Dimensions Somerset The Saplings

Updated 1 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

This inspection was carried about by one inspector, a member of the medicine team and an Expert by Experience to make phone calls to relatives. 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 The Saplings 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.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we have received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

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 or relatives and the person themselves. In this report, we used this communication tool with two people to tell us their experience. We also carried out multiple observations throughout the inspection to capture peoples’ experiences.

We spoke with eight members of staff including a provider’s representative, the manager, assistant manager and support staff. One health and social care professional was spoken with on site. Some of these were through video calls. We spoke with four relatives on the phone. We reviewed a range of records some on site and some virtually. We looked at four people’s care records and multiple medicine records. 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 information, rotas and quality assurance records. We spoke with two health professionals and one member of staff on the telephone.

Updated 1 February 2022

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 guidance CQC follows to make assessments and judgements about services supporting people with a learning disability or autistic people

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

Systems were not always in place to protect people from the risk of infection spreading. Staff did not always use personal protective equipment (PPE) such as aprons, gloves and masks safely or follow government guidance. People were not always kept safe as there were not always enough staff deployed effectively to meet people’s needs. Risks to people had not always been recognised or guidance provided.

People’s needs and their quality of life did not always form the basis of the culture at the service. Although staff were kind and caring, they did not always put people at the centre of their care. For example, staff levels and guidance were not always facilitating people to stay safe and meet all their needs. People were living in a service where there had been positive changes. For example, the current manager was promoting an open, transparent culture. Relatives of people felt they were kept informed of anything which happened. However, it was not clear whether these improvements were sustainable.

The provider had a culture of people receiving “active support” placing the person at the centre of their care. Leadership of the service had not always been consistent which meant improvements were required. However, examples were seen where staff made blanket decisions such as everyone having the same evening meal. Communication systems were not always empowering people to express their needs and wishes. Mixed opinions were heard from staff about how valued they felt.

¿ People were not always supported by enough appropriately skilled staff to meet their needs and keep them safe. Staff knew how to protect people from abuse and who to raise concerns to.

¿ People had opportunities for positive risk taking. People were starting to be involved in managing their own risks whenever possible. However, people’s existing risks were not always assessed regularly.

¿ People’s care and support was provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met their sensory and physical needs.

¿ People were starting to be supported to be independent and have control over their own lives. Their human rights were being considered and this was led by a new manager.

¿ People received kind and compassionate care from staff who protected and respected their privacy and dignity. Staff members understood most of people’s needs. However, people were not always having their communication needs met and information shared in a way that could be understood.

¿ People who could become distressed and upset resulting in behaviours towards others had proactive plans in place. However, these were not readily accessible to all staff working with them. Systems were in place to report and learn from any incidents although action could be delayed.

¿ People had opportunities to make choices with the limited communication strategies in place. They took part in activities which were part of their planned care and support. Staff were beginning to help people put aspirations and goals in place.

¿ People’s care, treatment and support plans reflected their sensory, cognitive and functioning needs. However, there were times these plans contained contradictory details or lacked key information.

¿ People received support which met most of their needs and aspirations. Support tried to be focussed on people’s quality of life and it was emerging that best practice was followed. Systems were not always in place for staff to evaluate the quality of support given, involving the person, their families and other professionals as appropriate.

¿ People received most of their care, support and treatment from trained staff and specialist able to meet their needs and wishes. Managers had not always ensured that staff had relevant training, regular supervision and appraisal.

¿ People and those important to them, including advocates, were beginning to be actively involved in planning their care. Where needed a multidisciplinary team worked together to provide the planned care. Although, there were times when reviews had been missed.

¿ People were not always being supported by staff who understood best practice in relation to learning disability and/or autism. Governance systems were being developed to ensure people were kept safe and received a high quality of care and support in line with their personal needs. People were not always equipped with tools to help them work with leaders to develop and improve the service. Although relatives felt involved.

Why we inspected

We undertook this inspection to follow up areas of concern raised with us around staffing and care people received. Also, to provide assurance that the service is applying the principles of right support right care right culture.

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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing, infection control practices and managing risks to people.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.