Dimensions East Anglia provides supported living and personal care for people with complex learning disabilities. At the time of our inspection, 178 people were using the service.

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.

At the last inspection, the service was rated Good. At this inspection we found the service was Outstanding in three key domains with Good in the remaining two.

The service provided exceptional, compassionate care to people which enhanced their lives, through adaptive and creative ways of communicating, leading to increased understanding and reduction of distress. Staff used individualised methods to promote people’s independence through achieving their identified goals and supporting them through each step. People’s privacy and dignity were highly respected, and this also was reflected in the detailed guidance provided within people’s care records. People were encouraged and supported to express themselves in the most effective way. This had a profoundly positive impact on people’s levels of distress and emotional well-being.

Staff were highly responsive to people’s individual needs, working in line with their preferences, dreams and desires. Care records contained ample guidance for staff on how to meet people’s individual needs and support them to achieve their goals. The service was engaged in creating an innovative approach to caring for people living with learning difficulties focussing on what people wanted to achieve in their lives, how they could overcome any obstacles, and ultimately achieve a positive outcome. People knew how to complain and felt that the management was always responsive to any concerns.

People and their families, where appropriate, were fully involved in the development of their care planning along with health and social care professionals and Dimensions staff. This included the recruitment of appropriate care staff to work with people.

The service was outstandingly well-led. The service actively promoted a positive, inclusive and open culture. The structure of the service worked for people, so that locality managers were always available to support staff and people when needed. The service worked in conjunction with other organisations to improve care, such as participating in research and engaging in external initiatives working towards improving standards and developing the service further. There were robust quality assurance systems in place which monitored the service, identifying potential areas for improvement, and actions were taken to improve these.

Staff were highly motivated and worked as a team and shared a common ethos of providing high quality, compassionate care with regard to people’s individual wishes and support needs. Staff were well-supported and supervised by the management team.

Staff knew how to keep people safe, and how to report any concerns. There were enough staff to keep people safe. People received their medicines as they had been prescribed, and the service was undertaking an initiative to review medicines regularly, with a view to decreasing psychotropic medicines use.

Risk to people was identified promptly and effective plans were put in place to minimise these risks, involving relevant people, such as relatives and other professionals. Where risks were more complex, comprehensive guidance was in place to guide staff, including the most effective approaches to use, or particular communication methods suited to the individual. Guidance was in place for staff so that they could mitigate risk, and support people to take sensible risks as safely as possible.

The manager and staff understood the requirements of th

Dimensions East Anglia Domiciliary Care Office is a registered community based adult social care service providing personal care to people living in a range of accommodation including supported living schemes and people living on their own. The agency provides support and care to people who have a learning disability in in Norfolk, Suffolk and Essex. The last inspection took place on 24 July 2013, during which we found the regulations we looked at were being met.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 safe as staff were knowledgeable about reporting any abuse. There were a sufficient number of staff employed and recruitment procedures ensured that only suitable staff were employed. Risk assessments were in place and actions were taken to reduce these risks. Arrangements were in place to ensure that people were supported and protected with the safe management of medicines.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS applications were being made to ensure that people’s rights were protected. Staff were supported and trained to do their job.

People were supported to access a range of health care professionals and they were provided with opportunities to increase their levels of independence. Health risk assessments were in place to ensure that people were supported to maintain their health. People had adequate amounts of food and drink to meet their individual likes and nutritional and hydration needs.

People’s privacy and dignity were respected and their care and support was provided in a caring and a patient way

Sufficient numbers of staff were available and the appropriate checks had been completed to ensure they were suitable to carry out their role. People’s hobbies and interests had been identified and they were supported to take part in a range of activities that were meaningful to them. A complaints procedure was in place and complaints had been responded to, to the satisfaction of the complainant. People could raise concerns with the staff at any time.

The provider had quality assurance processes and procedures in place to improve, if needed, the quality and safety of people’s support and care. People and their relatives were able to make suggestions in relation to the support and care provided and staff acted on what they were told. There were strong links with the external community. A staff training and development programme was in place and procedures were in place to review the standard of staff members’ work performance.

We spoke with or visited ten people using the agency. We also spoke with nine relatives of other people using the service. People told us that staff supported them with the things they wanted to do and tried to involve them in decisions about their care. For some people this included using photographs and two people had made videos of their discussions about their support. One person said, "Staff ask me about the kind of things I would like, what I want for my lunch and where I'd like to go." One person told us, "I'm happy with everything and I've got no complaints. They're all pretty good." Another told us about their support and said that the staff "...have got used to me." Our discussions with staff showed that they were aware of the needs of the people they supported, how to keep them safe and how to communicate with them.

Relatives spoken with were satisfied with the care that people received. However, it was clear that some felt this had not always been the case and that they had needed to complain in order to improve things and one was concerned that staff were not always available to provide the care expected. One relative described what they felt had been a 'rocky ride' with the agency. However, most felt that, where they had complained recently, improvements had been made. One said that there had been "...a lovely progression, to the point where it's working really well." Relatives and people spoken with knew how to complain if they needed to.

Systems for assessing the quality of the service, supervising and appraising staff and for maintaining records had improved since our last inspection.

People who were able to speak with us made positive comments about the staff. They did not feel that staff were ever rude and felt they were treated well. One person told us, "The staff are brilliant. They help me with what I need like shopping." Another person said, "I'm very happy. Staff are nice. They do talk to me about what I want to do, yes." Others told us staff were good and got on well with them. Where people were not able to speak with us we saw that they were comfortable in approaching staff on duty and heard some of them laughing round the table while staff talked to them during their evening meal.

We had some concerns about the way records were maintained. Not everyone using the service had the provider's new support plans fully completed and in place in their own homes. In some cases, the support required was not cross referenced with the assessments of risk so the information was not easy to find. Some files had information that was not easy to follow, was repetitive, or had not been maintained to ensure it reflected people's current needs. Copies of many of these records were incomplete in the agency's office, where they could not be located promptly for inspection or monitored by the management team.

We also found that the quality and safety of the service people received was not monitored and assessed as often as the provider's records suggested and that systems for following up improvements were not always robust to ensure that people remained safe.

We did not speak to people using the service during our visit on 28 February 2012.