs only. The home has a large accessible garden to the rear and parking to the front.

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 and associated Regulations about how the service is run. The registered manager also managed another two Dimensions services and was supported in these roles by an assistant locality manager.

Some areas required improvement.

Risks to people’s health and wellbeing were not always adequately assessed and planned for. Risk assessments had not been reviewed or updated when people’s needs changed.

New staff had not nationally recognised qualifications which demonstrate their competence to perform their role and responsibilities to a specific standard. Staff were not receiving regular supervision. Some staff had not received an appraisal. These are important tools which help to provide reassurances to the management team that staff are suitably skilled and have the right knowledge.

Improvements were needed to ensure that the registered manager had sufficient time to perform their duties effectively and provide support to the staff team.

The way in which the service was implementing the Mental Capacity Act (MCA) 2005 required improvement. This was because mental capacity assessments had not always been undertaken to establish if a person was able to make decisions about, and agree to, their support plan.

Improvements were needed to ensure that all areas of the home were suitable and enhanced people’s quality of life. However we noted that some areas required some cleaning and maintenance. For example, areas of the level access shower room were mouldy and the outer layer of parts of the wooden surround for the toilet had come away revealing the chip board below. This would make this area difficult to effectively clean. The carpet in the communal entrance area and corridors was stained and would benefit from being replaced.

Other areas were good.

Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team.

Appropriate arrangements were in place to manage people’s medicines. Medicines were only administered by staff who had been trained to do this.

There were sufficient staff to meet people’s needs and safe recruitment practices were followed. Appropriate checks had been undertaken which made sure only suitable staff were employed to care for people in the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations had been applied for.

People were supported to have enough to eat and drink. They were involved in decisions about what they ate and were assisted to remain as independent as possible with eating and drinking.

Staff had a good knowledge and understanding of the people they were supporting. Staff were able to give us detailed examples of people’s likes and dislikes which demonstrated they knew them well.

Staff showed people kindness, patience and respect and we observed positive interactions between people and their support workers.

There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving the best possible support.

Staff practices 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.

We reviewed care plans for three of the six people at 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 responsive to individual needs.

The provider had taken steps to ensure people were protected against the risks of infection by providing a clean and hygienic environment. The premises were designed and effectively maintained so as to be safe and suited to the specific needs of people living there.

Effective recruitment processes ensured people were cared for by staff who were sufficiently qualified, skilled and experienced to meet their needs There were adequate systems for recording and responding to complaints, and an easy-read guide to the process was available to people using the service.