Dimensions 6 Sadlers Lane

Dimensions 6 Sadlers Lane is a care home without nursing which is registered to provide a service for up to four 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. All accommodation is provided on one floor in a domestic sized dwelling.

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

The quality assurance system in place was not always 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 they kept clear records of actions taken as required in the duty of candour regulation when a notifiable safety incident occurred.

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

People were protected against abuse and neglect. Relatives and advocates felt the people who use the service 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 was an emergency plan in place to respond to unexpected events and the premises and equipment were kept clean. The staff reported they felt staffing levels were sufficient to enable safe and effective practice. Staff felt the registered manager was managing the service well, and they were accessible and open with the staff members. The recruitment process has been reviewed and improved however we were unable to measure the effectiveness of this as there was no new staff employed at the service since the last inspection. Accidents and incidents were addressed and documented.

The registered manager appreciated staff’s support, commitment and contributions to ensure people received the best care and support during difficult times of the pandemic. People were still encouraged and supported to keep in contact with their families as much as possible. Relatives and advocates told us they felt they could approach the registered manager and staff with concerns and that communication was good most of the time.

Staff felt supported and believed they had maintained great teamwork. 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.

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. Some improvements are required. 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. We identified breaches in relation to good governance at this inspection. This meant some aspects of the service were not always safe that would limit the assurance about safety and increase risk that people could be harmed. The service requires improvements to be made in the quality assurance, duty of candour and medicine records to ensure they are fully meeting the principles of the statutory guidance for people living with a learning disability.

The registered person had clear aims and objectives to ensure people with disabilities were protected, engaged in care and could live the best possible life. The staff and the registered person listened to people and those important to them and acted on the feedback, queries and suggestions.

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 9 April 2020) and there were multiple breaches. At this inspection enough improvements had not been made or sustained and the registered person was still in breach of regulations of 12 and 17, and new breach of regulation 20.

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.

The last inspection we carried out was an unannounced comprehensive inspection of this service on 10 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, fit and proper persons employed, good governance and 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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. 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 6 Sadlers Lane on our website at www.cqc.org.uk.

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. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified repeated breaches in relation to Regulations 12, 17, and new breach in regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 6 Sadlers Lane is a care home without nursing which is registered to provide a service for up to four 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. 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 quality assurance system in place was not always 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. Effective recruitment processes were not always 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 as serious injuries in a timely manner.

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 that the registered person ensured they keep clear records of actions taken as required in the Duty of Candour regulation when a notifiable safety incident occurred.

A relative told us they felt they could approach the management and staff with any concerns and that communication was good. The staff members felt staffing levels were sufficient to do their job safely and effectively. The registered manager appreciated staff contributions to ensure people received the best care and support. Staff felt the registered manager was managing the service very well, and they were accessible and open with the staff members.

A relative felt their family member was kept safe in the service. Professionals also felt people who use the service were protected from risks of harm. 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 was an emergency plan in place to respond to unexpected events and the premises and equipment were kept clean.

Staff had ongoing support via regular supervision and appraisals. They felt supported and maintained great team work. 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 was working with the staff team to ensure caring and kind support was consistent. People, their families and other people that mattered 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 fulfilling life with activities of their choosing 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 2 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to Regulations 12, 17, and 19 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dimensions- 6 Sadler’s Lane is a residential care home which is registered to provide a service for up to four people with learning disabilities. Some people had other associated difficulties such as being on the autistic spectrum. There were three people living in the service on the day of the visit. All accommodation is provided on one floor in a domestic sized dwelling.

At the last inspection, in September 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.

The service remained safe. People’s safety was contributed to by staff who had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff understood how to protect people and who to alert if they had any concerns. General risks and risks to individuals were identified and appropriate action was taken to reduce them.

There were enough staff on duty at all times to meet people’s diverse, individual needs safely. The service had a stable staff team. However, if they did recruit new staff they had systems in place to ensure, 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 were well-trained and able to meet people’s health and well-being needs. They were able to respond effectively to people’s current and changing needs. The service sought advice from and worked with health and other professionals to ensure they met people’s 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.

The service continued to be caring and responsive. The small, committed, attentive and knowledgeable staff team provided care with kindness and respect. Individualised care planning ensured people’s equality and diversity was respected. People were provided with a wide variety of activities, according to their needs, abilities, health and preferences.

The registered manager was on extended leave but remained highly thought of and respected. The interim manager was described as approachable and supportive and there was a team in place to support them. The quality of care the service provided continued to be assessed, reviewed and improved, as necessary.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found.

Is the service safe?

Representatives of people who use the service were complementary about people's safety being maintained by the provider. One representative told us 'They (staff) look after the people and ensure they are kept safe.' People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Personal evacuation plans were in place for each person to ensure their safety in the event of a fire at the service.

The home was secure and care workers had to use a key to enter the home. Visitors were asked for identification before being allowed entry. We found the building was well maintained and suitable for people who use the service. We found corridors and fire exits were free of clutter and easily accessible. Necessary checks of the home were completed to ensure the safety of people who use the service and staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to this type of service. While no applications have needed to be submitted for the people using the service, proper policies and procedures were in place. Relevant staff were trained to understand when an application should be made, and how to submit one.

Since our last inspection on 8 and 9 December 2013 we found actions had been taken by the provider to ensure records for people and staff were accurate and fit for purpose. We saw people's records were stored securely and could be located promptly when requested.

People were protected from the risk of inappropriate or unsafe care. This was because the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to incidents.

Is the service effective?

We spoke with two people and two representatives (one relative and one advocate) of people of people who use the service. They were complimentary about the care received. One person we spoke with said 'I like it here.' It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One relative told us. 'They (staff) understand X's needs.'

Staff had received training to meet the specific needs of the people living at the home. Examples of training included, management of epilepsy and percutaneous endoscopic gastrostomy (PEG) feeding. PEG feeding is a form of tube feeding for people who are unable to or have difficulties in swallowing. People's health and care needs were assessed with them, care to meet these needs was recorded in support plans. Relatives we spoke with told us the support plans reflected their family member's current needs. We noted people's involvement in annual reviews of their care.

Is the service caring?

People were supported by kind and supportive staff. One representative told us 'Staff are pleasant and are very caring. It (this service) is very homely.' All interactions we observed between the staff and people were open, respectful and courteous. We saw that care workers gave encouragement when supporting people. People were able to do things at their own pace and were not rushed. Our observations confirmed this. A representative told us 'the staff have such good interpersonal skills.'

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded in their support plans. Care and support had been provided in accordance with people's wishes for example arranging preferred activities, and holidays.

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

The provider had systems in place to regularly assess and monitor the quality of service that people received. The provider carried out quarterly quality audits of the service. The home manager told us a survey went out to staff, people and their relatives annually. This survey asked people what they thought about the quality of support provided. We saw the outcome of the last survey for 2013-14 was available to people in an accessible format. Records seen by us showed people were complementary about the service and any identified shortfalls were addressed promptly. Relatives we spoke with confirmed they had been listened to and provided examples of improvements made to the service following their feedback. As a result the quality of the service had continued to improve. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. One representative told us 'This service has come on a lot, it has definitely improved.'

We saw that health and social care providers were involved in care and treatment of people who use the service. They had good working relationships with the service making sure people living there received all support needed. Appropriate appointments records were kept in the service for a range of health reviews.

A system of supervision and appraisal was in place to support staff to carry out their work. Staff received appropriate training to enable them to deliver care to people safely and to appropriate standards. Each member of staff was able to monitor their training through an online profile with the manager overseeing this.

There was a process and written procedures, including an easy read version, in place to respond to and resolve complaints. The family members told us they were aware of who to speak to if they had any complaints or concerns.

The provider had a policy for storage, archive and disposal of records. All records relevant to the management of the service were stored securely in the office and easily accessible to staff. However, some health and social care and support records were not always accurate, up to date and fit for purpose.

We observed a clean environment throughout the home. Relatives and advocates told us that the home was always kept clean and tidy.

People were protected from the risk of infection because protocols based on current Department of Health guidelines had been followed. We found there were systems in place to manage and monitor the prevention and control of infection.

We spoke with staff and looked at people's support plans and daily records and found that their needs were assessed. People's care and support was planned and delivered in line with their individual support plans. There were arrangements in place to deal with foreseeable emergencies.

The provider did not have a robust recruitment process in place to ensure that people who use the service were not placed at risk of being cared for by inappropriate staff.

Relatives and advocates felt that they would be comfortable to raise concerns with the manager. The provider had a system for monitoring the quality of service provided. There were processes in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.