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

Dimensions- 6 Sadler’s Lane is a residential care home which is registered to provide a service for up to four people with learning disabilities. Some people had other associated difficulties such as being on the autistic spectrum. There were three people living in the service on the day of the visit. All accommodation is provided on one floor in a domestic sized dwelling.

At the last inspection, in September 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.

The service remained safe. People’s safety was contributed to by staff who had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff understood how to protect people and who to alert if they had any concerns. General risks and risks to individuals were identified and appropriate action was taken to reduce them.

There were enough staff on duty at all times to meet people’s diverse, individual needs safely. The service had a stable staff team. However, if they did recruit new staff they had systems in place to ensure, that as far as possible, staff recruited were safe and suitable to work with people. People were given their medicines safely, at the right times and in the right amounts by trained and competent staff.

The service remained effective. Staff were well-trained and able to meet people’s health and well-being needs. They were able to respond effectively to people’s current and changing needs. The service sought advice from and worked with health and other professionals to ensure they met people’s needs.

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 supported this practise.

The service continued to be caring and responsive. The small, committed, attentive and knowledgeable staff team provided care with kindness and respect. Individualised care planning ensured people’s equality and diversity was respected. People were provided with a wide variety of activities, according to their needs, abilities, health and preferences.

The registered manager was on extended leave but remained highly thought of and respected. The interim manager was described as approachable and supportive and there was a team in place to support them. The quality of care the service provided continued to be assessed, reviewed and improved, as necessary.

Not all the people using the service were able to tell us their experiences. We used a number of different methods, including observation to help us understand the experiences of the people that use the service. If you wish to see the detailed evidence supporting our summary please read our full report.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found.

Is the service safe?

Representatives of people who use the service were complementary about people’s safety being maintained by the provider. One representative told us “They (staff) look after the people and ensure they are kept safe.” People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Personal evacuation plans were in place for each person to ensure their safety in the event of a fire at the service.

The home was secure and care workers had to use a key to enter the home. Visitors were asked for identification before being allowed entry. We found the building was well maintained and suitable for people who use the service. We found corridors and fire exits were free of clutter and easily accessible. Necessary checks of the home were completed to ensure the safety of people who use the service and staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to this type of service. While no applications have needed to be submitted for the people using the service, proper policies and procedures were in place. Relevant staff were trained to understand when an application should be made, and how to submit one.

Since our last inspection on 8 and 9 December 2013 we found actions had been taken by the provider to ensure records for people and staff were accurate and fit for purpose. We saw people's records were stored securely and could be located promptly when requested.

People were protected from the risk of inappropriate or unsafe care. This was because 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.

Is the service effective?

We spoke with two people and two representatives (one relative and one advocate) of people of people who use the service. They were complimentary about the care received. One person we spoke with said “I like it here.” It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. One relative told us. “They (staff) understand X’s needs.”

Staff had received training to meet the specific needs of the people living at the home. Examples of training included, management of epilepsy and percutaneous endoscopic gastrostomy (PEG) feeding. PEG feeding is a form of tube feeding for people who are unable to or have difficulties in swallowing. People’s health and care needs were assessed with them, care to meet these needs was recorded in support plans. Relatives we spoke with told us the support plans reflected their family member’s current needs. We noted people’s involvement in annual reviews of their care.

Is the service caring?

People were supported by kind and supportive staff. One representative told us “Staff are pleasant and are very caring. It (this service) is very homely.” All interactions we observed between the staff and people were open, 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. Our observations confirmed this. A representative told us “the staff have such good interpersonal skills.”

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded in their support plans. Care and support had been provided in accordance with people’s wishes for example arranging preferred activities, and holidays.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

The provider had systems in place to regularly assess and monitor the quality of service that people received. The provider carried out quarterly quality audits of the service. The home manager told us a survey went out to staff, people and their relatives annually. This survey asked people what they thought about the quality of support provided. We saw the outcome of the last survey for 2013-14 was available to people in an accessible format. Records seen by us showed people were complementary about the service and any identified shortfalls were addressed promptly. Relatives we spoke with confirmed they had been listened to and provided examples of improvements made to the service following their feedback. As a result the quality of the service had continued to improve. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. One representative told us “This service has come on a lot, it has definitely improved.”

We observed how people expressed their views and were supported in consenting to their care and decisions. Staff spoke with respect and gave plenty of time to people to respond. Family members were complimentary of the support their relatives received and told us people were encouraged to be independent.

We saw that health and social care providers were involved in care and treatment of people who use the service. They had good working relationships with the service making sure people living there received all support needed. Appropriate appointments records were kept in the service for a range of health reviews.

A system of supervision and appraisal was in place to support staff to carry out their work. Staff received appropriate training to enable them to deliver care to people safely and to appropriate standards. Each member of staff was able to monitor their training through an online profile with the manager overseeing this.

There was a process and written procedures, including an easy read version, in place to respond to and resolve complaints. The family members told us they were aware of who to speak to if they had any complaints or concerns.

The provider had a policy for storage, archive and disposal of records. All records relevant to the management of the service were stored securely in the office and easily accessible to staff. However, some health and social care and support records were not always accurate, up to date and fit for purpose.

During our inspection we found the provider had put measures into place to strengthen the recruitment, interview and selection process. This was to ensure that 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. These included a revised application form and revision of existing staff recruitment files to ensure the recording of satisfactory explanations for any gaps in employment histories.

We observed a relaxed and welcoming atmosphere from the people living in the home and staff. People expressed their views and were supported in consenting to their care and treatment. One member of staff, referring to a person living in the home, told us” I give him a proper explanation in order to gain his consent.”

We observed a clean environment throughout the home. Relatives and advocates told us that the home was always kept clean and tidy.

People were protected from the risk of infection because protocols based on current Department of Health guidelines had been followed. We found there were systems in place to manage and monitor the prevention and control of infection.

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. There were arrangements in place to deal with foreseeable emergencies.

The provider did not have a robust recruitment process in place to ensure that people who use the service were not placed at risk of being cared for by inappropriate staff.

Relatives and advocates felt that they would be comfortable to raise concerns with the manager. 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.

When we visited, two people who lived at Sadlers Lane were at home. They were not able

to tell us what they thought about the care and support provided. However, during our visit,

we observed what life was like in the home and saw how staff interacted with people who

lived there. We saw that staff spoke with people in a calm and respectful way and that staff

respected the choices that people made.

This was an unannounced inspection which took place on 14 September 2015.

Dimensions-6 Sadler’s Lane is registered to provide care for up to four people. The home provides a service for people with learning and associated behavioural and physical disabilities. There were four people living in the service on the day of the visit.The service offered all 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’ safety was carefully considered by the service. Staff were trained in and understood health and safety matters and how to protect people in their care from harm or abuse. They understood all the relevant policies and procedures and action was taken, as necessary. Any general or individual risks were identified and action was taken to minimise them, as far as possible. The service took all the necessary steps to ensure staff were suitable to work with the people who live in the home. People were given their medicines safely.

The service made sure the staff team met people’s individual needs. Staff helped people to make as many decisions and choices for themselves, as they were able. People were supported to maintain or enhance their independence, as appropriate to their assessed needs.

Peoples’ 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’s care was provided by kind and caring staff who knew people and their needs well. People’s needs were met by attentive staff who responded to them immediately. People’s assessments noted staffing ratios individuals’ required for different activities and these were provided.

People’s individual needs, preferences and wishes were taken into account when planning daily activities. Various activities were provided, as appropriate. People were treated with dignity and respect at all times. Individualised care planning ensured people’s equality and diversity was respected.

People’s care was overseen by a registered manager and management team who listened to them, other professionals and the staff team. Staff described the registered manager as, ‘‘inspiring’’. The service maintained and improved the quality of care people received and ensured people received the correct amount of support to enjoy their lifestyle. Additionally people were assisted to develop skills to help them towards independence, if appropriate.