Dimensions Somerset The Brambles

Dimensions Somerset The Brambles is a residential care home providing personal care for up to seven people who have a learning disability, physical disability or autism. There were seven people living at the home when we visited.

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.

People were supported by enough staff to ensure their safety. When staffing levels were reduced, people were safe but their care and/or activities could be affected. Relatives did express some concern about the impact lower staffing levels had and the use of temporary staff. Staff recruitment was ongoing.

People were safe at the home. They were comfortable and relaxed with the staff who supported them. Relatives thought the home was a safe place for their family members to live. Staff knew how to recognise and report concerns about possible abuse.

People were supported to have meals of their choice. We observed very good mealtime interaction and support provided by staff.

Risk assessments were used to ensure people received safe care and support according to their individual needs. Risks to people’s physical health had been considered and planned for.

People received their medicines safely and at the right time. People were protected from catching and spreading infections.

People lived in a home which was well-organised, with clear lines of responsibility and accountability. There was honesty and accountability when things went wrong.

There was a clear structure within the staff team ensuring staff understood their own roles and responsibilities. Relatives and staff had high confidence in the management team.

Audits, surveys and observations were used to try to improve the care and facilities for people; where shortfalls were identified action was taken to make sure improvements were made. There was a clear, up to date improvement plan for the service. There was good support from senior staff within the organisation to help improve the service and develop new initiatives.

Staff training, support and teamwork were good. We saw staff were positive and engaged with people, treating them with kindness, dignity and respect.

Staff worked in partnership with other professionals, such as speech and language therapists and GPs to make sure people’s individual needs were met.

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.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were seen as individuals and were well supported so they could lead fulfilling lives. Staff treated each person with dignity, respect and respected their abilities, choices and human rights.

Right Support: The Brambles is a small care home, based in the community. People had their own rooms but also shared communal areas so people could spend time together. Most people had lived at the service for many years and saw the service as their home. People were supported to make choices, be involved in ‘home life’ and to take risks.

Right Care: People received personalised care, although staffing shortages could impact on the choices people had and in quality and consistency of care. There was a reliance on temporary staff, although staff recruitment was ongoing.

Right culture: The registered manager led by example. There was a positive culture at the service. Staff were committed to the provider's values, aims and objectives. People, staff and relatives were involved in the running of the home. Ideas for improvement were welcomed and incorporated in the home’s development plan. There was an honesty and openness about things which needed to improve.

Rating at last inspection

The last rating for this service was good (published 2 August 2018).

Why we inspected

This inspection was in response to a serious safeguarding incident, to examine the learning from the incident and to check people were currently safe. As a result, we undertook a focused inspection to review the key questions of ‘Safe’, ‘Effective’ 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 not changed and remains good.

We found no evidence during this inspection that people were at risk of harm from these concerns. However, it was evident that it was a very difficult time for people and staff as the investigation into the serious safeguarding incident was still ongoing, so learning from the incident was not yet complete.

We looked at infection prevention and control measures under the ‘Safe’ key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dimensions Somerset The Brambles 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, The Brambles 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.

The Brambles is registered to provide care and accommodation for up to seven 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 Brambles.

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 Brambles. 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 plans. We did address this with the registered manager who began updating risk assessments during the inspection process.

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, and we could see areas of the service had not been cleaned thoroughly. The manager told us they would arrange for a deep clean of the service to take place and implement regular hygiene checks.

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 quality monitoring arrangements had not consistently addressed identified shortfalls within the service. 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. When we raised this with the registered manager they immediately contacted the operational director and requested locked cupboards to be fitted in people’s rooms so that records could be stored securely. 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.

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 and knocking on doors before going into people’s rooms. Staff told us, “We care about people that live here and want things to be good for them.” 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.

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.