Dimensions Fountain House is registered to provide accommodation for up to eight people who require personal care. At the time of our inspection there were seven people living at the service. The people who live at the service have learning disabilities and profound physical needs.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated good:

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Risks to people were assessed and where required a risk management plan was in place to support people manage an identified risk and keep them safe.

Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. People’s representatives told us that they were satisfied about their relative’s safety.

People received effective support from staff that had the skills and knowledge to meet their needs. The provider ensured that new staff completed an induction training programme which prepared them for their role. Staff received on-going training to enable them to fulfil the requirements of the role.

Staff were supported through a supervision programme. Supervision is where staff meet one to one with their line manager to discuss their work and development.

People were supported to maintain good health and had access to external health care professionals when required.

Staff were caring towards people and there was a good relationship between people and staff. Staff demonstrated an understanding of the needs and preferences of the people they cared for.

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

There were systems in place to assess, monitor and improve the quality and safety of the service. To ensure continuous improvement the provider had a service improvement in place. This provided actions required within set timelines.

Further information is in the detailed findings below.

This inspection took place on the 18 December 2015 and was unannounced. When the service was last inspected in September 2013 there were no breaches of the legal requirements identified.

Dimensions Fountain House is registered to provide accommodation for up to eight people who require personal care. At the time of our inspection there were seven people living at the service. The people who live at the service have learning disabilities and profound physical needs.

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’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. We saw information in people’s support plans about mental capacity and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been applied for appropriately.These safeguards aim to protect people living in homes from being inappropriately deprived of their liberty.

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

Where appropriate people were encouraged to maintain contact with their family and were therefore not isolated from those people closest to them.

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. Staff were caring towards people and there was a good relationship between people and staff. People and their representatives were involved in the planning of their care and support. Staff demonstrated and in-depth understanding of the needs and preferences of the people they cared for. Specific cultural requirements were respected and enabled by the service, such as dietary requirements.

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.

There were systems in place to assess, monitor and improve the quality and safety of the service.   

The people who lived at the home were not able to tell us about their experiences of living at the home. This was because they had profound learning disabilities with physical care needs. We used SOFI to observe the way staff interacted with the people they were supporting.

Overall staff interacted well with people. We heard staff respond to people’s vocal sounds and we saw people enjoyed this interaction because they smiled. We heard staff explain to the person the task that was about to take place. Staff said “you are staying with me is that ok?” and “shall we take these splints off?” The staff knew the people that became anxious when tasks were taking place and used distraction techniques.

The staff knew the decisions people were able to make and how they expressed these decisions. Staff knew some people made decisions by refusing or by accepting their support. On the day of the inspection we were present while staff made a best interest decision for one person. Staff discussed their interpretation of the person’s behaviour and together they reached a best interest decision. The decisions staff made was the least restrictive to the person.

The staff we spoke with knew the needs of people they supported but the care plans were not detailed and staff said they were more useful to new staff. Staff told us they relied on daily reports and handovers which gave them more information about people’s changing needs.

We saw people smile and reach out for the staff. The staff we asked knew the signs of abuse and they knew it was their duty to report abuse.

Staff attended training that met the needs of the people they supported and supervision was the system used by the manager to monitors staff performance.

We visited Dimensions Fountain House on 27 July 2012 and spent the day at the service. We were accompanied for most of the visit by the registered manager and the deputy manager.

The seven people who lived at Fountain House when we visited had been at the service for many years. A number of them had lived there since they were children. Each person had profound physical and learning disabilities. We were therefore not able to talk with them about their experiences. Two people were home all day when we visited and we observed how they were supported. The five other people were out at daycentres or being supported to go swimming or with other activities. We met the other five people towards the end of the day when they came home.

Our evidence for this inspection came from talking with the parent of one person who lived at Fountain House. We also observed care provided by staff during the day and saw how staff carried out their daily roles and responsibilities. We talked with staff on duty and interviewed some at length. We looked at support plans and other records about how the service was run. We inspected the premises for safety and suitability and carried out a review of the management of medicines. We also looked at nutrition and hydration to see if people were supported to eat and drink sufficient amounts for their needs.

The parent we met told us the service was “pretty good now” and had “improved”. The home involved the family in the support planning for their relative. They were also able to get involved with the service through social events taking place from time to time. We were told staff “worked hard on hydration” and provided the person with a safe and healthy eating regime. This included fresh fruit and vegetables. A dietician and speech and language therapist had been involved with planning nutrition and training staff in preparing food and assisting people with eating. The service also involved physiotherapists and occupational therapists to improve and support the person’s posture. A new chair had recently been acquired to provide better and safer positioning for the person. Staff supported the person to visit a daycentre and to visit a hydrotherapy service.

During our observations we saw people’s rooms were decorated tastefully and where possible with people’s own possessions. There were photos of people who lived at the home around the walls. The home had sensory objects on the walls to help people with orientation. The home was safe and suitable for the people who lived there. It was clean and tidy. Most areas of the premises were safe and well maintained. The bedrooms and communal areas were fit for purpose. People were able to safely access the kitchen and garden with staff assistance.

When we were at the service, staff demonstrated how well they knew people’s needs and ensured people were treated with privacy and dignity. We checked how the service was administering medication and found this done safely. There were enough staff with the right skills at the service to meet people’s needs.

We observed staff treat people with affection, warmth and kindness. Staff were patient and their work centred on the people who lived at the home.