Archived: Dimensions 58 Church Lane East

Dimensions 58 Church Lane East is a residential care home that was providing personal care to four people. The premises were a converted three storey domestic premises with access to above ground level by stairs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

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, choice, control and independence. People receiving the service receive planned, and co-ordinated person-centred support that is appropriate and inclusive for them.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways:

A relative told us, "[Loved one] loves it there."

People were cared for safely by sufficient numbers of suitable staff who understood the risks for each person. People received their medicines from trained staff.

Staff ensured people’s care and support was planned and delivered in line with current legislation and best practice.

People were supported by staff who were appropriately supported in their role.

Staff ensured people were given choices about their food and drinks.

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.

People received kind and compassionate care from staff who cared about them and their welfare.

People benefited from positive relationships with staff, a number of whom had worked at the service for a long time.

Staff ensured people received responsive care, individualised to their needs and interests. Staff supported people to access a range of activities, of interest to them.

The service was well-led, and staff were motivated and clear about their roles and responsibilities.

The registered manager was working with staff to ensure they consistently recorded the temperature of the room and fridge where medicines were stored as required.

The registered manager took relevant action to ensure all staff followed the provider’s dress code regarding their nails.

Rating at last inspection:

At the last inspection the service was rated good (10 March 2017).

Why we inspected:

This was a planned inspection to check that this service remained good.

Follow up:

We did not identify any concerns at this inspection. We will therefore re-inspect this service within the published timeframe for services rated good. We will continue to monitor the service through the information we receive.

The service had a registered manager who also managers another service that is owned by the provider. 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.

Dimensions 58 Church Lane East provides accommodation and personal care for up to five adults with learning disabilities. At the time of the inspection there were four people living at the service who were assessed as Autistic. The premises were a converted three storey domestic premises with access to above ground level by stairs only. People who currently live at the service have lived there for many years and were a close cohesive group.

Some people who lived at the service had their own individual ways of communication through eye contact, gestures or noises. Throughout the inspection we saw staff responding to people’s needs and providing care and support in a person centred manner. Staff were able to immediately recognise when people needed or wanted help or support. Relatives told us; “Overall very pleased with the service, [person’s name] clearly enjoys being there and can’t wait to get back when she comes home. All the staff seem to have her best interest at heart. She is very happy there” and “Quite happy with the care and in fact the last few times he has been home it was a job to get him to come home. He must be happy as otherwise he would not be like that”. A person’s representative also told us: “There is such a good level of care might not be five star mansions but the care and the way the residents enjoy living is very obvious to me”.

People were kept safe because staff understood their responsibilities in protecting people and knew how to report any concerns. People were enabled to take positive risks as part of a person centred lifestyle.

People were supported by staff who consistently demonstrated kindness, compassion and a genuine interest in the people they supported. People showed us positive signs that they were relaxed and at ease with staff and their surroundings. Staff knew people well and it was apparent that positive relationships had been developed. A staff member told us: “There is a stable staff team that means we can build bonds and trust with the residents”.

There were sufficient numbers of suitable staff to keep people safe and staff had completed training to meet the needs of people who had a learning disability including Autism. Relatives and peoples representative’s told us: “All the staff seem to be good, never found them not to be able to cope [person’s name] with or anyone else” and “I have not seen anyone interact with her that does not understand her needs well or how to deliver that”. Staff told us how their induction and training had improved their skills. One staff member told us “The training really made me question how I was supporting people before; I think that now I have a much better understanding of why some of our residents act and behave in a certain way”.

People were supported to maintain good health and to access healthcare services as and when required. A relative told us: They are always pretty prompt in seeking medical help”. People received the food and drinks they preferred and were supported to ensure their nutritional needs were met.

People were encouraged to make decisions about their daily care and support. We saw how well staff understood people’s communication needs which enabled staff to support people to make choices as well as respond to people’s needs. Where people needed to have a legal representative or relative represent their views then these were sought and acted upon. One relative told us: “Yes I am very much involved in his care plan and they keep in regular contact”.

People received care and support that was responsive to their needs and were supported in a person centred manner. A person’s representative told us: “They support people with very complex needs and they have the mix of people just about right, so they can make sure that everyone is treated as an individual”. People were encouraged to be as independent as they could. A staff member told us: “We need to support people to be as independent as possible; I do this through positive encouragement”.

People were engaged in individual meaningful occupation and activities and were supported to take part in wider community activities. One person told us how they liked to watch TV and another person indicated to us how much they had liked their swimming session. A representative who supported several people across the provider’s services said of the provider: “They look to support each client individually to find activities which they are interested in, they are always looking at the individual activities, always individually geared”.

The service benefited from clear leadership and oversight. A professional told us; “Staff are very supportive and (registered manager) especially is very proactive and can be very vocal in making sure the cause of service is being listened to, but it is all in a good way”. Staff described the Registered Manager as “Approachable”, “Helpful” and “Very supportive”. A person’s relative /representative told us: “(Registered manager) is excellent to be honest, she used to be there all the time but now she has to split her time, I don’t think this effects the place as the other staff are so competent” and

The quality of the service provided was kept under review and was monitored by the Registered Manager and the provider to help continually drive improvements to the service.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

At the time of this inspection, the home was providing accommodation, care and support to four people who have learning disabilities. We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We observed the care and support being given and how staff interacted with people. We spoke with the manager and two staff and looked at care and support records. We also spoke with two relatives by telephone after the inspection visit.

This is a summary of what we found '

Is the service safe?

We saw that care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. People received health checks and support to attend any follow up appointments and staff followed advice given by other health and social care professionals.

We saw that medicines were kept safely and appropriate arrangements were in place in relation to the recording of medicine. Staff told us they were required to complete training and an assessment of their competence before they were able to administer medicine to people. We also saw records confirming that staff received training to give them the knowledge and skills they needed to safely handle and administer medicines to people.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. The manager was aware of recent changes to the legislation and was awaiting further guidance from the provider organisation.

Is the service effective?

The training records and programme showed that staff were provided with training and opportunities to gain relevant qualifications. Staff we spoke with confirmed that they received training that was relevant to their work and helped them to meet the needs of people using the service.

People were supported to be able to eat and drink sufficient amounts to meet their needs. We saw that people had personalised support plans, which showed that their dietary needs and preferences were taken into account. One person's plan gave guidance for staff on what to do if the person ate too fast. The records included a risk assessment in relation to choking and how to support and interact with the person at mealtimes.

Following consultation with a doctor and a dietician, another person had been supported to follow a specific regime in relation to their fluid intake. The manager and staff told us that this had been successful and the person now had a more balanced intake. This was reflected in the person's care and support records.

Is the service caring?

A relative told us 'The treatment is good' and 'The people working there are very good people'. Another relative told us how staff supported the person with personal care, in ways that upheld the person's dignity. Both relatives we spoke with commented that their relatives were 'Always happy to go back' to the care home after a visit. We observed that staff treated people with respect, communicated effectively with them and promoted a friendly and inclusive atmosphere in the home.

Is the service responsive?

The staff rota was organised in advance and flexibly to take account of people's planned activities and the level of staff support required. Staffing levels reflected the assessed needs of people using the service, as identified in their support plans and risk assessments. The manager was able to demonstrate how staffing was reviewed in relation to the changing needs of people who use the service. For example, following an assessment of one person's support needs, an additional five hours per late shift had been put in place.

Is the service well led?

Regular audits of the quality and safety of the service took place and action plans were developed and followed to address any issues that had been identified. Following an incident the service had reviewed a person's support and an alternative approach was put in place, which had beneficial results for the individual. This showed that learning from incidents took place and appropriate changes were implemented.

We saw evidence of consultation with and involvement of people's families and representatives, for example through person centred planning meetings. As a result of listening to the views of people who use the service, the staff recruitment process was geared toward matching staff to people's interests and activities. For example, the home had advertised for staff who liked swimming. A relative told us they were 'always involved' and had 'no complaints'. They said they had 'always been happy with the service provided'. The other relative said they had never had any reason to complain about the service. They confirmed that the service was well led.

We used a variety of methods to gain an understanding of people's experiences including observing the interactions between staff and people who used the service, talking to staff and reviewing the records. We observed that the staff spoke to the person present with respect and they offered choices and ensured their needs were met. Staff supported and assisted people to attend their chosen activities and to take part in activities in the home. The care plans gave a detailed picture of the individual support each person required to meet all aspects of their needs.

We found that the provider had cooperated with health care professionals to ensure that people had received an appropriate service.

The premises were suitable for the needs of the people who used the service.

Staff were supported and supervised to carry out their roles and responsibilities.

People were able to make complaints with appropriate staff support and there was a system for complaints to be listened to and acted upon.

People used noise, gesture, body language and facial expressions to express themselves.

The staff knew people well enough to interpret their choices, moods and feelings.

We used a variety of methods to gain an understanding of people's experiences including observing the interactions between staff and people who used the service, talking to staff and reviewing the records.

We observed that the staff spoke to people with respect and they offered them choices and ensured their privacy and dignity was maintained.

Staff supported and assisted people to attend their chosen activities and to take part in activities in the home.

The care plans gave an extremely detailed picture of the individual support each person required to meet all aspects of their health and care needs.

The staff were able to describe people's needs and how these were met.