Dimensions Somerset Frome Domiciliary Care Office

Dimensions Somerset Frome Domiciliary Care Office is a domiciliary care agency. It provides personal care for older and younger people with a learning disability and/or autistic people in their homes or flats in the community. Some people lived in one of the 10 supported living services whilst others lived in shared accommodation or individual homes and flats. Many of the households had multiple occupancy of over three people with shared living spaces and required 24-hour support.

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 66 people 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.

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 this practice.

People were supported by staff to pursue their interests, so people had a fulfilling and meaningful everyday life. Staff supported people to achieve their aspirations and goals. Staff supported people with their medicines in a way that promoted best possible health outcomes.

Right Care

People received kind and supportive care. Staff understood and responded to people’s individual needs. Staff understood how to protect people from poor care and abuse. 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 received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. Staff and people cooperated to assess 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. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them, were involved in planning and reviewing their care. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect 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 and update

The last rating for this service was requires improvement (published 21 December 2020).

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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

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

We carried out an announced inspection of this service in September 2020. Breaches of legal requirements were found in relation to Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance).

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at previous comprehensive inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dimensions Somerset Frome Domiciliary Care Office on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dimensions Somerset Frome Domiciliary Care Office is a domiciliary care agency. It provides personal care for older and younger people with learning disabilities and/or autism in their homes or flats in the community. At the time of the inspection 94 people were receiving support.

Some of the people lived in one of the 12 supported living services whilst other lived in shared accommodation or individual homes and flats. Many of the households had multiple occupancy of over three people with shared living spaces. Many of the people required 24-hour support and this changed for some during the COVID-19 pandemic.

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.

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

The service was not well led. Quality assurance systems did not effectively monitor each household and drive improvement. When concerns were identified they had not always been rectified. Some concerns found during the inspection had not been identified by the provider’s quality assurance systems.

People were not always kept safe from risks which could lead to potential harm. Care plans were mixed and missing key information or details known by staff. When people’s needs changed, care plans had not always been updated to reflect this.

There was a high turnover of senior staff and staff at each household leading to inconsistencies of support and systems. Agency staff were used and during the COVID-19 pandemic staff had been relocated from temporarily closed day services.

People told us they were safe or displayed they were comfortable around staff. Relatives had mixed views about the care and support their family members received. Staff had good understanding of how to recognise potential abuse. However, they lacked knowledge of external places they could report concerns.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. When households under the registration were not fully meeting the principles we heard of plans to find more suitable living arrangements and staff training. The provider had a model of support and care placing people at the centre of all the choices and support they received. Relatives confirmed they were involved in most decisions when people were less able to express choices themselves. Staff told us of the provider’s ethos where people’s privacy, dignity, human rights and choice were central to their daily lives. However, the COVID-19 pandemic had placed some limitations on practices because they were trying to follow government guidance to keep people safe.

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 (published 11 August 2018).

Why we inspected

We received concerns in relation to the management of the service and peoples’ safety. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. This is to provide assurance that the households visited, and the provider can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dimensions Somerset Frome Domiciliary Care Office on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to keeping people safe from potential harm and poor governance at this inspection.

You can read the end of this report for the action we took. This includes asking for an action plan and placing some conditions on their registration to drive improvement.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least Good. We will work with the 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 Somerset Frome Domiciliary Care Office is a domiciliary care agency. It provides ¿personal care to people living in their own houses and flats in the community. It provides a ¿service to older and younger adults who have a learning disability, autism or complex needs. It is ¿operated by Dimensions Somerset Sev Limited, part of a national not for profit organisation ¿providing services for people with learning disabilities, autism and complex needs. ¿

This service provides care and support to 96 people living in 14 'supported living' settings, so they ¿can live in their own home as independently as possible. Many of the people using the service ¿required 24-hour support from staff due to their care needs. People's care and housing are ¿provided under separate contractual agreements. CQC does not regulate premises used for ¿supported living. This inspection only looked at people's personal care and support.¿

The homes people lived in were located in Somerset. Some people lived on their own; some had ¿multiple occupation. Houses in multiple occupation are properties where at least three people in ¿more than one household share toilet, bathroom or kitchen facilities. There were offices and ¿sleep-in rooms for staff in some of the homes.¿

Not everyone using Dimensions Somerset Frome Domiciliary Care Office received a regulated ¿activity. CQC only inspects the service where people were provided with personal care. This ¿included support with eating, drinking, medicines and community access.¿

The care service has been developed and designed in line with the values that underpin the ¿Registering the Right Support and other best practice guidance. These values include choice, ¿promotion of independence and inclusion. People with learning disabilities and autism using the ¿service can live as ordinary a life as any citizen. Registering the Right Support CQC policy.¿

There are two registered managers in post. Each is responsible for a number of supported living ¿services. 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. ¿

¿ ¿

We spoke with people who used the service. Some people spoke about their service in some ¿detail. Other discussions with people were limited, so we also used our observations and our ¿discussions with people’s relatives and staff to help form our judgements.

¿

People and their relatives told us the service promoted people’s welfare and safety. One person ¿said, “Yes, I feel safe; very much so.” Staff understood how to recognise signs of abuse and knew ¿who to report it to. When accidents or incidents occurred, systems were in place to learn from ¿them. ¿

Medicines were managed safely. Risks were well managed which enabled people to retain their ¿independence and receive care with minimum risk to themselves or others.¿

Staff had developed close, trusting relationships with people. One person told us, “Staff are kind, ¿fantastic. I love them.” People and their relatives were happy with the care and support provided ¿by staff. ¿

The provider was currently consulting on a restructure ¿to the organisation. Relatives and staff both spoke about their anxiety if this resulted in changes to the ¿staff team. Both relatives and staff felt this would adversely affect people. Consultations were still ¿ongoing so it was not clear at the time of our inspection if the provider's proposals would be ¿adopted or what the impact may be.¿

Staff were well trained and had the skills and knowledge required to support people effectively. ¿One person said, “Yes, the staff are well trained. The staff know me very well.” People interacted ¿well with staff.