Background to this inspection
Updated
29 February 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
Dimensions The Laurels 3 Nine Mile Ride is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. The manager overseeing the service assisted us with the inspection. We will refer to them as ‘the manager’ in the report. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided. We will refer to them as ‘the registered person’ in the report.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
Prior to the inspection we looked at all the information we had collected about the service including previous inspection reports and notifications the previous registered manager had sent us. A notification is information about important events which the service is required to tell us about by law. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with one person who uses the service. We also spoke with the manager and one member of the staff team. We observed lunch, planned activities and interactions between staff and people living at the service. We carried out a tour of the premises. We reviewed a range of records relating to the management of the service, for example, audits and quality assurance reports; records of accidents and incidents; compliments and complaints and maintenance records. We looked at four staff recruitment files and staff support information. We looked at two people's support plans and associated records.
After the inspection
We continued to seek clarification from the manager to validate the evidence found. We looked at further training information, maintenance information, quality assurance audits, meeting minutes. We spoke to four relatives of people living at the service. We contacted eight more members of the staff team and spoke to three. We contacted 10 professionals who work with the service and received two responses.
Updated
29 February 2020
About the service
Dimensions - The Laurels is a care home without nursing which is registered to provide a service for up to six people with learning disabilities. Some people have other associated difficulties including, needing support with behaviours which could be distressing and/or harmful. There were four people living in the home on the day of the visit.
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 and what we found
The registered person did not always ensure the quality assurance system in place was used effectively to help oversee the service and ensure compliance with the fundamental standards. The registered person did not ensure the management of medicines was always safe. The registered person did not ensure effective recruitment processes were followed so that people were protected from staff being employed who were not suitable. The registered person did not ensure we were informed about events such allegations of abuse in a timely manner.
We have recommended that 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.
We have recommended that future ongoing staff training be updated in line with the latest best practice guidelines for social care staff.
Relatives felt they could approach the management and staff with any concerns. However, they felt communication between them and the staff team and what was happening at the service could be improved. The staff members felt staffing levels were adequate most of the time. The manager appreciated staff’s contribution to ensure people received the best care and support. Staff felt the manager was managing the service well, and they were accessible and open with the staff members.
Staff had ongoing support via regular supervision and appraisals. They reportedly felt supported and maintained great team work.
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 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, 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.
Relatives felt their family members were kept safe in the service. The 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 manager was working with the staff team to ensure caring and kind support was consistent. People and their families were involved in the planning of their care. The staff team recognised and 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 choosing and were supported to keep in contact with their families.
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 13 July 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 at this inspection.
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.