Dimensions 6 Sadlers Lane

Updated 4 February 2022

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 two domains and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Dimensions 6 Sadlers Lane 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

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 since the last inspection about the service including previous inspection reports and notifications the 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. We used all of this information to plan our inspection.

During the inspection

We spoke to the registered manager. We observed interactions between staff and people living at the service and spoke to one person who use the service. We reviewed a range of records relating to the management of the service, for example, records of medicine management, risk assessments, accidents and incidents; quality assurance system; and maintenance records. We looked at people's assessments and associated records.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at further records and evidence including quality assurance records, training data, and policies and procedures. We gathered feedback from four staff members. We spoke with two relatives and two advocates about their experience of the care provided. We contacted 10 professionals who work with the service and received two responses.

Updated 4 February 2022

About the service

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.