This inspection took place 19th June 2018 and was unannounced.

Dimensions Somerset, The Brambles 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.

The Brambles is registered to provide care and accommodation for up to seven 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 Brambles.

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 Brambles. 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 plans. We did address this with the registered manager who began updating risk assessments during the inspection process.

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, and we could see areas of the service had not been cleaned thoroughly. The manager told us they would arrange for a deep clean of the service to take place and implement regular hygiene checks.

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 quality monitoring arrangements had not consistently addressed identified shortfalls within the service. 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 them. When we raised this with the registered manager they immediately contacted the operational director and requested locked cupboards to be fitted in people’s rooms so that records could be stored securely. We have made a recommendation in relation to the storage of records and care planning. Including demonstrating how the provider involves people and their relatives in all aspect of care and support.

Although there were some concerns around how the provider managed risk in the service, we did observe people looking relaxed and happy. The provider had safeguarding systems in