Archived: Dimensions Somerset Yeovil Domiciliary Care Office

About the service

Dimensions Somerset Yeovil Domiciliary Care Office is a domiciliary care agency providing personal care to 57 people with learning disabilities and/or autism in their own homes or flats in the community.

Most people had limited verbal communication so were unable to feedback their views. Other ways of collecting their views were used, such as observations during visits and speaking with those important to them.

People receiving support from Dimensions Somerset Yeovil Domiciliary Care Office lived in 1 of the 14 supported living services, shared accommodation or individual homes and flats. Many of the households had multiple occupancy of over 3 people with shared living spaces and 24-hour care and support on site.

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

Right Culture:

Quality assurance processes were not always effective. Whilst medicines were generally managed safely, audit checks of medicine administration records were not always completed in line with the provider’s policy or best practice. There were inconsistencies in recruitment files and staff did not always have access to the most current information relating to people’s care needs, the provider took action to address these shortfalls during inspection. Record keeping varied across the service’s locations.

The registered managers demonstrated joint working with people and professionals, who provided specialist support to meet people’s health needs. The service involved people’s families and advocates as appropriate.

Right Support:

The provider had made improvements to the service following our previous inspection, to ensure it was safe for people. Where possible, the same staff supported people and so understood their individual communication needs. One registered manager explained to us, “I monitor the rotas to make sure that all staff have an opportunity to work with each person we support. It increases their confidence when working with people who may show behaviours of distress and helps them get to know people which then makes them more confident about how to safely support that person and take positive risks.”

A number of regular agency staff had applied to work for the service on a permanent basis.

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:

Support plans and risk assessments were person centred. People and relatives told us staff knew them well. Staff supported people in a kind and compassionate way, considering their dignity and privacy, one person told us, “I can lock my door, why not? It’s my space.” Another person put their thumbs up and answered “Yes” when asked if staff were kind.

People were supported to live full, active lives and encouraged to increase their independence.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 June 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an announced focussed inspection of this service on 17 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At our last inspection we found breaches in relation to safe care and treatment, keeping people safe from abuse and systems to manage the service.

We undertook this focused inspection to check the service had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dimensions Somerset Yeovil Domiciliary Care on our website at www.cqc.org.uk.

Enforcement

We have identified a continued breach in relation to good governance at this inspection. We have made a recommendation about the recruitment of staff.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dimensions Somerset Yeovil Domiciliary Care Office is a domiciliary care agency providing personal care to 63 people with learning disabilities and/or autism in their own homes or flats in the community. Most people had limited verbal communication so unable to feedback their views. Other ways of collecting their views were used such as observations during visits and speaking with those important to them.

People lived in one of the nine supported living services, shared accommodation or individual homes and flats. Many of the households had multiple occupancy of over three people with shared living spaces. Most people required 24-hour support, and this changed for some during the COVID-19 pandemic.

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

The service was not well led. Systems failed to ensure that the quality and safety of the service was effectively monitored. A reactive approach was found that relied on external agencies such as the local authority, clinical commissioning group and Care Quality Commission (CQC). The provider’s quality assurance action plans contained generic, copied phrases that lacked detail. There were shortfalls found during the inspection which had not been identified by the provider’s internal monitoring systems. Multiple breaches of regulations were found. We also made a recommendation about the retention of staff.

People were comfortable in staff presence and told us they were safe. Most relatives thought their family members were safe. However, people were placed at risk of potential harm, for example the risks from choking or skin damage had not been safely managed. Systems were not always working to protect people from abuse including the use of restrictive practices when a person's arm was prevented from moving during a blood test.

Medicines were not always administered in line with the provider’s policies and current best practice.

Systems to prevent the spread of infections during the COVID-19 pandemic were not being consistently followed. Not all staff knew how to safely remove and dispose of personal protective equipment (PPE) such as gloves, masks and aprons.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This provider was not able to demonstrate how the service was meeting some of the underpinning principles of ‘Right support, right care, right culture.’ A high staff turnover increased the risk that people’s personalised health and care needs would not be met. Risks of inappropriate restrictions placed on people from staff new to care was found to be impacting on people’s rights. We identified a reactive rather than proactive management approach across the service to deliver personalised care to people.

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 Good (published 18 April 2018)

Why we inspected

We received concerns in relation to about the provider including potential closed cultures, staffing and safe care and treatment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well led sections.

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 safe care and treatment, keeping people safe from abuse and systems to manage the service at this inspection.

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.