Archived: Dimensions Brambletye New Mill Road

Dimensions – Brambletye New Mill Road is a residential care home which is registered to provide a service for up to five people with learning disabilities. Some people had other associated difficulties such as physical limitations or behaviours that may cause distress to themselves and/or others. All accommodation is provided on one floor in a domestic sized dwelling. At the time of our inspection there were three people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting most parts of the underpinning principles of Right support, right care, right culture. The model of care is satisfactory; it ensured that people could live their lives how they chose and as an individual member of society. The staff supported people to have choice and control in their life. The care was person-centred and promoted people's dignity, privacy and human rights. The staff and the registered manager worked in a positive way to ensure that people received good care. However, some improvements were required.

The management of medicines was not always safe. Not all staff were up to date with their training to support appropriate risk management. Risks to people's personal safety had been assessed. However, the plans were not always in place to minimise those risks. Effective recruitment processes were not followed to ensure, as far as possible, that people were protected from staff being employed who were not suitable.

Quality assurance systems in place were not effective in ensuring compliance with the fundamental standards and identifying when the fundamental standards were not met. The registered person did not inform us about notifiable incidents in a timely manner. The registered person did not ensure that clear and consistent records were kept for people who use the service and the service management.

We have made a recommendation about gathering and acting on people’s feedback.

Relatives felt their family members were kept safe in the service. Professionals also felt people who use the service were supported well. Relatives felt they could approach the management and staff with concerns and that communication was good most of the time. The staff members felt staffing levels were sufficient to do their job safely and effectively. When incidents or accidents happened, they were reviewed and people provided with the required support. The registered manager appreciated staff contributions to ensure people received the best care and support. Staff felt the registered manager was managing the service well. The staff felt they could approach the registered manager for any advice, help or support. The registered manager and staff understood their responsibilities to raise concerns. There was an emergency plan in place to respond to unexpected events and the premises and equipment were kept clean.

During the pandemic, the registered manager continued working with the staff team to ensure they provided caring and kind support consistently. People, their families and other people that mattered were involved in the planning of their care.

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.

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 30 April 2020) and there was one breach of regulations. 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 the provider remained in breach of regulations.

At our last inspection we recommended that provider would seek advice and guidance on training that would support having competent assessors for medicine optimisation. At this inspection we found the provider had acted on the recommendation and they had made improvements.

Why we inspected

This was a planned inspection based on the previous rating.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We carried out an unannounced comprehensive inspection of this service on 2 March 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve notification of other incidents.

We undertook this focused inspection to check they 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 the last inspection to calculate the overall rating. The overall rating for the service has not changed. This is based on the findings at this inspection.

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

Enforcement and Recommendations

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.

We have identified breaches in relation to quality assurance; notification of incidents; record keeping; management of medicine; risk management, and recruitment. We have made a recommendation about seeking and using feedback from people, staff, others to improve the service.

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

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 - Brambletye is a residential care home which is registered to provide a service for up to five people with learning disabilities. Some people had other associated difficulties such as physical limitations or behaviours that may cause distress to themselves and/or others. The service was home to three people on the day of the visit. All accommodation is provided on one floor in a domestic sized dwelling.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service

The registered person did not always ensure we were informed about events such allegations of abuse or serious injury in a timely manner.

There were quality assurance systems put in place to monitor the running of the service and the quality of the service being delivered. However, this did not always ensure all tasks were completed as part of the management of the service such as submitting notifications on time.

We have made a recommendation to seek advice and guidance on training that would support having competent assessors for medicine optimisation.

We have made a recommendation that future ongoing staff training be updated in line with the latest best practice guidelines for social care staff.

We have made a recommendation the registered person ensured they recorded and kept a copy of actions taken as required in the Duty of Candour regulation when a notifiable safety incident occurred.

Relatives told us they could approach the management and staff with any concerns. We passed their feedback and queries to the registered manager and he provided prompt response with actions taken.

The staff members felt staffing levels were sufficient to allow them to carry out their role safely and effectively. The registered manager appreciated staff’s input to ensure people received the best care and support. Staff felt the registered manager was managing the service well, and they were accessible, approachable and open with the staff members. Staff had ongoing support via supervisions and annual appraisals. They reported they felt supported by the registered manager and maintained great team work.

Relatives felt their family members were kept safe in the service. The registered manager and staff understood their responsibilities to raise concerns. Risks to people’s personal safety had been assessed and plans were in place to minimise those risks. There were contingency plans in place to respond to emergencies and the premises and equipment were kept clean.

People received effective care and support from staff who knew them well. People enjoyed the food and could choose what they ate and where to eat. People had their healthcare needs identified and were able to access healthcare professionals such as their GP.

The registered manager worked with the staff team to ensure caring and kind support was consistent. People and their families were involved in the planning of care. The staff team recognised, responded to changes in risks to people and ensured a timely response and appropriate action was taken. People were encouraged to live a fulfilled life with activities of their choice and were supported to keep in contact with their families.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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.

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 23 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to submitting notifications to inform CQC about notifiable events.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dimensions- Brambletye is a residential care home which is registered to provide a service for up to five people with learning disabilities. Some people had other associated difficulties such as physical limitations or behaviours that may cause distress to themselves and/or others. The service was home to four people on the day of the visit. All accommodation is provided on one floor in a domestic sized dwelling.

At the last inspection, in, August 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good:

There is a registered manager running the service. 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.

People, staff and visitors to the service continued to be kept as safely as possible. Everyone’s safety was maintained by staff who had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff fully understood how to protect people and who to contact if they had any concerns. General risks and risks to individuals were identified and appropriate action was taken to minimise them, as much as possible.

High staffing ratios ensured there were enough staff on duty at all times to meet people’s diverse and individual needs safely. Recruitment systems were in place to make sure, that as far as possible, staff recruited were safe and suitable to work with people. People were given their medicines safely, at the right times and in the right amounts by trained and competent staff.

The service remained effective. Staff continued to be well-trained and supported to make sure they could meet people’s varied well-being and highly complex health needs. They responded very effectively to people’s current and quickly changing needs. The service sought advice from and worked with health and other professionals to ensure they met people’s distinctive needs.

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 practise.

People continued to be supported by a kind and caring staff team who were responsive to their needs. The staff team were attentive and were able to communicate with people by using individual communication systems. Support planning was highly individualised which ensured people’s equality and diversity was respected. People were provided with activities to enable them to lead as fulfilling a lifestyle as possible.

The registered manager was highly thought of and respected. She was described as approachable, effective and supportive. The quality of care the service provided continued to be assessed, reviewed and improved, as necessary.

The four people living at Dimensions Brambletye New Mill Road were not able to communicate with us verbally. People used noise, gesture, body language and facial expressions to express themselves. We used a variety of methods to gain an understanding of their experiences living at the home. Those methods included talking with relatives, observing what people were doing during the day and observing interactions between staff and the people who use the service.

We found, before people received any care, they were asked for their consent and the staff acted in accordance with their wishes. They were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment. This was because the staff worked in co-operation with others. One relative told us that staff "have a good knowledge and take prompt actions if there are problems."

People were cared for by staff who were supported to deliver care and support safely and to an appropriate standard. The two relatives we spoke with said they felt staff had the skills they needed when providing care and support to their family member. One relative commented "I think their personal care is excellent" and another said "At the moment there is a good strong staff team, they work well together."

Relatives we spoke with felt their comments and complaints were listened to and acted on effectively. They were aware of the complaints procedure and one relative commented "they always listen if I have any concerns, they are good like that."

We used a variety of other methods to gain an understanding of people's experiences. Those methods included talking with staff, looking at records, observing what people were doing during the day and observing interactions between staff and the people who use the service.

We saw staff spoke with and treated people with respect and involved them in everything that was happening. People's privacy and dignity was protected and staff encouraged and enabled people to be as independent as they could be.

Staff we spoke with were able to explain the care each person required and how they met those needs. We saw staff offered support and care to people who use the service in a way that matched the information recorded in their care plans.

All interactions we observed between staff and the people who use the service were positive. We saw staff had an in depth understanding of the people who use the service, their likes and dislikes and how they communicated. People using the service were relaxed and showed trust in the staff supporting them.

We found the provider met the outcomes we inspected and had systems in place to monitor their own compliance.