Dimensions Norfolk Domiciliary Care Office

Dimensions Norfolk Domiciliary Care Office provides the regulated activity of personal care. Staff provide care and support to people living in their own homes or flats, or in supported living services. The service provides support to a total of 55 people with a learning disability and or autistic people. At the time of our inspection there were 46 people in receipt of the regulated activity. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of the service and what we found:

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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Value was consistently placed on the condition and cleanliness of people’s homes, with regular checks in place to ensure people lived comfortably. People’s care records demonstrated people and their relatives, as well as health and social care professionals were involved in the development of these documents. People’s privacy, dignity, choice and control, and their human rights were consistently upheld. 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.

Right Care: People were empowered to have choice and control over their daily lives. The care provided was person-centred and led by the wishes of the individual. Staff valued feedback from people and their relatives to tailor their care accordingly. Care outcomes were regularly reviewed, and staff worked collaboratively with health and social care professionals to achieve positive results. People led meaningful lives, making valuable contributions to their local community and households. Healthcare professional guidance was followed to protect people from risks such as pressure sores, choking, epilepsy and diabetes.

Right Culture: Registered managers provided clear leadership to their staff teams. People and their relatives were familiar with the registered managers and knew how to contact them if needing to discuss any concerns. Feedback was openly encouraged from people, their relatives and staff, and the registered managers valued all contributions as a way of driving service improvement. The provider had implemented a ‘closed cultures checklist’ which registered managers regularly reviewed to monitor the morale and health of their staff teams, this demonstrated a clear commitment by the provider to implementing Right Support, Right Care, Right Culture into their services.

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 Outstanding published 06 October 2017.

Why we inspected

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

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

There was a registered manager in post. 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.

At the last inspection, the service was rated Good. At this inspection we found the service was Outstanding in three key domains with Good in the remaining two.

The service provided exceptional, compassionate care to people which enhanced their lives, through adaptive and creative ways of communicating, leading to increased understanding and reduction of distress. Staff used individualised methods to promote people’s independence through achieving their identified goals and supporting them through each step. People’s privacy and dignity were highly respected, and this also was reflected in the detailed guidance provided within people’s care records. People were encouraged and supported to express themselves in the most effective way. This had a profoundly positive impact on people’s levels of distress and emotional well-being.

Staff were highly responsive to people’s individual needs, working in line with their preferences, dreams and desires. Care records contained ample guidance for staff on how to meet people’s individual needs and support them to achieve their goals. The service was engaged in creating an innovative approach to caring for people living with learning difficulties focussing on what people wanted to achieve in their lives, how they could overcome any obstacles, and ultimately achieve a positive outcome. People knew how to complain and felt that the management was always responsive to any concerns.

People and their families, where appropriate, were fully involved in the development of their care planning along with health and social care professionals and Dimensions staff. This included the recruitment of appropriate care staff to work with people.

The service was outstandingly well-led. The service actively promoted a positive, inclusive and open culture. The structure of the service worked for people, so that locality managers were always available to support staff and people when needed. The service worked in conjunction with other organisations to improve care, such as participating in research and engaging in external initiatives working towards improving standards and developing the service further. There were robust quality assurance systems in place which monitored the service, identifying potential areas for improvement, and actions were taken to improve these.

Staff were highly motivated and worked as a team and shared a common ethos of providing high quality, compassionate care with regard to people’s individual wishes and support needs. Staff were well-supported and supervised by the management team.

Staff knew how to keep people safe, and how to report any concerns. There were enough staff to keep people safe. People received their medicines as they had been prescribed, and the service was undertaking an initiative to review medicines regularly, with a view to decreasing psychotropic medicines use.

Risk to people was identified promptly and effective plans were put in place to minimise these risks, involving relevant people, such as relatives and other professionals. Where risks were more complex, comprehensive guidance was in place to guide staff, including the most effective approaches to use, or particular communication methods suited to the individual. Guidance was in place for staff so that they could mitigate risk, and support people to take sensible risks as safely as possible.

The manager and staff understood the requirements of the MCA, and people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service also supported this practice. Staff consistently obtained people’s consent before providing support and, if people lacked capacity to make some decisions, staff understood how to act in people’s best interests to protect their human rights. Best interests decisions were recorded thoroughly.

People were supported to follow healthy diets, and this had a positive impact on their wellbeing. They were also supported to access healthcare services when they needed to.

Relatives spoken with were satisfied with the care that people received. However, it was clear that some felt this had not always been the case and that they had needed to complain in order to improve things and one was concerned that staff were not always available to provide the care expected. One relative described what they felt had been a 'rocky ride' with the agency. However, most felt that, where they had complained recently, improvements had been made. One said that there had been "...a lovely progression, to the point where it's working really well." Relatives and people spoken with knew how to complain if they needed to.

Systems for assessing the quality of the service, supervising and appraising staff and for maintaining records had improved since our last inspection.

We had some concerns about the way records were maintained. Not everyone using the service had the provider's new support plans fully completed and in place in their own homes. In some cases, the support required was not cross referenced with the assessments of risk so the information was not easy to find. Some files had information that was not easy to follow, was repetitive, or had not been maintained to ensure it reflected people's current needs. Copies of many of these records were incomplete in the agency's office, where they could not be located promptly for inspection or monitored by the management team.

We also found that the quality and safety of the service people received was not monitored and assessed as often as the provider's records suggested and that systems for following up improvements were not always robust to ensure that people remained safe.