Dimensions is a domiciliary care agency which provides personal care to people in their own homes. At the time of our inspection there were 32 people using the service.

At our last inspection we rated the service good.

There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People told us they felt safe.

We saw evidence of a robust medicine management in place and staff were trained and competent in this area to ensure all policy and procedures were followed.

People and their relatives told us they were happy using the agency and felt the staff had the right training to be able to support them with their care needs.

Individual risks to people's safety were known by staff. Accident and incidents were reported and robust in looking at any lessons learnt.

Staff had regular opportunities to update their skills and professional development. Staff demonstrated an understanding of the Mental Capacity Act (MCA) 2005.

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.

Staff were motivated and worked well as a team, with effective support from one another and from the management team. Staff had supervisions and an annual appraisal as well as team meetings. We saw documentation to support this.

Care records contained clear information covering all aspects of people’s care and support and staff had a caring approach to working with the people who used the service.

There was a clear management structure so that all staff knew their roles and responsibilities. There was an open and transparent culture in which staff felt valued and able to approach the registered manager.

Further information is in the detailed findings below.

This inspection took place on 01 April and 04 April 2016.

Dimensions Wakefield provides domiciliary care across supported living locations, to people with a learning or physical disability in their own homes. Some people require 24-hour care. At the time of our inspection, 18 people were being supported.

The service had a registered manager. 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 told us they felt safe with the staff that supported them.

Staff received training in how to safeguard people from abuse. Staff were supported by the provider who had policies and procedures in place to support staff to act on any concerns raised Staff were familiar with these policies and procedures. Staff understood what action they should take in order to protect people from abuse. Risks to people's safety were identified, minimised and tailored towards individual needs so people could be supported in the least restrictive way possible and build their independence.

People and their families had been involved in planning their care

People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. People told us their medicines were given in a timely way and as prescribed. Checks were in place to ensure medicines were managed safely.

There were enough staff to meet people's needs effectively. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who received services. Staff told us they had not been able to work until these checks had been completed.

People told us staff asked for consent before supporting them in ways they were comfortable with. People were able to make their own decisions and staff respected their right to do so. Staff and the registered manager had a good understanding of the Mental Capacity Act.

People told us, and we saw, staff were respectful and treated people with dignity, and records confirmed how people's privacy and dignity was maintained.

People were supported to make choices about their day to day lives. For example, they were supported to maintain any activities, interests and relationships that were important to them.

People had access to health professionals when needed and we saw the care and support provided was in line with what had been recommended. People's care records were written in a way which helped staff to deliver personalised care and gave staff information about people's communication, their likes, dislikes and preferences. People were involved in how their care and support was delivered.

People told us they felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. Staff told us the management team were approachable and responsive to their ideas and suggestions. There were systems in place to monitor the quality of the support provided.

Two adult social care inspectors carried out this inspection. At the time of this inspection Dimensions (Wakefield) was providing care and support to approximately 60 people.

As part of our inspection we contacted 43 people who used the service or their relatives. We spoke with eight people who used the service and with five relatives to obtain their views of the support provided.

We also visited the agency office and spoke with five care workers and the operations director. In addition we looked at a selection of records.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service and relatives told us they felt safe when the care workers were in their home and that their belongings and furniture were looked after well. Two people said, “there is nothing I’m not happy with.”

We found risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant that people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their lives.

We found there was an effective recruitment procedure in place to ensure people employed were of good character and had the skills and experience necessary for the work they performed

The service had completed enhanced Disclosure and Barring Service (DBS) checks, formerly known as Criminal Records Bureau (CRB) checks for all staff working at the agency. This helped to protect people who were receiving a service.

Is the service effective?

Most people and relatives spoken with said they preferred to have regular care workers that they could get to know and who would know what care they needed. Most people said they did not always have regular care workers and this could be a problem when the care to be delivered had to be explained to different care workers.

There were mixed views from relatives we spoke with. Positives views from relatives were that the regular care workers were really good, supported their loved ones and had a good relationship with them. One relative said, “it’s more than a job [to the staff] it’s like they're looking after their own daughter.”

Three relatives we spoke with were unhappy about the number of agency staff used. One relative told us, “it makes it difficult for [family member] as agency staff have no experience of working with them. Agency staff do not have the time nor the inclination to do tasks.” Another relative told us, “we have discussed with Dimensions the inability to maintain core staff. They always promise to get a core team in place but it always seems to fall apart.”

People who used the service and relatives said that staff, “always turned up and were never late.”

People’s health and care needs were assessed on a regular basis. We saw people who used the service and their relatives had been involved in writing plans of care and these were reviewed and updated regularly.

People who used the service and relatives told us they thought their regular care workers were experienced and well trained. Relatives did not feel that some of the agency staff were so well trained. One relative said, “a lot of agency workers are used and things go wrong. Our [family member] needs a very restricted diet and also needs exercise and if agency staff are working they wouldn’t be able to take them out as they are frightened of their disability and they can’t cope.”

Is the service caring?

People who used the service told us most care workers were kind, patient, cheerful, polite and caring, especially their regular carers. Positive comments included, “I do like living here, yes they do look after me. They [staff] help me to get dressed and prepare food,” “it is a nice place to live” and “nothing I’m not happy with.”

Relatives told us, “it’s been excellent and very poor. It varies a great deal due to staff moving in and out. There are some good staff and some terrible staff, so it’s not a consistent service” and “we’re really happy. She’s [daughter] got a lovely social life, better than she had with us. Staff help with everything from personal hygiene to preparing food. It’s 24 hour care. Staff work in shifts and there’s always somebody with her.”

Is the service responsive?

Relatives said they would contact the office if they had a concern or a complaint. They all knew how to contact the office. In the main relatives said they had a good relationship with office staff and managers'. One relative said, “office staff keep us informed of meetings etc. and have told us we can contact them at any time if we have any worries or concerns.”

One relative told us they had raised a concern with a manager twice and had not been given any feedback regarding their concern. The relative said they were disappointed that no one had done anything. We fed this back to the operations director who was unaware of this concern and said he would deal with it.

Is the service well-led?

Satisfaction surveys and review meetings had been used to enable people to share their views on the service provided. This helped the provider to assess if people were receiving the care and support they needed. We found evidence to confirm people had been listened to and changes made to improve their care and support package.

When asked if there was anything about their care service they would change, the most common response was: care to be provided from regular, experienced carers and less from unknown carers (agency staff).

We spoke with 20 people who used the service or their families where people were not able to speak with us. Seven people we spoke with were face to face, five of whom were in their own homes and the remainder we spoke with by telephone. People told us they were satisfied with the service they received. Most family members who spoke on behalf of people who used the service said they were satisfied with the standard of care.

We saw how staff interacted with people in their own homes and we spoke with six care staff in person and one staff over the telephone. We also spoke with one locality manager, the operations director and the regional managing director. We observed staff to be patient and kind with people. Staff demonstrated a good knowledge of people’s individual needs and personal preferences.

We looked at care documentation for four people which showed their individual needs were identified.

We found staff understood their responsibilities to ensure people were safeguarded from abuse. People told us they felt safe when they were supported by Dimensions.

We spoke with six care staff about how they felt supported by their managers to carry out their work and had opportunities for training and development. We saw evidence of support systems for staff.

We looked at the complaints policy and a record of how any complaints had been dealt with. Most people and their families told us they would know what to do if they were unhappy with the service and wished to complain.

On this occasion there was not the opportunity to speak to people using the service, however, a sample of service customer satisfaction surveys show, people make decisions about where they live and what happens to them.

The surveys also show, they are happy with where they live and the way they are treated by support staff.

The sample of customer satisfaction surveys show, they have a say in choosing who supports them and they are supported by staff to do the things they want to do and spend time with the people they like and want to be with.

On this occasion there was not the opportunity to speak to people using the service, however, a sample of customer satisfaction surveys show, people are supported to go out when they want, and to use the same local shops and services as everyone else and also show, people are involved in making changes about their lives.