Background to this inspection
Updated
9 December 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 the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency and is registered to provide personal care to people living in their own houses or flats. This service also provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. At the time of inspection, one person was receiving support with personal care. Person’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at person’s personal care and support.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 48 hours’ notice of the inspection to be sure that the registered manager would be in the office to support the inspection. Inspection activity started on 21 September 2022 and ended on 22 September 2022. We visited the location’s office on 22 September 2022.
What we did before the inspection
Prior to the inspection we looked at all the information we had collected about the service including notifications the provider had sent us. A notification is information about important events which the service is required to tell us about by law. We looked at the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We checked information gathered as part of monitoring activity that took place on 9 August 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection. We also visited the supported living service, spoke to the person and observed how staff interacted and supported the person using the service.
During the inspection
We spoke with the registered manager and the operations manager. We reviewed a range of records including person's care and support plans and other associated records. We also looked at a variety of records relating to the management of the service, including quality assurance, incidents and accidents, and some policies and procedures.
After the inspection
We contacted seven staff and spoke to three staff team members. We looked at further information such as training data, recruitment, incidents/accidents, further records of care and support, policies and other service management records sent to us after the inspection. We sought feedback from the local authority and professionals who work with the service and received one response.
Updated
9 December 2022
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
About the service
Dimensions Berkshire & Hampshire Domiciliary Care Office is a domiciliary care agency providing personal care to people in their own homes. This service provides care and support to people living in a number of 'supported living' settings, so that they can live as independently as possible. The service provides support to older people, younger adults and people with a learning disability and associated needs. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of inspection, one person was receiving support with personal care.
People’s experience of using this service and what we found
Right Support:
¿ The registered manager did not use safe recruitment procedures to employ staff. There was a risk the person could be supported by unsuitable staff putting them at higher risk of harm.
¿ Staff supported the person with their medicines in a way that promoted their independence. However, other aspects of medicine management such as record keeping and checks needed improvement.
¿ The person had a choice about their living environment and were able to personalise their rooms. The person invited us to view their room and showed us how they sorted their rooms.
¿ The service and staff supported the person to have the maximum possible choice, control and independence, over their own lives.
¿ Staff focused on person’s strengths and promoted what they could do, so the person had a fulfilling and meaningful everyday life.
¿ The person were supported by staff to take part in activities and pursue their interests in their local area and achieve their aspirations and goals.
¿ The service worked with the person to plan for when they experienced periods of distress or anxiety and supported them to overcome it.
¿ The service made reasonable adjustments for the person so they could be fully involved in discussions about how they received support, including support to travel wherever they needed to go.
¿ Staff supported the person to make decisions following best practice in decision-making. Staff communicated with the person in ways that met their needs.
¿ Staff supported the person to play an active role in maintaining their own health and wellbeing and access specialist health and social care support in the community.
¿ We judged the person was 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. However, the policies and systems in the service had to be improved to continue supporting this practice.
Right Care:
¿ Person’s care, treatment and support plans did not always reflect their range of needs and support so staff could promote their wellbeing and enjoyment of life.
¿ The service did not always have enough appropriately skilled staff to meet person’s needs and keep them safe following best practice guidance.
¿ The registered manager assessed and reviewed risk assessments and actions of mitigation with staff’s support. They worked with the person to help them review and assess risks they might face.
¿ Person could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. Staff spoke to the person politely giving them time to respond and express their wishes.
¿ Person received care that supported their needs, aspirations and was focused on their quality of life.
¿ Staff promoted equality and diversity in their support for the person. They understood person’s cultural needs and provided culturally appropriate care.
¿ Person received kind and compassionate care. Staff protected and respected person’s privacy and dignity. They understood and responded to their individual needs.
¿ Staff understood how to protect person’s 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.
¿ Person had opportunities to try new activities that enhanced and enriched their lives.
Right Culture:
¿ The registered manager did not always follow their quality assurance policy effectively so they could assess, monitor and mitigate any risks relating to the health, safety and welfare of the person using services, the service and others.
¿ The registered manager did not consistently maintain accurate and complete records relating to person’s care and service management.
¿ Person was able to lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.
¿ Staff knew and understood the person well and were responsive, supporting their aspirations to live a quality life of their choosing.
¿ Staff turnover was low, which supported the person to receive consistent care from staff who knew them well.
¿ Staff placed person’s wishes, needs and rights at the heart of everything they did.
¿ The person and those important to them were involved in planning and reviewing of their care.
¿ The person was supported by staff who understood their different range of needs or sensitivities. This meant the person received compassionate and empowering care that was tailored to their needs.
¿ The service enabled the person and those important to them to work with staff to develop the service. Staff valued and acted upon person’s views.
¿ Staff and the service ensured risks of a closed culture were minimised so that the person received support based on transparency, respect and inclusivity.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.
Rating at last inspection
This service was registered with us on 1 December 2020 and this is the first inspection.
Why we inspected
This inspection was based on the information we held about this service. The service has not been inspected since their registration.
Enforcement and Recommendations
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 quality assurance, risk management, record keeping, management of medicine, staff training and competence and recruitment. We have made a recommendation about meeting the Accessible Information Standard.
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.