We undertook an unannounced inspection of Dimensions Broomfield on 20 September 2018. The last inspection of the service was carried out on 21 October 2017. At that time, we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations, and one breach of the Care Quality Commission (Registration) Regulations 2009. These breaches concerned the recording of necessary checks, and notification of incidents.

Following the inspection, the provider sent us an action plan in January 2018. This described what they were planning to do to comply with the regulations and to improve in specific areas. At this inspection, we reviewed the actions the service had taken to meet the regulations. We found that the necessary improvements had been made.

Dimensions Broomfield is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Dimensions Broomfield can accommodate three people in one adapted bungalow. At the time of our inspection, three people were living there. Broomfield had three bedrooms with shared bathroom facilities and communal living areas which were accessible to all. This included a living room, kitchen and dining room, as well as a garden. There was also office space and staff sleep-in facilities.

The service worked in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was in post at the time of our inspection. 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.

Effective recruitment procedures were followed to ensure prospective staff were suitable to work in this service. Sufficient staff were employed, and they received training in a range of subjects to make sure people received safe and effective care.

Staff knew how to keep people safe from potential abuse and harm. Systems and processes were in place to help keep people safe.

Medicines were administered to people as prescribed and checks were in place to ensure this was done safely. Staff received training and their skills and abilities in this area were checked.

Policies, procedures and checks were in place to manage health and safety. This included the reporting of incidents and accidents, as well as regular equipment checks and maintenance.

Staff knew people's needs and preferences, and were compassionate and caring. People were comfortable around staff, and relatives told us that staff were patient and supportive.

People were enabled to make choices where possible, for example with food. We saw staff supporting people to eat and drink, and people had a balanced diet.

Staff contacted healthcare professionals promptly when there were concerns about a person’s health, as well as for routine checks and monitoring.

Relatives told us that they were consulted and informed about people’s care. Records were clear and reflected people's needs and preferences.

People had access to a complaints procedure and they were confident any concerns would be acted upon.

This inspection was unannounced and took place on 21October 2017. At the last inspection on 24 August 2015 the service was rated Good.

Dimensions Broomfield 40 Gladstone Road is a care home registered to accommodate up to three people. The home supports people with learning disabilities and profound physical needs.

There is 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 had not notified the Care Quality Commission of all significant events which have occurred in line with their legal responsibilities.

The registered manager and provider undertook checks to review the quality of the service provided. However, these did not identify all the shortfalls we found. Where the quality checks identified improvements, these were not always followed up and fully recorded.

Although people’s medicines were managed safely, there were some areas where improvements were needed. These included guidance for staff around the use of patches which delivered medicines and creams. Audits had not identified the shortfalls we found.

Staff told us and records confirmed people were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the registered manager was accessible and approachable. Staff and relatives felt able to speak with the manager and provided feedback on the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We met and talked with the families of two of the three people living at Dimensions Broomfield. On this visit we met one of the people living at the home. The other two people were at a local day centre. We have met all three people before on a number of occasions. We met one of the other people who was at the day centre when they were attending music therapy at another Dimensions' home in April 2013. We observed care delivered on this occasion delivered with fondness and warmth. We saw people supported to live full lives with lots of daily activities and social events organised with them in mind.

We found the home was keeping people safe from infection by maintaining standards of hygiene and cleanliness. There were, however, some areas of the home showing signs of age and wear and tear which made them less easy to clean. Staff cooperated with other health and social care providers. This ensured people's care was safe and coordinated when shared with or transferred to another provider. Staff were supported through training and appraisal to support people safely and competently.

We visited Dimensions Broomfield on 16 October 2012 and found the home was not compliant with the management of medicines. The provider sent us an action plan and we went back on 2 January 2013 to see what improvements had been made.

On our return visit we found the home had made improvements to the management of medicines. The new system for medicines meant they were managed safely and effectively. People were having their medicines when they needed them. Medicines only given to people when required had written guidelines to ensure staff knew when and how to give these safely. Stocks of medicines were correctly managed and records were well organised and accurate.

The three people living at Dimensions Broomfield had learning disabilities and profound health needs. They were not able to talk with us about their experience. We observed people's care and support given by five members of staff on duty at various times during our visit. Care was delivered with patience, kindness and enthusiasm.

One person was supported to attend a day centre. The other two people were around the house in the morning spending time with staff who were also cleaning, attending to laundry, preparing food and drinks. People were included in the running of the home and accompanied staff and got involved with everyday tasks where they could.

In the afternoon two people were taken out in the minibus to visit another Dimensions' location in the centre of Bath. This was to enable the people to enjoy the sensory room created at this other location and to meet and socialise with other people living there.

The staff were able to tell us about gaining valid consent from people, or if they did not have capacity to make a decision from others acting in their best interests. The support plans for people were clear and contained relevant and appropriate information. The home had a sufficient mix of experienced and skilled staff. People had good arrangements made for their safe nutrition and hydration.

Medicines had been given safely and when people needed them but the recording of medicines, and how and when they should be used needed to be improved.

This inspection took place on the 24 August 2015 and was unannounced. When the service was last inspected in May 2013 there were no breaches of the legal requirements identified.

Dimensions Broomfield 40 Gladstone Road is a care home registered to accommodate up to three people. The home supports people with learning disabilities and profound physical needs. At the time of our inspection three people were residing at the house. They had all lived at the home for a number of years.

A registered manager was in post at the time of inspection. 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 were unable to tell us of their experience of living in the house. We found that people’s rights were being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. There was documentation related to a service user’s capacity to make decisions and how to support a service user when there was evidence that they lacked capacity to make informed decisions.

People had their physical and mental health needs monitored. All care records we viewed showed people had access to healthcare professionals according to their specific needs.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those closest to them.

The provider had arrangements in place to respond to suspected abuse. Positive comments were received from relatives we spoke with about the relationships they had with staff and people felt safe in their company.

Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. Staff we spoke with felt the staffing level was appropriate. People were supported with their medicines by staff and people had their medicines when they needed them.

People received effective care from the staff that supported them. We received positive comments from relatives we spoke with about the staff. One relative commented, “They’re very dedicated members of staff.”

Staff were caring towards people and there were good relationships between people and staff. People and their representatives were involved in the planning of their care and support. To ensure their attendance, one relative told us that they would prefer to be given more notice regarding meeting dates. Staff understood the needs and preferences of the people they cared for.

Support provided to people met their needs. Supporting records highlighted personalised information about what was important to people and how to support them. People were involved in activities of their choice.

The provider had a complaints procedure and relatives felt confident they could speak with staff about matters of concern. There were systems in place to assess, monitor and improve the quality and safety of the service. Arrangements were also in place for obtaining people’s feedback about the service