Dimensions Somerset Ashbury

Dimensions Somerset Ashbury is a residential care home which is able to provide personal care and accommodation to up to eight people. The home specialises in the care of people who have a learning disability. At the time of the inspection seven people lived at the home.

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

The home had been open for some years and therefore had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. However, the service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control and inclusion. People's support focused on them having as many opportunities as possible to make choices about their care and lifestyle.

People were cared for by staff who worked together to meet people’s needs. Staff felt well supported and happy in their roles. This helped to create a relaxed and happy atmosphere for people to live in.

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 were supported by staff who knew them well and were able to communicate with them in their chosen way. This ensured people could make choices about their day to day routines.

People were supported by adequate numbers of trained and experienced staff to keep them safe and meet their needs. The provider had a robust recruitment process which helped to minimise the risks of abuse to people. People were very comfortable and relaxed with the staff who supported them.

People’s needs were assessed, recorded and met. Each person had a support plan which gave staff guidance about how people preferred to be cared for. Staff knew people well and were able to provide very individualised support to people.

The provider worked with other health and social care professionals to make sure people received the care and treatment they required. This included meeting changing health care needs and end of life care.

People benefitted from a provider and management team who has systems in place to monitor quality and implement improvements to the service people received. People were involved in decisions about the running of the home according to their abilities.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism.

Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the operations director at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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 18 July 2018.) There were no breaches of regulations.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dimensions Somerset, Ashbury is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ashbury is registered to provide care and accommodation for up to eight people. The service specialises in the care of people who have learning disabilities and complex physical disabilities. The building is a single storey bungalow with a range of aids and adaptations in place to assist people who have mobility difficulties. All bedrooms are for single occupancy. The service is staffed 24 hours a day and all areas are accessible to wheelchair users. At the time of the inspection, seven people were living at Ashbury.

The people we met on the day of the inspection had complex physical and learning disabilities and not everyone could tell us about their experiences whilst living at Ashbury. We therefore used our observations of care and our discussions with staff, relatives, and visiting professionals to help form our judgements.

The service had a registered manager. The manager had been registered with CQC since April 2017. 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.

This is the first inspection of this service since it was transferred to Dimensions from the local authority in April 2017.

During this inspection, we identified that the provider needed to make improvements to ensure staff cared for people safely. For example, we identified concerns in relation to risk management. Staff had identified risks to people’s health and safety in care plans but had not always completed a risk assessment and management plan. This meant new staff or agency staff would not know how to manage any identified risks for people.

There were improvements needed to some aspects of medicines recording. We identified the provider had not updated two, ‘when required’ medicines protocols, or recorded staff competency checks. We also found recording of covert medicine administration details were not completed. We have made a recommendation in relation medicines management including how the provider ensures all staff are familiar with the current national guidelines for managing medicines in care homes.

The provider did not carry out checks to make sure infection control was kept to a high standard. We found three of the communal toilets did not have hand washing signs, soaps, or hand towels for people to wash their hands. This meant people were at risk of spreading infections. We raised this with the registered manager who immediately put up hand washing signs and arranged for hand washing products to be refreshed.

At the time of the inspection quality monitoring arrangements had not consistently identified shortfalls within the service. Internal governance systems were either not in place or had not been effective. The registered manager had a commitment to improving the care and support people received. However, they had not carried out internal audits or put an action plan in place with clear objectives to make sure they addressed the actions identified through the provider’s quality and compliance checks. This meant the team found it difficult to know what was a priority. Following the inspection, the registered manager sent us further information that included service reports. These reports had identified actions required to develop the service.

We also identified areas of concern around confidentially and people being involved in their care planning; Care records were kept in places where visitors had access to them. Although, when we raised this with the registered manager they removed the care files and by the end of the inspection, peoples care records were moved to each person’s room where people had access to them. We have made a recommendation in relation to the storage of records and care planning. Including demonstrating how the provider involves people and their relatives in all aspect of care and support.

Records showed that the provider did not involve people or their family members in any best interests meetings held. This meant staff could be providing care and support that would not be the persons preferred choice. Although, throughout the inspection we did observe staff asking people what they would like to do.

Although there were some concerns around how the provider managed risk in the service, we did observe people looking relaxed and happy. The provider had safeguarding systems in place, which staff knew about. Staff received training on how to recognise the various forms of abuse, which was regularly updated and refreshed.

We observed care staff addressing each person by name. Staff told us, “The most important people here are the people who live at the home.” “We have to look after them as best as we can.” Staff appeared kind and interacted with people well. Relatives told us they would be comfortable raising a concern or making a complaint if they needed to.