About the service: Dimensions Somerset Taunton Domiciliary Care Office is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older and younger disabled adults including people on the autistic spectrum. Many of the people using the services have limited verbal communication.

This service provides care and support to 65 people living in 10 different ‘supported living’ settings, so that they can live in their own home as independently as possible. Many of the people using the service required up to 24-hour support from staff due to their disabilities. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The provider was aware of their responsibilities of developing care and support 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’s experience of using this service:

The majority of people were happy and relatives told us their family member was safe. The management were proactive and responsive to anything we found during the inspection to maintain people’s safety. Medicines were managed safely, although the storage of medicines in fridges could be improved. Risks to people had been identified with ways to mitigate them. Systems were in place to manage the levels of people’s anxiety to reduce the likelihood of behaviours which could challenge themselves or others. People were protected from the spread of infection.

The provider and management had completed a range of audits to identify concerns and issues at the service. When these had identified issues, action had been taken to resolve them. They had strong values of improving the support people received. Systems were being put in place to involve people and their families to be part of the improvement discussions.

People and staff felt there were enough staff, although some relatives thought there could be more staff to increase community opportunities. Staff had received a range of training considered mandatory by the provider. In addition, staff had received a range of specialist training to meet people’s needs. There were occasions specific training had not been identified because of changes in the management of a specific supported living setting. Actions to resolve this were taken during the inspection.

Many people using the service lacked capacity to make specific decisions and there were appropriate systems in place to make them. People were involved in making choices about their day to day care and these were respected by staff. Relatives were actively encouraged to be involved in the decisions when people were unable to make choices for themselves.

People had care plans which were personalised and provided a wealth of information for staff to use to support their needs and wishes. There were some inconsistencies about how frequently people had their care needs reviewed. There were good links with other health and social care professionals.

People were supported by kind and caring staff who knew them incredibly well. Staff respected people’s privacy and dignity throughout the inspection. People’s individual culture wishes were valued and facilitated by staff. Links had been developed with the community.

More information about the detailed findings can be found below.

Rating at last inspection:

At the last inspection, published on 6 June 2018, this service was rated good.

Why we inspected:

This inspection was brought forward due to information of risk or concern we had received.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as

per our re-inspection programme. If any concerning information is received w

This inspection took place on 24 and 26 April 2018 and was announced. We gave the provider short notice of our inspection due to the nature of the service. This was so the registered manager could be available to assist us with our inspection.

This service provides care and support to people living in their own homes up to 24 hours a day, in a variety of settings, mostly single occupancy flats or houses. This means people can live in their own home as independently as possible. All of the people supported are living with either a learning disability and/or Autism Spectrum Disorders. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.

The service had a manager who has been registered with CQC since July 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 taken over by Dimensions from the local authority in April 2017.

People told us they felt safe. Safeguarding and whistleblowing policies and procedures were available for staff to access. The provider carried out risk assessments that included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person.

People were kept safe from potential abuse because there was safe recruitment processes were completed. The provider made sure there was enough staff cover across the geographical area so people received a consistent and reliable service, although people did not know who the registered manager was.

The provider had policies and procedures in place to manage health and safety this included the management of incidents and accidents.

Staff had access to medicines policies and procedures to guide them on managing people’s medicines safely. The provider was currently updating these policies. Staff followed good infection control practices

The provider had suitable processes to assess people’s needs and choices to check the service could meet the person’s needs. Staff had the appropriate skills, knowledge, and experience to deliver effective care and support. All staff completed an induction when they started to work for the provider. There was a system in place to remind staff when their training was due to be renewed.

The provider worked across organisations to deliver effective care, support, and treatment.

Care records demonstrated staff shared information with professionals and involved them appropriately.

The registered manager and staff had received training on the MCA. Staff asked people for their consent before delivering care or support and they respected people’s choice to refuse care. We observed staff being kind, compassionate, and caring. Staff we spoke with demonstrated enthusiasm about their role. Staff maintained people’s privacy and dignity. Staff knew about confidentiality.

Where appropriate, the provider consulted with other people involved in people’s care and involved them when writing up their support plan. The support plans were detailed, clearly set out and easy to read. Activities reflected people's needs and interests outlined in their care plans. People were encouraged to be active members in their community.

The provider promoted communication and information sharing in line with the Accessible Information Standard. There was a system in place to manage and investigate any complaints.

There was a registered manager at the service. The registered manager had a clear understanding of the key values and focus of the service. Staff that had a clear line of accountability supported people.

Staff had a