Dimensions Newton House (formerly Tanners Walk) is a service providing respite care for people with learning disabilities and/or physical disabilities. It is registered to accommodate up to five people who require personal care. There were 22 people currently using the service, although a maximum of five people stayed at the home at any one time. At the time of the inspection, three people were staying there. The service is located in a residential area on the edge of Bath.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

The home continued to ensure people were safe. There were enough suitable staff to meet people’s needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People received their medicines safely and, where possible, were supported to administer their own medicines. People were protected from abuse because staff understood how to keep them safe, including more senior staff understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised.

People continued to receive effective care. People who lacked capacity had decisions made in line with current legislation. Staff received training to ensure they had the skills and knowledge required to effectively support people. People told us, and we saw, their healthcare needs were met. People were supported to eat and drink according to their likes and dislikes. 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 practice.

The home continued to provide a caring service to people. People and their relatives told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People were involved in decisions about the care and support they received. People’s choices were always respected and staff encouraged choice for those who struggled to communicate with them.

The home remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. People were supported to follow their own activity programmes. These considered people’s hobbies and interests and reflected people’s preferences. People knew how to complain and there were a range of opportunities for them to raise concerns with the registered manager and designated staff.

The home continued to be well led. People and staff spoke highly about the management. The registered manager continually monitored the quality of the service and made improvements in accordance with people’s changing needs.

The service met all relevant fundamental standards.

This inspection took place on the 12 August 2015 and was unannounced. When the service was last inspected in September 2013 there were no breaches of the legal requirements identified.

Dimensions Newton House provides respite care for people with learning disabilities and/or physical disabilities. It is registered to accommodate up to five people who require personal care. The service is located in a residential area on the edge of Bath.

The people met by the inspector on the day, stay frequently either each week or for long periods of time, however, the service have a number of people whose stay may vary from weekly, less frequent monthly or for some, an annual holiday break. At the time of our inspection four people were staying at the house.

A registered manager was not 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. We were told that a new manager has been appointed and is due to start in September 2015.

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, or had variable capacity to make informed decisions.

People felt safe staying at the home and the provider had arrangements in place to respond to suspected abuse. Positive comments were received from people and 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 safely with their medicines by staff and we observed people having their medicines when they needed them.

People received effective care and gave positive feedback about the staff that supported them. We received positive comments from people we spoke with at the home and relatives about the staff. One relative commented, “The staff are very knowledgeable. They’re very calm and take things in their stride.”

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. People’s support records reflected people’s involvement and the decisions made in their care planning. Staff understood the needs and preferences of the people they cared for.

People were involved in activities of their choice and staff continually ensured the support people received was in line with their wishes.

There were arrangements in place for obtaining people’s feedback about the service. The provider had a complaints procedure and people felt confident they could speak with staff about matters of concern. People who had raised concerns felt they had been listened to and thought the manager was approachable.

When we visited Newton House in June 2013 we found some concerns with the management of medicines. We told the provider to improve in this area. The manager sent us an action plan about how the service planned to improve.

We went back to Newton House in September 2013 to check on these improvements. We found the provider had made the existing systems more robust, and the records and procedures for management of medicines had improved.

People who stayed at Newton House (formerly known as Tanners Walk) for respite care usually lived in the community, often with their parents or other family members. The service supported people with learning disabilities, some whom were quite independent, and others less so. Some people had physical disabilities and needed support with personal care and mobility. Most people came regularly for several days each week or each month. Some came when their regular carers were going on holiday or might have to visit hospital.

People we met said they were happy with the support they received at Newton House. Relatives of people who stayed there regularly were also happy with the care and support for their family member. One relative said the person "looks forward to coming here." Another relative said "we get a break from each other, and they enjoy going to stay there." This person said "the staff have been there a long time and are pretty good." A person who used the service regularly described the staff as "kind" and another said "they are good and I like them all really."

We found the service made sure people had food and drinks when they needed them, although needed to look at the nutritional value of some food they provided. Staff understood how to keep people safe and report any concerns. Staff were trained to carry out their roles, although support needed to be regularly delivered. The management and administration of medicines required improvement.

We went to the Dimensions' respite facility at 10 Tanners Walk on 20 November 2012 to follow-up on concerns identified at a scheduled review in July 2012. At the July visit we identified a concern around some of the support plans and associated paperwork being incomplete or contradictory in places. We judged this had a minor impact of people who used the service.

We were not able to talk with people who stayed at Tanners Walk for respite care as they were out in the community on the day we visited. We met a number of them and talked with their relatives during our review in July 2012.

On this visit we found improvements had been made to records, although there were still some areas needing more thought and attention to detail.

We visited Dimensions 10 Tanners Walk on 24 July 2012 and spent the day at the service. We were accompanied for most of the visit by the deputy manager and later in the day by the registered manager.

We met two of the three people staying at the house for respite care. The third person was visiting a local day centre at the time of our visit. One of the people we met was able to talk with us at length about their experience of staying at Tanners Walk. They said: “staff are very kind, very caring”. The other person had limited communication but was sitting in the kitchen with staff and laughing and smiling. We asked them if they were “OK” and they said “yes”. We said “are you happy here?” and they said “yes” with a big smile on their face.

We telephoned the parents of two of the people who stay at Tanners Walk. One was the parent of a person at the home when we visited. The other was the parent of a person we met on a previous visit and a regular visitor to Tanners Walk for respite care. One parent said staff were “brilliant” and “give me a real break”. Staff “got to know people they look after really well”. The other parent said staff were “very caring” and “flexible and helpful”.

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 and had been enough staff with the right skills at the service to meet people’s needs. When new people came to the service they were able to have short introductory visits and staff were able to assess their needs. Families and carers were able to contribute to new and ongoing support plans and see how needs were being met.

Our one area of concern was with records of people’s support needs which were not fully accurate or adequately maintained in places. Records were confidentially held and secure, but some were contradictory or not complete. We have asked the provider to make improvements to these records. Other records were fit for their purpose and held securely.