The inspection took place on 18, 19 and 20 January 2016, and was announced. This was to ensure people and staff we needed to speak with were available. Dimensions Hampshire Domiciliary Care Office provides personal care and support for people living in their own homes across the county of Hampshire. This included supported living housing arrangements, with shared tenancies and sometimes 24 hour care support. At the time of our inspection, the service supported 83 people with personal care, and another 67 people were supported with care that is not regulated by the Care Quality Commission (CQC). Regulated activities means care that a provider must be registered by law to deliver and includes providing personal care.
A registered manager is a person who has registered with the CQC 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.
Within this report we sometimes refer to staff. This is used to describe all staff roles, including support workers and locality managers. The registered manager devolved responsibility for people’s day to day support management to 11 locality managers. Each of these managed several supported living houses and/ or commissioned care packages within a geographical area, known as a locality.
This was the first inspection for this service, as it was registered with CQC in April 2015. It was registered at this time because the provider had just been awarded substantial additional commissioned care packages, which meant an additional office location was required. People and their support staff had been transferred to the provider’s organisation from several other services at this time. The provider had planned for this additional work load. They were still resolving some of the issues that had resulted from the transfer of people and staff into the service at the time of our inspection.
Concerns had been shared with CQC regarding people’s safety, support arrangements and choice. Concerns had also been shared regarding staff availability and allegations of abuse of people by the staff supporting them. These had been investigated by the provider and local safeguarding authority, and appropriate actions put into place to address the concerns raised. We inspected the service to ensure these actions had been successfully embedded to protect people from harm.
People were protected from harmful risks. Staff were trained and encouraged to report potential areas of harm, including abuse. The provider had taken robust actions in response to allegations of abuse, and had reviewed safeguarding measures to promote people’s safety. The provider’s whistle blowing policy explained the process to raise concerns outside of the organisation if necessary. Staff told us they were aware of the provider’s safeguarding policy, and had seen it instigated to protect people from harm.
Risks specific to individual’s needs and wishes were identified, assessed and managed safely. People were supported to engage with activities and develop life skills. Staff were encouraged to support people to manage risks associated with their preferences rather than neglect people’s preferences because of the risks involved. Risks associated with people’s health conditions were managed safely, because support workers were trained and followed guidance to keep people safe from harm.
People’s needs and commissioned care directed the amount of support they received. Where people’s needs had changed, the registered manager liaised with care commissioners to change support worker hours accordingly. Sufficient staff were deployed to meet people’s identified needs.
The registered manager followed the provider’s recruitment policy to ensure people were supported by staff suitable for their role. A review of recruitment files, and planned updates of pre-employment checks, ensured that staff continued to be suitable for employment.
People unable to manage their own medicines were supported to take these safely. Support workers were trained and their competency assessed to ensure people were administered their medicines safely.
Staff were trained to ensure they had the skills to meet people’s care and support needs effectively. Training was refreshed to ensure staff retained and updated their knowledge. Regular meetings, both informal and planned, provided opportunities for support workers and managers to discuss issues and concerns, as well as developmental aspirations.
People were supported to make decisions important to and for them. Support workers listened to and followed people’s wishes. When people had been assessed as lacking the mental capacity to make an informed decision, for example about medical interventions, the principles of the Mental Capacity Act 2005 were implemented. This ensured that the decision was made in the person’s best interest, by those appropriate to represent them, including for example their family, GP or staff.
When people required support to meet their nutritional needs, support workers guided and encouraged people to make healthy choices. People were supported to attend health appointments when appropriate. Staff followed guidance from health professionals to ensure that people’s care and support was provided effectively, promoting their health and wellbeing.
People told us they liked the staff who supported them. They looked to support workers for advice and comfort. People were encouraged to make decisions about their care, and were supported to develop life skills and independence. Staff took pride in people’s achievements. People had private space and time when they wanted this, as staff understood and respected their wishes and preferences.
Each person’s care and support needs had been reviewed since the provider took on their care packages from April 2015. Document updates had been prioritised to address people’s risk and health needs, to ensure people’s safety and wellbeing were supported. People told us the care and support they experienced was responsive to their health needs and promoted their independence. They, or those important to them where appropriate, were involved in their care planning. People influenced the support they experienced, because staff listened to and met their wishes.
People were supported to engage in a range of activities, hobbies and work in the community as they wished. Links with local organisations assisted people to build support networks outside of their commissioned care.
The provider’s complaints process was shared with people and those important to them to enable them to raise and resolve concerns. A ‘family forum’ provided the opportunity to discuss issues, as well as share ideas and the provider’s future plans.
The provider’s values of empowering people to be involved in the local community, and develop their independence as far as they were able, were understood and demonstrated by staff. People’s views, and those of others important to them, were considered to drive improvements and develop the service.
People and staff spoke positively about the support they experienced from managers. The registered manager was described as accessible and supportive.
Systems were in place to monitor and assess delivery of people’s care against legal requirements. Learning from audits and reviews was evaluated and implemented as necessary to drive improvements to the quality of people’s care and support. Staff proactively engaged with external agencies to represent people’s wishes and needs in the local community, and people were included on the provider’s boards to represent their peers. This ensured that people’s views informed decisions within the organisation, and drove changes to improve people’s care experience.