Dimensions Somerset Newholme

Dimensions Somerset Newholme is a residential care home registered to provide personal care to up to eight people. At the time of the inspection there were seven people living at the home. The home specialises in the care of people who have a learning disability and/or autism. People living at the home also have complex physical healthcare needs.

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.

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

Right Support:

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. However, records relating to capacity assessments were not regularly reviewed.

Most staff told us there were enough staff to meet people's needs, although this included a high use of agency staff. Staffing levels were based on the needs of the people living at the service. We observed safe staffing levels throughout the inspection and staff appeared unhurried and responsive to people. Safe recruitment processes were in place.

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that has recently been decorated to take into account people’s sensory needs. The premises were homely, and people's bedrooms were personalised.

People were supported to maintain their health and wellbeing. Staff enabled people to access specialist health and social care support in the community.

Right Care:

Care records were under review at the time of the inspection and we identified areas where improvements were required to ensure safe consistent care was provided.

Staff were not always trained appropriately to support people.

People received their medicines in line with their preferences by staff who knew people well. Staff mostly followed systems and processes to safely administer medicines, however improvements were needed to ensure medicines were stored safely.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People could communicate with staff because staff supported them consistently and understood their individual communication needs.

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.

Right Culture:

The ethos, values, attitudes and behaviours of the management and staff provided support in the way each person preferred and enabled them to make meaningful choices. People had care plans in place. However, these had not always been reviewed or updated. The registered manager was prioritising updating records.

Staff and the management team at the service spoke positively about people within the service and wanted people to live their best lives. Staff demonstrated their knowledge of people and how to support them to manage their individual risks. 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.

People’s quality of life was enhanced by the service’s culture of improvement 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 requires improvement (published 24 June 2021)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 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 identified a breach in relation to the management of the service, and have made recommendations in relation to consent and the management of medication.

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.

Dimensions Somerset Newholme is a residential care home registered to provide personal care to up to eight people. At the time of the inspection there were seven people living at the home. The home specialises in the care of people who have a learning disability and/or autism. People living at the home also have complex physical healthcare needs.

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

People lived in a home where improvements had been made to promote the safety of the premises and the care they received. There were systems in place to identify, monitor and minimise risks to them.

There had been several changes to the management of the home which had led to poor morale and confusion for staff. However, all staff spoken with said this had improved greatly in the past few months which was leading to a calmer environment for people to live in. Further management changes were taking place at the time of the inspection.

Where shortfalls in the service had been identified action was being taken to improve the care and support people received. This included further training for staff and improvements to the décor.

People were cared for by staff who were kind and caring. People looked relaxed and happy with the staff supporting them.

Staff were practicing good infection prevention and control practices to keep people safe.

People had their needs assessed and they, and/or their representatives, were involved in planning their care.

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.

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.

Right Support

People lived in a house in a residential area. They had access to transport to enable them to access community facilities according to their interests and preferences.

Right Care

People were receiving care that met their individual needs and they had opportunities to take part in activities according to their abilities and needs.

Right Culture

The management in the home were committed to continuous improvement to make sure people received good quality person centred care.

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 requires improvement (published March 2019). The provider was in breach of one regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to staffing and the care of people who lived at the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 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.

The overall rating for the service has not changed from 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 well led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dimensions Somerset Newholme 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.

Dimensions Somerset Newholme is a residential care home for people with learning disabilities and/or autism that was providing personal care for up to eight people. At the time of inspection there were eight people living at the home. Most people had a range of complex needs and most had limited verbal communication.

People’s experience of using this service:

This 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.

Although people were happy and relatives told us their family member was safe we found people were not always being kept safe. Systems to reduce the risk to people in the event of a fire were not consistently being used. Medicines were not being audited and some management of medicines was not in line with best practice. Not all risks had been identified or ways to mitigate them put in place.

Most people in the service lacked capacity to make specific decisions and there were systems in place to make them. However, when people were deprived of their liberty systems were not in place to ensure it was lawful. People were involved in making choices about their day to day care and these were respected by staff.

The provider had completed a range of audits to identify concerns and issues at the service. However, there had been a large amount of recent changes in staffing and management. This meant the improvement plan in place was still being worked through. Staff were starting to feel supported by the new manager.

People had care plans which were personalised and provided a range of information for staff to use to support their needs and wishes. There were good links with other health and social care professionals. Staffing levels had been an issue due to all the changes occuring. Staff and the provider had worked hard to prevent impact to the people.

People were supported by kind and caring staff who knew them incredibly well. Staff respected people’s privacy and dignity throughout the inspection.

More information about the detailed findings can be found below.

Rating at last inspection:

This is the first inspection for this service since it changed providers.

Why we inspected:

This was a planned inspection based on the service’s new registration.

Enforcement:

We have made a recommendation about staff training in line with people’s assessments.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around safe care and treatment.

Details of action we have asked the provider to take can be found at the end of this report.

Follow up:

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