Dimensions Somerset Northmead House

Updated 17 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 11 and 13 July 2018 and was unannounced. One adult social care inspector and one medicine Inspector carried out the inspection.

We reviewed the Provider Information Record (PIR) before the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well, and the improvements they plan to make. We also looked at notifications sent in by the service. A notification is information about important events, which the service is required to tell us about by law.

During our inspection, we met with six people who used the service, the registered manager, one support lead and four support workers. Some people who used the service were unable to communicate verbally and therefore we observed their interaction with staff and spoke with four family members who were closely involved in people’s care and support. We also contacted five professionals requesting feedback about the service delivered at Northmead House. One professional responded to our request.

We looked at records relevant to the management of the service. This included five care plans, risk assessments, staff recruitment files, training records, medicine records, complaint and incident reports and performance monitoring reports.

Updated 17 August 2018

This inspection took place on 11 and 13 July 2018 and was un-announced. This is the first inspection of this service since it was transferred to Dimensions from the local authority in April 2017.

Dimensions Somerset ¿Sev Limited, is part of a national not for profit organisation providing services for people with ¿learning disabilities, autism and complex needs. Northmead House provides respite (short stay) accommodation and personal care to a maximum of 10 people with a learning disability. At the time of inspection there were ten people living at the service. Three people were being accommodated for a longer period to allow for a transition to an appropriate service that could meet the people's longer-term needs.

The people we met on the day of the inspection had complex physical and learning disabilities. Some of the people we met could verbally communicate with us and others were not. To capture the opinions of people who could not communicate directly with us, we observed peoples, interactions with staff and their reactions. We also spoke to people’s relatives to help us form a judgement.

The 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

The provider's recruitment processes had not fully minimised the risk of employing unsuitable staff at the time of the inspection. This was discussed with the registered manager who demonstrated they had recently applied for all staff to have an updated Disclosure Barring Service (DBS) check and were waiting for the applications to be processed. However, the service was sufficiently staffed.

At the time of the inspection there was a registered manager in place. The manager had been registered with CQC since April 2017. 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 building had a range of aids and adaptations in place to assist people who had mobility difficulties. All bedrooms were for single occupancy. The service is staffed 24 hours a day and all areas are accessible to wheelchair users.

People told us or indicated they felt safe living at Northmead House. One relative we spoke with said, “(Persons name) wants to go there for a start, that’s more than half the battle.” They added, “If they didn’t want to go there, they wouldn’t.”

The service had effective safeguarding systems, and managed safeguarding concerns promptly. The registered manager and staff understood their responsibilities to raise concerns and report these internally and externally. The provider had a proactive approach to anticipating and managing risks to people’s health and safety. People received their medicines as prescribed. The service was clear about its responsibilities and role in relation to medicines.

The provider managed the control and prevention of infection well. Staff had access to, and followed, policies and procedures on infection control that met current and relevant national guidance.

Staff understood their responsibilities to raise concerns and report incidents and accidents. People knew how to complain and staff had given information about advocacy support to help people in the event they needed their voice heard.

People received effective care and support from competent and well-trained staff. When restrictive practices had been identified, such has having bed rails or straps on their wheel chairs, there were risk assessments and guidance in place to protect people.

People we spoke with told us staff always asked their consent when carrying out personal care However, records showed consent to care and treatment was not always sought in line with legislation and guidance. For example, best interest decisions for people who could not communicate did not demonstrate how people and their relatives had been involved.

All staff we spoke with could tell us how to protect people’s dignity when supporting people with personal care but staff did not always protect people’s privacy. During the inspection, we observed care records in an unsecured room. We discussed this with the manager who took immediate action. Staff respected people’s religious and cultural differences.

There was a management team with clear roles and ¿responsibilities. Staff spoke highly about the registered manager. There were effective quality assurance arrangements at the service to raise standards and drive improvements. The registered manager completed regular audits to ensure quality in all areas of the service were checked, maintained, and where necessary improved. The registered manager and provider promoted the ethos of honesty, learned from mistakes and admitted when things had gone wrong. Staff worked in partnership with other health and social care professionals.

The provider had notified the Care Quality Commission (CQC) of significant events in line with current legislation. This meant external agencies could monitor the care and safety of people using the service.