Disabilities. There were three people living there at the time of our inspection. The home had two floors; each person had their own bedroom. On the ground floor there was a kitchen, dining room and lounge. All doors were wide enough to accommodate wheelchairs, and people had access to a rear garden.

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. 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’s healthcare needs were met. People were supported to eat and drink in line with their nutrition assessments. People were supported to have maximum choice 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. 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 interests and reflected people’s preferences. One person told us they knew how to complain and there were a range of opportunities for them to raise concerns with the manager and designated staff.

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

This inspection took place on the 22 December 2015 and was unannounced. When the service was last inspected in December 2013 there were no breaches of the legal requirements identified.

Dimensions Theobald House is registered to provide care and support for up to four people with a learning disability. The home is located in a residential street in Bath. On the day of our inspection three people lived at the service.

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 who used the service were unable to tell us of their experience of living in the house. We found that 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 capacity to make informed decisions.

Staff endeavoured to keep people safe because they understood their responsibilities should they suspect abuse was taking place. They knew the protocol of how to report any suspected concerns. Risks to people’s safety had been assessed and measures had been put in place to mitigate these risks. For example, if people were at a risk of choking they had been assessed by an appropriate professional and guidance was in place for staff.

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

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

There were enough staff on duty to meet people’s needs, both within the home and when people wished to go out. Staff we spoke with felt the staffing level was manageable The provider’s recruitment procedures helped ensure that only suitable staff were employed to work in the service

People’s medicines were managed safely. People were supported with their medicines by staff and people had their medicines when they needed 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. Staff treated people with respect and supported them in a way that maintained their privacy and dignity.

People’s individual care plans reflected the most up to date care people required. Care plans were person-centred and focussed on the individual and their specific needs. People had access to a wide range of activities which were both individualised as well as being meaningful to them.

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

We used a number of different methods to help us understand the experience of people in this service, because people were unable to verbally communicate with us and were not easily able to tell us about their experiences.

There were four people in this service at the time of our visit. We viewed care records, observed staff interactions and spoke with the manager and three staff.

We saw that people who use this service received good quality of care and support. People were routinely encouraged to express themselves and were involved in their care and support as they liked. People's choices were promoted at all times and staff were very knowledgeable about each person's support needs.

During our visit, we saw that staff treated people with dignity and respect, and were supportive and patient. They spent time explaining and reassuring people when they were with them.

People's families were encouraged to be involved in developing their relative's support plans where the person wished. We saw that support plans were person centred and reflected each person's individuality.

Staff told us "it's lovely to work here because the people give so much back to us". Another staff told us "working here is a joy".

Care records demonstrated that people were protected from abuse and that their care was delivered in a respectful and safe way.

We saw that the manager had a system for monitoring feedback from others, with a view to looking to improve.

We used a number of different methods to help us understand the experience of people in this service, because the people using the service were unable to verbally communicate and were not able to tell us about their experience.

There were four people in this service at the time of our inspection. We observed interactions and spoke with three members of staff.

We saw that people who used this service received good quality of care and support. People were encouraged to express their views and were involved in their care. People’s wishes were promoted at all times and staff were knowledgeable about their support needs.

We saw staff treating people with dignity and respect, were unhurried, supportive and patient at all times. They explained and reassured people when they were supporting them.

People and their families were encouraged to be involved in how the service was run and how support plans were developed. Plans were person centred and reflected each person’s needs and preferences.

We spoke to staff and reviewed records which showed us that people were protected from abuse and that their care was planned and delivered in a respectful and safe way.

From viewing records, we saw that complaints and concerns were listened to and acted upon immediately. We saw that the service took all reasonable steps to prevent the possibility of any abuse from happening.

We saw that people had active social lives and appeared happy.

We visited Theobald House on 5 March 2012 to follow-up on some improvements that were needed following a planned review in December 2011.

We found that people who lived at Theobald House had a review carried out of their capacity to make decisions. We saw that where people were assessed as not being able to make certain decisions that best interest meetings would be held with relevant people who spoke for that person.

The medication administration record charts, care records, and hospital admission records now correctly recorded people's medications and allergies and intolerances, where appropriate.

Staff were now having regular supervision and all staff were booked for appraisals with the manager. This would be concluded by the end of March 2012.