Background to this inspection
Updated
11 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 the overall quality of the service 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
Two inspectors, a member of the CQC medicines team and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Dimensions Somerset Greengates 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 who was registering with the Care Quality Commission. This means that, when registered, they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. Following the inspection, the manager was registered by CQC.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we have received about the service since the last inspection. We sought feedback from the local authority. 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 are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff. In this report, we used this communication tool with two people to tell us their experience.
We spoke with another person who used the service and four relatives on the telephone about their experiences of the care provided. We also carried out multiple observations throughout the inspection to capture peoples’ experiences.
We spoke with 10 members of staff including the manager and a representative of the provider. We reviewed a range of records. This included three people’s care records and medication records. We looked at staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
11 February 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
Dimension Somerset Greengates is a residential care home providing personal care for up to seven people with learning disabilities and/or autism. At the time of the inspection there were four people living at the service. People were not always able to verbally communicate with us, so observations and alternative methods were used. At the time of the inspection the home was going through a refurbishment.
People’s experience of using this service and what we found
Right Support
¿ Staff supported people to make decisions following best practice in decision-making. Staff understood people’s current communication methods because they knew them well. However, further exploration on communication strategies was planned.
¿ The service supported people to have as much choice, control and independence over their own lives, as possible.
¿ People had a choice about their living environment and were able to personalise their rooms.
¿ Staff enabled people to access specialist health services and social care support in the community.
¿ Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.
¿ Staff supported people to play an active role in maintaining their own health and wellbeing.
Right Care
¿ People received kind and compassionate care.
¿ 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.
¿ The service had enough appropriately skilled staff to meet people’s needs and keep them safe. However, there were occasions when staffing had not considered people’s quality of life needs.
¿ People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. There were occasions of contradictions and actions were in place to rectify care plans.
¿ Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.
¿ People were protected from infections spreading including during the recent COVID-19 pandemic. Relatives comments included, “All the staff wear gloves and aprons and they make you take a test too. They seem to be very vigilant in that area” and, “They [staff] are very strict on gloves and masks. They always wear them, even when we meet outside.”
Right culture
¿ People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.
¿ People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes.
¿ Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.
¿ Staff placed people’s wishes, needs and rights at the heart of everything they did.
¿ Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.
¿ The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.
¿ People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.
¿ Staff ensured risks of a closed culture were minimised so that people 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
The last rating for this service was good (published 24 August 2018).
Why we inspected
We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. However, the inspection also was prompted in part due to concerns about management and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. A decision was made for us to inspect and examine those risks. 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. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well led sections of this full report.
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.
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.