Dimensions 21 Searing Way

The inspection took place on 27 February 2018 and was unannounced. Which meant the staff and provider did not know we would be visiting.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Policies, procedures and staff training were in place to protect people from avoidable harm and

abuse. Staff had identified risks to people and these were managed safely. Recruitment

processes were followed to ensure suitable staffing levels and the provider had thorough pre-employment checks in place to determine prospective candidates’ character and skills. This was to ensure staff were suitable to support people with a learning disability. Where agency staff were used the provider ensured people received good consistency and continuity of care by deploying the same staff. Arrangements were in place to receive, record, store and handle medicines safely and securely.

People were cared for by staff who had received appropriate training, support and supervision in their role. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported to eat and drink sufficiently for their needs. Staff supported people to see a range of healthcare professionals in order to maintain good health and wellbeing.

Staff treated people with kindness and compassion, they cared about people. Staff supported

people to make choices about their lives. Staff treated people with respect and upheld their dignity

and human rights when delivering their care.

People had a comprehensive assessment of their support needs and guidelines were produced for staff about how to meet their individual needs and preferences. Support plans were reviewed with people and their families and relevant changes made where needed. Staff encouraged people to be as independent as possible. Activities that were appropriate to each person were offered and encouraged. Processes were in place to enable people to make complaints and these were responded to appropriately.

The service had clear and effective governance in place. The provider encouraged people, their families, staff and professionals to be actively involved in the development and continuous improvement of the home. The provider had robust quality assurance systems which were operated across all levels of the service. Staff had worked effectively in partnership with other agencies to promote positive outcomes for people.

Further information is in the detailed findings below

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. The provider has been made aware of the requirement to have a registered manager for this location and process for deregistering the existing registered manager.

On the day of the inspection five people were living in 21, Searing Way, although one person was on holiday being supported by the locality assistant manager and a volunteer. People who use the service had complex needs and were not able to communicate with us verbally. However, we were able to find out about their experience of the service by observing care and talking with their families and staff. During our inspection we spoke with the locality manager, the assistant locality manager, two lead support workers, five care workers, two agency care workers, a visiting locality manager and a service volunteer. We also spoke with the relatives of four people who use the service.

This is a summary of what we found;

Is the service safe?

We found that the service was not always safe because the provider had not protected people against the risks of receiving unsafe or inappropriate care because they had not reviewed their support plans and risk assessments to reflect changes in their needs.

Relatives of two people told us that their family member's needs had changed, particularly regarding their requirement for two to one support. All staff we spoke with confirmed the care needs of these two people had increased and that more support was required to meet their needs. We found that the provider had not carried out a review of their support plans in response to these increased needs. We examined all of the support plans of people who use the service and found that they had not been updated appropriately in 2013, in accordance with the provider's own policy. This meant that the provider had not ensured that people always received care and support which met their changing needs.

One relative told us, 'Their needs have increased in the last two years so they now need a lot of two to one care when they are moving and more support to encourage them to eat. We have told Dimensions but they think it is the family and social services role to complete needs assessments.'

A care worker told us, 'We have repeatedly told the managers that people's needs have changed and there just aren't enough staff to make sure people are always safe.' We have told the provider to make improvements to ensure that people's care needs are appropriately assessed.

Family and staff told us that there was often insufficient appropriately skilled staff to safely meet the needs of people. Agency staff had been used to cover for staff annual leave and sickness. On the day of our inspection two out of the three care workers had been provided by a care agency. Staff and relatives told us that some agency staff were very good but others did not know what they were doing. Staff told us this increased the pressure upon them because people who use the service had complex needs.

The provider had suitable arrangements in place for obtaining and acting in accordance with the consent of people who use the service. Where people had the capacity to make decisions about their care they had been supported to do so. Staff sought people's verbal permission to provide their care. Where people lacked the capacity to make specific decisions the provider had assessed this and had followed the correct legal processes to make decisions in peoples' best interests.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which apply to services like 21, Searing Way. The locality manager told us they had not needed to apply for any DoLS authorities but they were aware of the process to follow.

Is the service effective?

We found that the provider had an effective system to ensure staff received appropriate learning and development. We reviewed staff records which showed the provider supported staff with an effective system of training, supervision and appraisal. However, there were occasions when we found the service was not always effective. For example, in responding to recorded feedback from staff in relation to the increased needs of people and the requirement to address the staffing levels accordingly.

We found that the service had effectively managed people's nutritional and hydration requirements and where necessary people had assessments and plans completed by a dietician.

Is the service caring?

People were supported by kind and compassionate staff, who spoke with people in a caring manner. We saw that care workers gave encouragement to people who were able to do things at their own pace. A person's relative told us, 'The staff are wonderful and are always willing to go the extra mile. If it wasn't for them I'd be really worried because there isn't enough staff.' We spoke with a volunteer who had recently retired from the service. They told us, 'The people have been such a large part of my life that I will always do what I can to help out.' We noted that the volunteer provided support on every week day for about five hours. Another relative told us about the key worker of their family member. 'You can see they genuinely care and all the people respond to her.'

Is the service responsive?

We found the service was not always responsive. A relative told us their family member's care needs had increased 18 months ago. Despite raising concerns with the provider no further needs assessment or review of the staffing analysis had been completed by the provider.

Is the service well-led?

We found that the service was not always well-led. The registered manager left the service in November 2013 and there had been two temporary managers until the locality manager had been appointed in April 2014. A relative of one person told us, 'Dimensions keep restructuring and they keep diluting and diluting and diluting so the manager is never there. Sometimes it feels completely rudderless.' Another relative praised the assistant locality manager. They told us, 'Bless them. They are run ragged because they have got too much on their plate. They have to manage Searings Way and two other services and two other people in supported living.' A care worker told us that 'This service hasn't been managed properly since they gave the manager two services to run, and now they got three.'

The care plans were detailed and gave staff information on how best to offer support to each person living in the house. Independence and community involvement were encouraged through participation in activities.

There were suitable processes in place to ensure the safe storage and administration of medication.

The recruitment process ensured that staff were suitable, skilled, qualified and experienced.

There was a complaints policy readily available in a variety of formats. Making a complaint or raising a concern was discussed regularly with the people living in the home and their families.

Each person had a detailed support plan which they had been involved in writing. The plans contained detailed information which informed staff on how best to support them.

All staff had completed their training. We spoke with three staff and the manager and they all told us that they felt supported. They said that they were confident they could raise any issue and that it would be dealt with. All staff members had completed safeguarding training and those we spoke with were able to demonstrate a good understanding of abuse issues.

The manager regularly reviewed all aspects of the home and where improvements were required an action plan was completed and followed through.