Background to this inspection
Updated
11 May 2019
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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection was prompted in part by a range of concerns or risks we had received in relation to the support people were receiving. This inspection examined those concerns and risks to make sure people were safe. The concerns we had received were not substantiated during this inspection.
Inspection team:
This inspection was carried out by two inspectors for three days. An inspection manager attended the focus group with parents on the last day.
Service and service type:
Dimensions Somerset Taunton Domiciliary Care Office is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older and younger disabled adults including people on the autistic spectrum.
This service provides care and support to people living in 10 different ‘supported living’ settings, so that they can live in their own home as independently as possible. Many of the people using the service required up to 24-hour support from staff due to their disabilities. 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. During the inspection we visited all 10 supported living settings.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.’
Notice of inspection:
We gave the service 48 hours’ notice of the inspection visit because we needed the registered manager to arrange for us to have consent to visit people in their own homes. We also requested the registered manager to arrange an invitation for relatives who wanted to attend a focus group on the final day of the inspection.
Inspection site visit activity started on 12 March 2019 and ended on 18 March 2019. We visited the office location on 12 and 18 March 2019 to see the registered manager.
What we did:
The provider had not completed a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. During the inspection we covered the information which would have been contained within the PIR. We looked at other information we held about the service and provider before the inspection visit. We also contacted health and social care professionals who were in regular contact with the service.
We spoke with 20 people who used the service and had more informal interactions with five people who had limited verbal communication. We carried out observations during visits to each of the supported living settings. During the inspection we spoke with one relative on the telephone. On the last day of inspection, we held a focus group which 11 relatives attended.
We spoke with the registered manager, performance coach and 23 members of staff including locality managers and care staff.
We looked at 12 people’s care records in various depths. We observed care and support in communal areas. We looked at staff files, information received from the provider, staff rotas, quality assurance audits, staff training records, the complaints and compliments system and medication records.
Following the inspection, we asked for further information. We received all the information in the timescales given and the information has been included in this report.
Updated
11 May 2019
About the service: Dimensions Somerset Taunton Domiciliary Care Office is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older and younger disabled adults including people on the autistic spectrum. Many of the people using the services have limited verbal communication.
This service provides care and support to 65 people living in 10 different ‘supported living’ settings, so that they can live in their own home as independently as possible. Many of the people using the service required up to 24-hour support from staff due to their disabilities. 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.
The provider was aware of their responsibilities of developing care and support 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’s experience of using this service:
The majority of people were happy and relatives told us their family member was safe. The management were proactive and responsive to anything we found during the inspection to maintain people’s safety. Medicines were managed safely, although the storage of medicines in fridges could be improved. Risks to people had been identified with ways to mitigate them. Systems were in place to manage the levels of people’s anxiety to reduce the likelihood of behaviours which could challenge themselves or others. People were protected from the spread of infection.
The provider and management had completed a range of audits to identify concerns and issues at the service. When these had identified issues, action had been taken to resolve them. They had strong values of improving the support people received. Systems were being put in place to involve people and their families to be part of the improvement discussions.
People and staff felt there were enough staff, although some relatives thought there could be more staff to increase community opportunities. Staff had received a range of training considered mandatory by the provider. In addition, staff had received a range of specialist training to meet people’s needs. There were occasions specific training had not been identified because of changes in the management of a specific supported living setting. Actions to resolve this were taken during the inspection.
Many people using the service lacked capacity to make specific decisions and there were appropriate systems in place to make them. People were involved in making choices about their day to day care and these were respected by staff. Relatives were actively encouraged to be involved in the decisions when people were unable to make choices for themselves.
People had care plans which were personalised and provided a wealth of information for staff to use to support their needs and wishes. There were some inconsistencies about how frequently people had their care needs reviewed. There were good links with other health and social care professionals.
People were supported by kind and caring staff who knew them incredibly well. Staff respected people’s privacy and dignity throughout the inspection. People’s individual culture wishes were valued and facilitated by staff. Links had been developed with the community.
More information about the detailed findings can be found below.
Rating at last inspection:
At the last inspection, published on 6 June 2018, this service was rated good.
Why we inspected:
This inspection was brought forward due to information of risk or concern we had received.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk