Dimensions Somerset The Saplings

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.

The Saplings provides personal care and accommodation for people with learning disabilities. There were six people living in the home at the time of our inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

What life is like for people using this service:

People who used the service looked comfortable and relaxed in the presence of staff. Relatives and health professionals spoke positively and told us they felt people were safe.

Improvements had been made to the management of medicines. Further improvements were needed to make sure shortfalls were promptly identified and acted upon.

Staff had received training to carry out their roles and demonstrated a good understanding of safeguarding and knew how to report concerns.

Improvements were needed to make sure all care related records were in good order and easily accessible.

People were supported to access health care services and regular visits were undertaken by healthcare professionals.

People’s dietary needs were assessed, and people received the support they needed at mealtimes.

People received care that was kind and respectful. Care plans were detailed and reviewed each month. Further improvements were needed to make sure changes were fully incorporated and clearly recorded.

A range of audits and monitoring systems were in place. They did not always identify shortfalls, so actions were not always taken to mitigate all risks and make improvements.

The management structure in the home needed to be further strengthened to make sure all staff were fully aware of their role and responsibilities.

The service met the characteristics of Requires Improvement in the key questions Safe and Well-led, and Good in the key questions Effective, Caring and Responsive.

Therefore, our overall rating for the service after this inspection remains Requires Improvement.

More information is in detailed findings below.

Rating at last inspection:

Requires Improvement (report published in June 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor information received about the home 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

Dimensions Somerset The Saplings is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Saplings is registered to provide care and accommodation to up to seven people. The home specialises in the care of people who have learning disabilities and complex physical disabilities. All accommodation for people is on the ground floor and all areas are accessible to wheelchair users. At the time of the inspection seven people were living at the home.

The care home has been open a number of years and was previously owned and managed by Somerset County Council. This was the first inspection of the home since it was registered with Dimensions Somerset Sev Limited.

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.

There was a registered manager in post, however at the time of this inspection the registered manager had been away from the home for a number of weeks and the home was being managed by the deputy manager. 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.

Improvements were needed to make sure the home was well led. The quality monitoring was not always effective in making sure that improvements to the service people received was implemented in a timely manner. Records relating to the safe running of the home and people’s personal care were not always clear, up to date or correct. Information, such as care plans and the complaints policy was not always available to people in a format which met their individual needs.

Staff were not always following up to date guidance in relation to the safe storage and recording of medicines.

People were comfortable and relaxed with the staff who supported them. The provider had systems to minimise the risks of abuse to people and staff knew how to report concerns. Risk assessments were carried out to enable people to take part in activities and receive care safely.

Staff worked with other professionals to make sure people’s care and support met their needs. Staff followed advice given and monitored people’s well-being, although records relating to people’s individual care were not always clear.

Staff knew how to support people who lacked the capacity to make decisions. People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible. When people lacked capacity, decisions had been made on their behalf following current legislation.

People were cared for by staff who were kind and compassionate. Long term staff had built trusting relationships with people and tried to involve them in day to day activities according to people’s abilities. People’s physical needs were well managed and staff ensured people had opportunities for social stimulation.

The home was situated close to local facilities which enabled people to access community facilities such as shops, cafes and the park. At the time of the inspection people had limited access to transport due to issues with staff training.

We recommend that the provider ensures all staff are familiar with the current national guidelines for managing medicines in care homes.