Dimensions 149 Ash Street provides accommodation, care and support to five people with learning disabilities. The home is situated in a residential area with accommodation over two floors.

The inspection took place on 10 November 2016 and was unannounced.

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. The registered manager was unavailable during the inspection, support was provided by the deputy manager to access records and information.

At our last inspection in August 2015 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People’s medicines were not stored securely and the principles of the Mental Capacity Act 2005 were not always followed. At this inspection we found that improvements had been made. All medicines were now being stored in a locked cabinet and capacity assessments and best interest decisions were in place, where required, to ensure people’s legal rights were protected.

Medicines were managed safely and records showed that people received their medicines in accordance with prescription guidance. People were supported to maintain good health and had regular access to a range of healthcare professionals. People were supported to have a nutritious diet and were able to make choices regarding what they had to eat and drink.

People appeared relaxed and comfortable in the company of staff. Staff had a good understanding of their responsibilities in safeguarding people from potential abuse. Risks to people’s safety and well-being were assessed and measures were in place to keep people safe. Environmental risks were monitored and there was a contingency plan in place to ensure that people would continue to receive care in the event of an emergency. Accidents and incidents were reviewed in order to identify any trends and minimise the risk of them being repeated.

There were sufficient staff deployed and staff worked flexibly to meet people’s individual needs. Safe recruitment practices were followed to help ensure that staff employed were suitable to work at the service. Staff received an induction when starting work which gave them the opportunity to get to know people’s needs. Staff received training and support that provided them with the knowledge and skills required to support people in an effective, person centred manner. Staff told us they felt supported by the management of the service and records showed they received regular supervision to monitor their performance.

People were supported by staff who treated them with respect and understood the importance of developing and maintaining people’s independence. We observed people were actively involved in the running of their home. People were supported to maintain relationships with those important to them and where appropriate had access to advocacy services.

Staff were knowledgeable about the people they supported and knew their likes, dislikes and interests. Care plans had been developed which were person centred and described people’s preferences, choices and how they wanted their care to be provided. People were provided with a range of activities to pursue their individual interests and hobbies.

Quality assurance systems were in place to monitor the quality of service being delivered. Where actions were identified these were completed in a timely manner. A complaints policy was in place and we found complaints were investigated and responded to in line with the provider’s policy. There was a positive culture and staff were clear about their responsibilities in providing person centred care.

Dimensions 149 Ash Street is a care home which provides care and support to five people with learning disabilities. The home is situated in a residential area with accommodation over two floors.

This inspection took place on 5 August 2015 and was unannounced. The inspection was carried out by two inspectors.

There was a registered manager in post who assisted us with our inspection on the day. 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.

Medicines were not always stored and administered safely. Some medicines were stored in an unlocked drawer in the office as the medicines cabinet provided did not allow adequate storage. People’s medicines were dispensed from packs which did not have a pharmacy label attached to guide staff. This meant people were at risk of not receiving their medicines as prescribed. Systems were in place for recording medicines administered which included as and when required medicines. There was an arrangement in place for unused medicines to be disposed of safely. Any changes to people’s medicines were verified and prescribed by the person’s GP.

Staff did not have a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. This meant people had restrictions in place without the proper procedures being followed and reviewed at regular intervals.

People were safe at the home. There were sufficient staff deployed in the home. Staffing numbers were flexible to ensure people’s individual needs were met. There were enough staff to enable people to go out and to support the people who remained at home.

Where risks to people had been identified, action had been taken by staff to mitigate these risks. Staff had a clear understanding of how to safeguard people and knew what steps they should take if they suspected abuse. There was an effective recruitment process that was followed which helped ensure that only suitable staff were employed.

Staff received training and supervision to enable them to have the necessary skills to carry out their role. Training was regularly reviewed to ensure staff had the most up to date information.

People were involved in choosing what they had to eat and drink and menus were displayed in a pictorial format. People could choose where they ate their meals and specialist dietary requirements were catered for.

People had access to healthcare professionals to enable them to stay healthy. Health appointments were recorded in detail and shared with staff. People’s weight was recorded regularly.

Staff showed people kindness and compassion. They recognised people’s individual personalities and respected their privacy. Visitors were made to feel welcome in the home.

Detailed assessments were completed prior to people moving into the service. Comprehensive care plans were in place and completed in a person centred way. Care plans and risk assessments were regularly reviewed meaning that staff had up to date information on how to support people.

People had access to a range of activities which were planned according to their individual needs and preferences. Staffing levels were adjusted where required to ensure people had the right support when taking part in community activities.

There was a complaints policy in place which was displayed in an easy read format. Relatives told us they knew how to make a complaint should they have any concerns.

Staff were involved in all aspects of the home and attended regular staff meetings. Staff felt supported by the manager and senior staff and felt they were always available to give advice and support. Staff understood the ethos and values of the service. Quality assurance audits were completed and actions identified were completed. Relatives were asked their views of the service, results were positive.

During the inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. Observation during the inspection showed

staff supporting people to make their own choices about what they had for lunch and what activities they took part in. Staff were knowledgeable about the needs of each person using the service and how they communicated which meant people's wishes were understood and respected.

We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis.

People chose how to occupy themselves in the service. We observed that people were supported to follow their routines which included going shopping, attending art class and going horseriding. There were 'My social story for routine' pages within care plans that provided step by step instructions and photos for staff to follow. During our inspection we observed staff following these routines for one person. We observed staff spending the majority of their time with people who used the service, listening to music, watching television and talking about their likes and interests. They frequently checked on them to ensure they were alright when spending time on their own and supported people to participate in activities.

We inspected 149 Ash Street as part of our planned schedule of inspections. The inspection was unannounced, this meant that the manager staff and people that used the service did not know we were going to visit. On the day of our inspection there were two members of staff in the home, a third had been deployed to take some people that used the service to their activity of choice. The manager of the service returned from a pre planned appointment during the inspection and the services operational manager visited while we were at the home.

People that used the service who were in the home were not able to communicate verbally with us during our inspection and we had limited opportunities to observe their care and support. This was because people had arranged to go out on planned activities or outings of their choice.

We saw that people's care records provided good information about how people's care needs should be met and were subject to regular review. This meant that people's care records were up to date.

We spoke with all of the staff on duty during our inspection. We found that staff on duty had a good understanding of the needs of people and that they supported them to meet their needs. Staff had been trained in areas relevant to the specific needs of people who used the service. Staff had knowledge about safeguarding procedures in the home.

We saw that the provider had procedures in place for managing and investigating complaints.