Background to this inspection
Updated
19 January 2023
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 Health and Social Care Act 2008.
Inspection team
The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service provides care and support to people living in ‘supported living’ settings, their own homes and flats, so that they can live as independently as possible. In ‘supported living’ settings, people’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there were four registered managers in post.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 27 October 2022 and ended on 16 November 2022. We visited the location’s office on 2 November 2022.
What we did before the inspection
Before the inspection we reviewed information, we held about the service including statutory notifications. Statutory notifications include information about important events which the provider is required to send us. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.
During the inspection
We visited five people in their homes and had telephone calls, or received written feedback, from the relatives of nine people. We spoke with ten members of staff, the four registered managers and the operations director. We also spoke with, or received written feedback, from six health and social care professionals.
We looked at records related to the care and support of six people. We also reviewed records relating to the management of the service including service improvement plans, the oversight of incidents, staff meeting minutes, rotas, training records, and four staff files.
Updated
19 January 2023
About the service
Dimensions Dorset West Domiciliary Care Office provides care and support to people with learning disabilities and autistic people who live in their own homes. It is registered to provide personal care. At the time of the inspection the service was delivering personal care to 21 people. Most people lived in their own home; some people house shared with up to two other people. Where staff slept in to ensure people were safe overnight, they had a private space to do so in people’s spare rooms. Staff did not have allocated space that people could not access in their homes. Staff worked in teams focussed on the support of individual people. People lived in their own home, or shared a home with up two other people who they got on well with.
In 'supported living' settings people's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.
CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
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.
Right Support:
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. Restrictions were reviewed and creative solutions sought to reduce their use.
Staff sought opportunities for people to increase their opportunities for choice and control through environmental and equipment changes, improved communication tools and strategies and skill development. This meant people were in control of most aspects of their day to day life.
Staff maintained exceptional focus on people’s strengths and promoted what they could do, this meant people had a fulfilling and meaningful everyday life and opportunities for new experiences.
People were supported to achieve their aspirations and pursue their interests. Staff worked collaboratively with people and their circles of support to review progress and find solutions to obstacles. This had led to people achieving goals they were rightly very proud of.
Staff worked creatively with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.
All restraint and restrictions were recorded and reviewed. Staff learned from these incidents and actions were taken to reduce the chances of people becoming distressed.
The staff worked collaboratively with people, their families and professionals to ensure they had housing that met all their needs including sensory and physical needs. For people with very complex needs who caused damage to property when they were distressed this reduced the likelihood that they might lose their home and support. Where people had not yet secured appropriate housing staff advocated strongly on their behalf.
Staff enabled people to access appropriate health care. Staff supported people to play an active role in maintaining their own health and wellbeing. Staff worked collaboratively with professionals and families and sought creative solutions to reduce the impact of health inequalities.
Staff sought every opportunity to support people to make decisions. Staff used people’s preferred communication methods and style to optimise their choices, control and connections.
Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.
Right care
Staff were all respectful. They understood people’s cultural needs and provided culturally appropriate care and support respecting family traditions, and ways of living and communicating.
People received extremely kind and compassionate care. Staff valued and respected the person/people they worked with and this meant they always protected and respected people’s privacy and dignity.
Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
The service had enough appropriately skilled staff to meet people’s needs and keep them safe.
People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.
People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff because staff had the necessary skills to understand them.
People’s support plans were exceptionally detailed and personalised and reflected their range of needs and this promoted their wellbeing and enjoyment of life. Staff knew people very well and spoke confidently about these needs without reference to the documentation.
People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives.
People, families, professionals and staff collaborated to seek solutions that reduced risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.
Right culture
People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. The management structure had been created to support the organisation’s ethos, values, attitudes and behaviours.
People were absolutely at the centre of collaborative and respectful circles of support. Staff valued the knowledge and experience of people’s relatives and held them in high regard.
People were supported by staff who understood how best to support them as individuals. This meant people received compassionate and empowering support that was tailored to their needs. This support was rooted in a culture of transparency, respect and inclusivity.
Staff were extremely well supported and this reduced staff turnover. This supported people to receive consistent care from staff who knew them well.
Staff placed people’s wishes, needs and rights at the heart of everything they did. They valued the involvement of families and professionals. The management team enabled people, and families, to worked with staff to develop the service. Staff valued and acted upon people’s views.
Staff evaluated the quality of support provided to people. They involved people, their families and other professionals in a variety of ways in this process. People’s quality of life was enhanced by the service’s culture of ongoing improvement and inclusivity.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 1 September 2021 and this is the first inspection.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.