Dimensions 1 Michigan Way

About the service

Dimensions 1 Michigan Way is a residential care home providing personal care to up to five people. The home is registered to support people who have learning disabilities or autism. The property provides ground floor accommodation and has been adapted to meet the needs of people who may also be living with physical disabilities. At the time of our inspection there were five people using the service.

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

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People received care and support in a clean and well-equipped environment that met their physical needs. Staff understood people and their individual needs well. Staff provided kind, caring, person-centred care and support. Staff communicated with people in ways that met their needs. Staff enabled people to access specialist health and social care support in the community. People and their relatives were able to personalise their bedrooms.

Right Care:

Support plans were detailed, and person-centred ensuring people were supported to live full, active lives and encourage them to be as independent as possible. The home had enough staff to keep people safe.

Staff had training on how to recognise and report abuse and they knew how to apply it. Staff employed by the home and agency staff received a robust induction and had specialist training to help them support people.

Right Culture:

The provider's monitoring processes were not always effective in helping to ensure people consistently received good quality care and support. Staff turnover had been high, which meant people were supported by agency staff. Permanent and regular agency staff knew and understood people well and were responsive to their needs. People and those important to them, were involved in planning their care. The registered manager demonstrated joint working with health professionals which provided specialist support to people, involving their families and other professionals as appropriate. Staff demonstrated good understanding around providing people with person centred care and spoke knowledgably about how people preferred their care and support to be given.

Rating at last inspection

The last rating for this service was good (published 18 November 2017).

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

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall 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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement

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 safe care and treatment, upholding people’s rights and good governance at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

1 Michigan Way is a residential care home providing personal care to up to five people. The service provides support to people who have learning / and or physical disabilities or autism. At the time of our inspection there were four people using the service.

We found the following examples of good practice.

• The provider had robust entry procedures. We had to evidence our vaccination status and a negative COVID-19 lateral flow device (LFD) test on arrival. Staff took our temperature and recorded our details and we signed in and used sanitising hand gel before entering the premises.

• The provider had completed a comprehensive risk assessment to enable non-vaccinated workers to access the service to refit a condemned boiler. The contractor, selected by the housing trust who owned the premises, did not comply with guidelines and had been unable, when asked by the provider, to provide only vaccinated staff who would consent to LFD tests and mask wearing. They had been restricted to a small area of the premises where the boiler was and had to access through the nearest door, at no time accessing areas where people were.

• Staff had cared for two people in their rooms, isolating after hospital visits. They did so without affecting their well-being and while keeping other people safe. Necessary personal protective equipment (PPE) and waste bins were positioned by their rooms and staff ensured the premises were well ventilated. Following isolation guidelines and using LFD tests ensured people were safely able to integrate with peers again.

• There had been no outbreak of COVID-19 at 1 Michigan Way but the provider had considered what actions would be needed should there be one. Plans were in place to ensure safe access for staff and an area for them to don and doff PPE. All plans ensured people were the focus and remained safe at all times.

• People had been supported to cope with the changes that COVID-19 and the lockdown had presented. One person in particular needed additional support for a short period when staff members began wearing face masks, after two weeks they became less anxious and used to being unable to see staff’s faces. People had been supported with testing who lacked capacity to understand why this happened. Staff were empathetic with them and gently supported them to test. Staff and relevant others had contributed to Mental Capacity Act 2005 assessments and best interest decisions to consider peoples participation in testing.

• The provider had struggled at times with staffing as there had been a number of staff leave the service. They had used agency extensively and been able to block book staff to ensure continuity for people and minimise the risk of using agency staff who worked elsewhere when not at 1 Michigan Way.

• We checked the premises for IPC risks and found some areas would benefit from additional maintenance to improve how well staff could keep them clean. There had been no impact to people from this and the assistant manager reported them for completion immediately after our visit.

We were assured that this service met good infection prevention and control guidelines.

This inspection took place on 19 September 2017 and was unannounced. There were five people living in the home.

The service had a registered manager in post. A registered manager is a person who has registered with 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.

There was a friendly atmosphere in the home and staff supported people in a kind and caring way that took account of their individual needs and preferences.

Staff understood how to identify, report and manage any concerns related to people’s safety and welfare. There were systems and processes in place to protect people from harm, while promoting their independence.

Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and competency assessments.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

People were supported to eat and drink enough to meet their needs and to make informed choices about what they ate.

People and their relatives or representatives were involved in planning the care and support provided by the service. Staff listened to people and understood and respected their needs and wishes.

The service was responsive to people’s needs and there were systems in place to help ensure any concerns or complaints were responded to appropriately. Healthcare professionals were involved in people’s care when necessary.

The provider and the registered manager were promoting an open and inclusive culture and continued to look for ways to improve the service. There was a range of systems in place to assess and monitor the quality and safety of the service and to help ensure people were receiving appropriate support.

Dimensions are a specialist provider of a range of services for people with learning disabilities and people who experience autism. This service provided care and support for up to five people with a learning disability. At the time of our inspection there were four people using the service. Their home is a single storey building, consisting of five bedrooms, a dining and kitchen area, a laundry room and a level access shower room. The home is fully accessible to wheelchair users. The home has a large accessible garden with parking to the front.

At the time of our inspection the registered manager was not overseeing the day to day running of the service. The provider had put interim management arrangements in place while they recruited a registered manager. 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.

We found improvements were required with the quality assurance system in place as this did not always show what actions had been taken, when areas for improvement were identified through incidents or accidents.

We found that risks some people had in relation to dysphagia had not been reviewed recently even though there had been a recent significant incident within the home.

Positive interactions were observed between staff and the people they cared for. People's privacy and dignity was respected and staff supported people to be independent and to make their own choices. Staff provided information to people and included them in decisions about their support and care. When people were assessed by staff as not having the capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person's best interest.

We found there were policies and procedures in place to guide staff in how to safeguard people from harm and abuse. Staff received safeguarding training and knew how to protect people from abuse.

People lived in a safe environment and staff ensured equipment used within the service was regularly checked and maintained.

Recruitment and selection procedures were in place and appropriate checks were carried out before staff started work. This included obtaining references from previous employers and disclosure and disbarring checks (DBS) to show staff employed were safe to work with vulnerable people. Sufficient staff were deployed to ensure people's needs were met.

There was a complaints procedure in place which was available in a suitable format which enabled people who used the service to access this if needed. People and relatives we spoke with knew how to make a complaint and told us they had no concerns about raising issues with the staff team.

We saw that systems were in place to gain and review consent from people who used the service, and to act on their wishes. Staff we spoke with demonstrated a clear understanding of the care planning process and of individual's needs. We saw that appropriate records were maintained and that suitable arrangements were in place for supporting people with medicines. There were enough qualified, skilled and experienced staff to meet people's needs.

A person's relative told us that staff respected people for who they were and involved them in making decisions. We observed staff supporting a person in a way that matched the person's preferences as recorded in their care plan. Staff we spoke with demonstrated their understanding of the care planning process and of the outcomes they were supporting people to achieve. We observed that there were opportunities offered throughout the day for people to take part in home or community based activities, such as trips out for shopping or lunch. A person's relative praised the service for the care and support it provided and said 'I know he's well looked after'. They told us that staff 'Really are good. I don't think anybody could do a better job. Nothing is too much trouble'. They told us that they were consulted and kept well informed by the service.