This was an unannounced inspection which took place on 10 October 2017.

Dimensions – 2 Dunstan’s Drive is a residential care home which is registered to provide a service for up to four people with learning disabilities. Some people have other associated difficulties including physical and sensory needs. There were four people living in the home on the day of the visit. The service offered ground floor accommodation in four bedrooms.

At the last inspection, on 7 October 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good:

There is a registered manager running the service. 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.

Staff continued to ensure people were kept as safe as possible from abuse, harm or poor practice. Staff had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Additionally they were trained in health and safety policies and procedures which provided them with the knowledge and understanding of how to keep people, visitors and themselves safe. High staffing ratios ensured people were supported safely and staff were able to meet people’s individual needs. The recruitment procedures remained effective in making sure appointees were suitable and safe to work with people. People were given their medicines safely.

People’s current and changing needs continued to be responded to effectively and in a timely way. People’s health and well-being needs were met by staff who worked with health and other professionals to ensure they received any necessary medical or specialist care.

People continued to be supported to have maximum choice and control of their lives. Staff offered them care in the least restrictive way possible, the policies and systems in the service supported this practice.

People continued to benefit from receiving care form a kind and caring staff team. Highly individualised care planning ensured staff used a person centred approach and respected people’s equality and diverse needs.

The service remained well - led which ensured it was able to provide good quality care. The registered manager was on extended leave but the service was managed by an interim team, in their absence. The management team were described as accessible, approachable and supportive. The quality of care the service provided was assessed, reviewed, improved and developed as necessary.

This was an unannounced inspection which took place on 07 October 2015.

Dimensions -2 Dunstan’s Drive is registered to provide care for up to four people with learning and associated physical disabilities. There were four people living in the service on the day of the visit. The service offered ground floor accommodation.

There is a registered manager running the service. 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.

People who use the service, staff and visitors’ were kept as safe, from harm, as possible whilst in the service. Staff understood how to identify abuse and knew what action to take if they had any concerns about people’s safety. Staff were trained in and understood health and safety matters and followed the relevant policies and procedures. The service made sure that individual or general risks were identified and action was taken to minimise them, as far as possible. There were enough staff to look after people safely. The necessary steps had been taken to ensure, that as far as possible, staff were suitable to work with the people who live in the home.

People’s health and well-being needs were met effectively. The service worked with other professionals to ensure people were kept as healthy as they could be and enjoyed their lifestyle as much as possible. Medicines were given safely by properly qualified staff.

Peoples’ human and civil rights were understood, and upheld by the staff and registered manager of the service. The service understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. DoLS provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm. The registered manager made appropriate DoLS applications. People were supported to control their lives as far as they were able to.

People’s care was provided by kind, caring and committed staff who knew people and their needs well. Their needs were met by an attentive staff team who responded to them in a timely way. Individualised care planning ensured people’s equality and diversity was respected

People were provided with a variety of activities, according to their needs, abilities and preferences.

People’s care was effectively overseen by a registered manager and management team who listened and responded to them and others. The culture of the home was described as open and positive. The registered manager was highly thought of. The quality of care the service provided was maintained and improved, when necessary.

During our inspection we found the provider had put measures in place to improve the recruitment and selection process. The manager told us existing staff recruitment files had been reviewed to ensure the required pre-employment checks were completed. When we checked staff recruitment records, however, we found all the required information checks were completed with the exception of two staff members. We found these files did not contain a full employment history. The provider was unable to provide a satisfactory written explanation for these gaps in employment histories. For one of these two staff members, proof of conduct checks from previous health and social care employers were not completed. This meant the provider did not have an effective recruitment process, to ensure that people who use the service were not placed at risk of being cared for by staff who were not suitable.

People were protected from the risk of infection because the guidelines published by the Department of Health had been followed.

We found the provider had put measures in place to improve standards of cleanliness and hygiene in the shower and bathroom areas of the home. However, the provider had not maintained appropriate standards of cleanliness and hygiene in one of the shower rooms in the home. We observed a clean environment throughout the rest of the home

People's records and other records relevant to the management of the service were not always accurate and fit for purpose. Records could be located promptly when requested. However, people’s records and some confidential staff information were not securely kept.

There was a new registered manager at this service during this inspection. The previous home manager left the service in December 2013.

We used a number of different methods to help us understand the experiences of people using the service. This is because the people using the service had complex needs which meant they were unable to tell us their experiences.

During our inspection we observed a relaxed and welcoming atmosphere from the people living in the home and staff. One relative of a person using the service we spoke with was complimentary about the care their relative received. They told us “I am very happy with the care X receives. I know X is very happy in the home.”

Care was planned with the involvement of the people who use the service and their relatives where appropriate. Support plans reflected their individual needs. We found people were provided with appropriate care to meet their needs.

A relative we spoke with told us the home was always kept clean and tidy. However the provider had not maintained appropriate standards of cleanliness and hygiene in the shower rooms in the home. This meant people were not protected from the risk of infection. We observed a clean environment throughout the rest of the home.

All the required information checks were in place prior to the employment of staff with the exception of full employment histories. The provider was unable to provide a satisfactory explanation for these gaps in employment histories. This meant the provider did not have an effective recruitment process, to ensure that people who use the service were not placed at risk of being cared for by staff who were not suitable.

There were processes in place for recording, investigating and resolving complaints from people who use the service and their relatives. The provider had written information on their complaints procedure, including an easy read version, which had been made available to people who use the service and their relatives.

People's records were accurate and fit for purpose. People’s records could be located promptly when requested but were not securely stored. There were incomplete records relating to people employed.

During our inspection we observed a relaxed and welcoming atmosphere from the people living in the home and staff. People expressed their views and were involved in making choices about their care. One member of staff we spoke with said “we support people to live the life they want.” Relatives told us staff treated the people living in the home with respect and supported them to make their own choices. One relative said “the staff talk to him, not at him.” We observed staff communicating and listening to people in a respectful and meaningful way.

We spoke with staff and looked at people's support plans and daily records and found that their needs were assessed. People’s care and support was planned and delivered in line with their individual support plans.

People living at the home were protected from the risk of abuse. During our visit we observed that staff had a good understanding of situations which could cause increased anxiety for individual people living in the home. Relatives felt that they would be comfortable to raise concerns with the manager.

Staff were supported to deliver care safely and to an appropriate standard. They had attended appropriate training and supervision. The provider had a system for monitoring the quality of service provided. There were processes in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

The inspection team consisted of one adult social care CQC inspector. On the day of our inspection four people used the service. People who use the service were not able to communicate verbally with us. However, we were able to find out about their experiences of people using the service through observation and speaking with their family or representatives. We spoke with four people, two people’s relatives, two care workers, and the registered manager. We observed staff interactions with people. Records relating to the management of the home were reviewed. These included two people’s support plans, daily support records, incident records and the employment files for six staff members.

We considered all the evidence we had gathered under the outcomes we inspected, which related to people’s care and welfare, Infection control and cleanliness, requirements relating to workers staffing, assessing and monitoring the quality of service provision and records. We used the information to answer five key questions; is the service safe, effective, caring, responsive and well-led.

This is a summary of what we found. The summary describes what people’s relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

Relatives of people who use the service were complimentary of how the provider maintained people’s safety. One relative told us “”X feels safe there. X is definitely much happier there.” Personal evacuation plans were in place to ensure people’s safety in the event of a fire at the service.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to this type of service. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to this type of service. The service was safe because requirements in relation to the DoLs had been met. The registered manager had received training in relation to DoLs and was aware of the recent case law. They told us the people they provided care for did not have the capacity to determine where they wanted to live and all received a high level of support and supervision within the service. The registered manager informed us that they had started the process of submitting DoLs applications for these people following consultation with the local authority. This was confirmed by our observations during the inspection.

The service was safe because the provider had taken action to ensure people were protected from the risk of infection. People were cared for in an environment that was safe, clean and hygienic. People were protected from the risk of infection because protocols based on current Department of Health guidelines were followed.

We found the provider had put measures in place to improve the recruitment and selection process. This meant people who use the service were not placed at risk of being cared for by staff who were not suitable to provide their care and treatment.

Is the service effective?

The service demonstrated effective practices through the assessment of people’s health and care needs. People's views about the type of care they wanted had been sought. People confirmed their involvement in the development of their support plan. We found staff had a good understanding of people’s care and specific support needs.

The relatives we spoke with were complimentary about the care received. One relative told us “staff manage the (specific care) needs of X very well. I have confidence in them.”

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to incidents. There was a system for monitoring and learning from incidents. The provider could identify possible trends that may require additional actions, such as risk assessments and the implementation of appropriate actions, to minimise the risk of occurrences to people and others.

The provider had taken action to ensure people's records and other records relevant to the management of the service were always accurate and fit for purpose. People’s records and confidential staff information were stored securely.

Is the service caring?

People were supported by kind and supportive staff. One relative told us “The staff are very caring . Overall it is a very friendly place.” All interactions we observed between the staff and people were respectful and courteous. We saw that care workers gave encouragement when supporting people. People were able to do things at their own pace and were not rushed.

We saw feedback from relatives was positive. People were complimentary about staff support and care. One relative said “They (staff) know X very well. They are good at meeting X’s needs.”

Is the service responsive?

The service was responsive. Relatives we spoke with confirmed they had been listened to and provided examples of improvements made to the service following their feedback. One relative told us “I feel listened to; they take my ideas on board.” Another relative told us that they could give their feedback on the service at the annual person centred reviews and when staff contacted them. A relative said “I find the person centred review helpful. There is an opportunity to put my suggestions for improvement forward. They (the provider) have acted on suggestions I have made.”

We saw people’s and relative’s feedback was sought through meetings and surveys. The provider was responsive to comments from people, such as improvements to the supper menu and the implementation of a planned refurbishment of the service to meet people’s wishes and suggestions.

Records confirmed people’s preferences and diverse needs had been identified. Staff provided examples of care and support being provided in accordance with people’s wishes, for example, in relation to activities and personal hygiene.

Audits and checks ensured people’s safety and wellbeing was promoted. Where issues were identified, an action plan was formulated. Progress and completion of this was monitored. We saw issues were identified and actions completed appropriately.

Is the service well-led?

The service was well led. We spoke with relatives who told us that they felt the service was well led.

The staff were very satisfied with the leadership and the management of the service. Staff told us that they were able to call the registered manager if they had any concerns.

The provider had systems in place to regularly assess and monitor the quality of service that people received. In relation to staff training, systems were in place to ensure staff always received appropriate training to be able to deliver care to people safely and to an appropriate standard.