Dimensions Somerset Greengates

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.

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.

Dimensions Somerset Greengates accommodates up to seven people with learning disabilities, including autism. At the time of the inspection there were five people living at the home. Most of the people were unable to communicate verbally with us. Their opinions were captured through observations, interactions they had with staff and their reactions. People had their own bedrooms and there were shared bathrooms. Within the home there were communal spaces including two living rooms and a kitchen. There was a garden people were free to access throughout the day.

"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”. Registering the Right Support CQC policy.

At the time of the inspection there was a registered manager in post. 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.

Although people and their relatives told us they were safe, we found there could be improvements to keep people safe in the event of a fire. Staff knew how to prevent the spread of infection and people’s medicine was managed safely. Health and safety checks such as testing the water for a specific disease were regularly completed to keep people safe.

People told us they were happy and others appeared comfortable in the presence of staff. Those able to tell us and one relative told us they were kept safe. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others.

The management had developed positive relationships with people, their families and other professionals. There were enough staff to keep people safe including using regular agency staff. Staff had received a range of training to meet most of the people’s needs. Recruitment systems were in place to reduce the risk of inappropriate staff working at the home.

People were protected from potential abuse because staff understood how to recognise signs of abuse and knew who to report it to. When there had been accidents or incidents systems were in place to demonstrate lessons learnt and how improvements were made. People had their healthcare needs met and staff supported them to see other health and social care professionals. When changes were identified to manage health needs staff liaised with health professionals.

People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible. There was clear guidance to inform staff how people would give their consent. When people lacked capacity, decisions had been made on their behalf following current legislation. People were supported to eat a healthy, balanced diet and had choices about what they ate. Specialist diets were understood and staff had enough guidance to support people.

Care and support was personalised to each person which ensured they could make choices about their day to day lives. Care plans contained information about people’s needs and wishes and staff were aware of them. These were updated in line with people’s changing needs. People were listened to when they were upset and knew how to complain. There was a system in place to manage complaints.

People and relatives told us they liked the staff. We observed staff were kind and patient. People’s privacy and dignity was respected by staff. Their cultural or religious needs were valued. People, or their representatives, were involved in decisions about the care and support they received.

The service was well led and most shortfalls identified during the inspection had been identified by the management. There was a proactive approach from the management and provider to driving improvements in the home. The provider had completed statutory notifications in line with legislation to inform external agencies of significant events.