Dimensions 27 Sampson Avenue

About the service

Dimensions 27 Sampson Avenue is a residential care home providing personal care to 6 people at the time of the inspection. People’s needs were varied and included people with a learning disability, autistic people, and people with physical disabilities. The service can support a maximum number of 6 people.

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

Right Support:

We found concerns around infection control. Some parts of the service were poorly maintained and unhygienic.

Staff supported people to take their medicines as prescribed. However, we found shortfalls around some aspects of the management of medicines.

Staff supported people to make decisions following best practice in decision-making.

Staff enabled people to access specialist health and social care support in the community.

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.

Right Care:

Staff assessed and reduced risks to people’s health, care and safety.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People’s care and support plans reflected their range of needs and this promoted their wellbeing, and equality and diversity.

Right Culture:

The service’s quality improvement processes needed to improve as they failed to identify the issues we found at this inspection. The service had also failed to act on certain areas of concern, which were identified at the previous inspection.

People received good quality care and support because staff were trained and people had access to specialist support when needed. Staff knew and understood people well and were responsive to their needs.

The service enabled people and those important to them to work with staff to develop the service.

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 19 September 2018).

Why we inspected

This focused inspection was prompted by a review of the information we held about this service. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dimensions 27 Sampson Avenue on our website at www.cqc.org.uk.

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.

Enforcement and recommendations

We have identified breaches in relation to premises and equipment, and good governance at this inspection.

We have made a recommendation about some aspects of the management of medicines.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The service is registered to provide accommodation and personal care for up to six people. There were five people using the service at the start of this inspection. The service specialises in the care and support of people with learning and physical disabilities. It is operated by a national care provider.

The service has a registered manager, which 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.

This was an unannounced comprehensive inspection, to make sure the service was providing care that is safe, caring, effective, responsive to people's needs, and well-led. It was the first time the service has been inspected under our ratings inspection process, having been dormant for a period until people moved into the service in the summer of 2017.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At this inspection we found the service was not consistently safe. Equipment and premises were not consistently checked to ensure environment safety risks were addressed. We had to remind the service that a professional check of the electric wiring was a few months out-of-date. Staff checks of some safety matters including wheelchairs, emergency lighting and first aid boxes had not recently occurred, and the last fire drill had not been documented.

Training on the prevention of choking was not complete for all permanent staff, despite some people using the service being identified as at risk of choking. Systems to check agency staff had received this training had not been followed.

We identified a few infection control risks during the inspection visit. Comprehensive infection control audits were not occurring, to help identify and eliminate poor practices.

We found the decoration of some communal areas of the building to be worn or incomplete. The dining room was not adapted for people in wheelchairs to use easily. The main fridge-freezer had been faulty for over six weeks without remedy.

The registered manager sent us updates and action plans on the above concerns shortly after our visit. This helped to reduce the seriousness of our findings.

There had been good work at the service this year to identify and meet some people’s increasing care needs. There was effective co-operative working with community professionals in support of meeting people’s health needs. Staffing levels had been increased where needed. Equipment such as more suitable wheelchairs had been acquired where appropriate.

Feedback from people, their relatives, visitors and community professionals was highly positive on how staff treated people. Staff interacted well with people regardless of some people’s complex communication needs. There were established systems of providing people with personal care support where needed. People were encouraged to make choices where possible and their consent for care was sought in line with legislation.

People were treated as distinct individuals at the service, with care and support being offered accordingly. Staff supported people to follow their interests, have appropriate mental and physical stimulation, and maintain relationships that mattered to them.

The service supported people to eat and drink enough, maintain a balanced diet and be offered their medicines as prescribed.

Systems, processes and practices safeguarded people from abuse and made sure that ongoing learning took place when things went wrong.

The service promoted a positive and inclusive culture that achieved many good outcomes for people. Staff felt supported by the management team who displayed good competency and appropriate values for their roles.

The provider had a clear vision and credible strategy to deliver high-quality care and support. It engaged with and involved stakeholders in the development of the service. Systems at the service were designed to enable sustainability and support continuous learning and improvement.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff were caring and respectful and we saw that, people being supported by them, responded positively. For example, we saw people responding to staff in a positive manner whilst they were preparing lunch.

There were appropriate arrangements in place to manage medicines safely. We saw that staff with responsibility for administering medication were qualified to do so. However, medication audits were infrequent and we noted several gaps in recording.

People were supported to access other health and social care services they needed, including a speech and language therapist for people with special dietary requirements for thickened drinks and pureed food.

Systems were in place to gather information about the quality of the service. Relatives confirmed that the service asked their views about the quality of care provided by staff.

People were treated with dignity and respect. At the time of our visit we saw that staff were around to ensure that people were safe and received support that met their needs. People using the service were encouraged to make choices regarding their food and drink and where they wanted to sit. People appeared appropriately dressed and well cared for. This ensured people using the service were treated with respect and their rights upheld.

Systems were in place to ensure that people were protected from abuse and that they received the care they needed. There were systems in place to monitor medication and staff training.