Dimensions Midlands Domiciliary Care Office

Dimensions Midlands Domiciliary Care Office is registered to provide personal care services to people in their own homes or in supported living settings. At the time of inspection 37 people were receiving the regulated activity. Most people lived in their own property with a small number sharing with other people or living with their families.

People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

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.

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

Improvements were needed to the providers governance of infection prevention and control and monitoring of care records. Although managers confirmed checks were in place there were no records of what had been checked and any issues identified. This increased the risk of people receiving inconsistent care. People told us they felt safe and were able to approach managers with any concerns.

Checks on medication were in place, however we did find some gaps in recording of prescribed creams. Staff had received training in relation to infection control, but some staff were not aware of the correct order to don and doff PPE.

Staff received training in safeguarding and knew how to recognise and report signs of abuse. The service ensured accidents and incidents were recorded and reviewed to improve care and lessons learned were shared across the service.

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.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People told us how they were supported to make choices about their care and where they lived. Care was person centred and individualised to each person.

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 03 September 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of fire risks. This inspection examined those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

Planning and promoting person-centred, high-quality care and support; and how the provider understands and acts on duty of candour responsibility

• We saw the provider had submitted notifications since the last inspection. This meant we could see how the provider had reacted to any incidents or concerns and how people were supported.

• People told us they were happy with the service received. One person told us, “I am happy to use the service, I would recommend it to others.” A relative told us, “Dimensions are marvellous.”

Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements

• We found systems and processes to monitor the quality and safety of the service were in place and regular audits were carried out. These included, but were not limited to care plans, medicine and environment. We were told how there were also checks carried out in conjunction with family members of people using the service. As part of a specific audit they visited a premises and spoke with people about their thoughts on the service. We saw that actions were taken in response to this, an example being, where a person shared they were unhappy with a particular staff member, this was addressed. The registered manager told us how they were able to identify patterns and trends from the information audited.

• We found the previous CQC inspection rating was displayed on the provider’s website as is required and in the office setting.

• People using the service told us they were familiar with the registered manager. One person said, “[Registered manager’s name] is fantastic, he will call and ask if I want to go to the pub for a drink to get me out of the house, I enjoy it when we go out, I can talk to him and tell him how I am feeling.” A second person said, “I know the manager, I think he is alright.” A relative told us, “Good management, no worries I am very satisfied they go that extra mile.”

• We found staff were supported by the registered manager and the provider and one staff member told us, “The service is well led, we get support from managers.

• A professional we spoke with told us, “Since the new manager has come in, things have settled and at this moment in time, I have no concerns with the service”. The professional shared that the registered manager appeared to be ‘more proactive in doing things with people than the last manager.”

Engaging and involving people using the service, the public and staff, fully considering their equality characteristics

• We found feedback was taken from people in relation to the registered manager’s annual appraisal. The overall effectiveness of the service was considered and staff told us this information was fed back to people verbally.

• We saw residents meetings occurred, but these were carried out over multiple sites and it was down to individual managers and team leaders as to when these took place. One person told us, “We have meetings and talk about how things are going, you don’t have to go, I choose if I want to.”

• Team meetings for staff also occurred in individual settings. One staff member told us, “We have team meeting every month. We can speak up and are listened to. A second staff member said, “We have team meetings on site. We have discussions around how we can make things better and I suggested the communication policy and managers are now looking at my idea.”

Continuous learning and improving care

• The registered manager told us how they were always learning from people’s changing needs and would continue to improve as much as possible.

Working in partnership with others

• The registered manager told us of how they worked with professionals to share required information to ensure people’s wellbeing and we saw contact with professionals was recorded, for example where people received specific healthcare or support with behavioural issues.

Dimensions is registered to provide personal care to people who live in their own homes. On the day of our inspection 20 people were using the service.

This was the first rating of the service since it was registered on 07 July 2015.

The service had a registered manager. 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 registered manager was available on the day of the inspection.

People using the service felt safe. Care staff were aware of the processes they should follow to minimise risk to people. Systems were in place to protect people from the risk of harm and abuse. Care staffing levels and skill mix ensured that people’s needs would be met.

Care staff had the skills and knowledge required to support people effectively. Care staff received an induction prior to them working for the service and they felt prepared to do their job. Care staff could access on-going training and regular supervision to assist them in their role. Care staff knew how to support people in line with the Mental Capacity Act 2005 and gained their consent before assisting or supporting them. Care staff assisted people to access food and drink.

Where possible people were involved in making their own decisions about their care and their specific needs. Care staff provided dignified care and showed respect to people. People were encouraged to retain their independence with care staff there ready to support them if they needed help.

Care staff understood people’s needs and provided specific care. People’s preferences had been noted and acted upon where possible. People knew how to raise complaints or concerns and felt that they would be listened to and the appropriate action would be taken.

People were happy with the service they received and felt the service was led in an appropriate way. Quality assurance audits were in place to provide an awareness of any patterns or trends, which may develop and impact upon the service provided to people. We received notifications of accidents or incidents that had occurred.