Dimensions Bracknell & Surrey Domiciliary Care Office

Dimensions Bracknell & Surrey Domiciliary Care Office is a domiciliary care agency. The service provides support to older people, young adults, autistic people and people living with learning disability. Staff provide personal care to people living in their own homes and supported living settings. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection 49 people using the service were receiving personal care.

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.

The provider was able to demonstrate how they were meeting most of the underpinning principles of Right support, right care, right culture.

Right Support:

Procedures did not always ensure suitable staff of good character were recruited to safely support autistic people or people living with learning disabilities. Risk assessments did not always assure risks to people had been mitigated.

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.

People experienced good continuity and quality of care from staff they knew well, which consistently achieved successful outcomes. There were enough staff to meet people's care and support needs. Staff had training in relation to safeguarding and knew how to report any concerns.

Staff were focused on people's strengths and promoted their independence, which meant people enjoyed an enriched and fulfilling life. People's needs were assessed, and care plans were developed with them, and their relatives where required. Where people had specialist diets, this was understood, and staff knew how to support people safely in accordance with linked positive behaviour strategies. Staff enabled people to access specialist health and social care support in the community.

Right Care:

People received kind and compassionate care from staff who protected and respected people's privacy and dignity. Staff knew people well and responded to their individual needs, promoting equality and diversity in their daily support for people. We observed warm and caring interactions between people and staff. People's communication needs were clearly explored and documented. People were supported to maintain contact with people who mattered to them and to take part in activities that were meaningful to them.

Staff engaged well with other agencies to ensure people had access to the support they needed for their healthcare and wellbeing needs. The service made referrals and liaised with other healthcare professionals when required. Staff treated people with dignity and respect.

Right Culture:

People were empowered live fulfilled and enriched lives due to the values, attitudes and behaviours of the management and staff. People experienced good quality care and support in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. People's care plans were person centred and reflected how people wanted to receive their care. Effective training and supervision enabled staff to provide compassionate and empowering care that was tailored to meet people’s individual needs. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. People's wishes, needs and rights were at the heart of everything staff did to support people. People and those important to them were involved in planning their care. Registered managers valued and acted upon people's views. The registered managers had developed an open culture based on mutual trust and respect, inclusivity and improvement, which enhanced the quality of people’s lives. The service ethos built on transparency, respect for equality and diversity ensured the risks of a closed culture developing were minimised.

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 (report published 20 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We identified breaches in relation to recruitment, risk management and quality assurance of the service.

Please see the action we have told the provider to take at the end of this report.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dimensions Bracknell Domiciliary Care Office is a domiciliary care service providing personal care to people in their own homes. The people they support have learning disabilities and/or autistic spectrum disorder.

At the time of our inspection the service was supporting a total of 243 people. Of those, 64 people were supported with personal care needs. Fifteen people were living in their own flats or houses. The remaining 49 people were living in supported living settings in 15 different houses. In supported living settings people’s care and housing are provided under separate contract agreements. Not everyone using Dimensions Bracknell Domiciliary Care Office received a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’, help with tasks related to personal hygiene and eating. In addition, CQC does not regulate any premises used for supported living, this inspection only looked at people’s personal care and support.

The service had a registered manager as required. 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. The registered manager was present and assisted us during the inspection.

We have recommended that the provider review their duty of candour policy to ensure it provides accurate information to staff. We have also recommended that future ongoing staff training be updated in line with the latest best practice guidelines for social care staff.

People were protected from the risks of abuse. Some staff recruitment issues were identified, but were dealt with by the registered manager before the end of the inspection. People and their relatives confirmed people were encouraged and supported to maintain and increase their independence.

People were treated with care and kindness. They were consulted about their support and could change how things were done if they wanted to. People were treated with respect and their dignity was upheld. This was confirmed by people and the relatives who gave us their views.

People received care and support that was personalised to meet their individual needs. People were supported to maintain relationships with those important to them. The service provided access to local events to enhance social activities. This meant people had access to activities that took into account their individual interests and links with different communities.

People received effective care and support from staff who knew them well and were well trained. They told us staff had the training and skills they needed when providing their care and support. People received effective health care and support. Medicines were stored and handled correctly and safely.

People mostly knew how to complain and knew the process to follow if they had concerns. People's rights to make their own decisions were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Where people were potentially being deprived of their liberty, the service had made the relevant commissioning authorities aware. This was so that commissioners could make applications to the Court of Protection for the appropriate authorisations.

People's right to confidentiality was protected and they received support that was individualised to their personal preferences and needs. People's diversity needs were identified and incorporated into their care plans where applicable.

People benefitted from a service which had an open and inclusive culture and encouraged suggestions and ideas for improvement from people who use the service, their relatives and staff. Staff were happy working for the service and people benefitted from staff who felt well managed and supported. People and the staff felt the service was well-led.