This inspection took place on 5 and 6 June 2018 and was announced.

Dimensions Somerset, Ashbury 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.

Ashbury is registered to provide care and accommodation for up to eight people. The service specialises in the care of people who have learning disabilities and complex physical disabilities. The building is a single storey bungalow with a range of aids and adaptations in place to assist people who have mobility difficulties. All bedrooms are for single occupancy. The service is staffed 24 hours a day and all areas are accessible to wheelchair users. At the time of the inspection, seven people were living at Ashbury.

The people we met on the day of the inspection had complex physical and learning disabilities and not everyone could tell us about their experiences whilst living at Ashbury. We therefore used our observations of care and our discussions with staff, relatives, and visiting professionals to help form our judgements.

The service had a registered manager. The manager had been registered with CQC since April 2017. 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.

This is the first inspection of this service since it was transferred to Dimensions from the local authority in April 2017.

During this inspection, we identified that the provider needed to make improvements to ensure staff cared for people safely. For example, we identified concerns in relation to risk management. Staff had identified risks to people’s health and safety in care plans but had not always completed a risk assessment and management plan. This meant new staff or agency staff would not know how to manage any identified risks for people.

There were improvements needed to some aspects of medicines recording. We identified the provider had not updated two, ‘when required’ medicines protocols, or recorded staff competency checks. We also found recording of covert medicine administration details were not completed. We have made a recommendation in relation medicines management including how the provider ensures all staff are familiar with the current national guidelines for managing medicines in care homes.

The provider did not carry out checks to make sure infection control was kept to a high standard. We found three of the communal toilets did not have hand washing signs, soaps, or hand towels for people to wash their hands. This meant people were at risk of spreading infections. We raised this with the registered manager who immediately put up hand washing signs and arranged for hand washing products to be refreshed.

At the time of the inspection quality monitoring arrangements had not consistently identified shortfalls within the service. Internal governance systems were either not in place or had not been effective. The registered manager had a commitment to improving the care and support people received. However, they had not carried out internal audits or put an action plan in place with clear objectives to make sure they addressed the actions identified through the provider’s quality and compliance checks. This meant the team found it difficult to know what was a priority. Following the inspection, the registered manager sent us further information that included service reports. These reports had identified actions required to develop the service.

We also identified areas of concern around confidentially and people being involved in their care planning; Care records were kept in places where visitors had access to th