Dimensions Worcester Domiciliary Care Office is a domiciliary and supported living service for people with learning disabilities. The provider currently supports 105 people live in their own homes.

At the last inspection December 2015, the service was rated Good. At this inspection on 21 and 22 November 2017 we found the service remained Good.

Why the service is rated Good

People continued to receive care which protected them from avoidable harm and abuse. Risks to people’s safety were identified and measures were in place to help reduce these risks. When people required support to take their medicines this only happened when staff had received the training to do so. Regular checks on staff practices were undertaken to support people’s safety.

Staff were available to respond to and meet people's needs safely without people feeling rushed. Recruitment checks were completed on potential new staff to make sure they were suitable to support people in their own homes. People were involved in the recruitment of staff, who would be potentially supporting them.

People were provided with care which continued to be effective in meeting their particular needs. Staff had received training to provide them the skills and knowledge they needed to provide the right care and support people required.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice

Staff asked people's permission before they assisted them with any care or support. People's right to make their own decisions about care and how they were supported by staff was respected. When needed, arrangements were in place to support people in remaining in good health and have enough to eat and drink. People were assisted to choose and prepare food menus so their independence was maitianed.

People continued to receive support from staff that had a caring approach. People knew the staff that supported them and had good relationships with them. People felt involved in their own care and staff listened to how they preferred their care and support to be delivered. Staff respected people's privacy and dignity when they supported them and promoted their independence. People were supported to follow their own interests and hobbies.

People were provided with care and support which was individual to them. Their care and support needs were kept under review and staff responded when there were changes in these needs.

People were encouraged to raise concerns and make complaints and were happy these would be responded to. The management team used feedback from complaints and questionnaires to assist them in identifying areas of improvements for the benefit of people. The provider arranged forums throughout the year so people could express their opinions on the service delivered.

Staff were happy in their work and were clear about their roles and responsibilities. There was an ethos of continuously looking for improvement of the service delivered.

There was a clearly defined management structure which had changed since our previous inspection. People felt listened to when they provided feedback about the service they received and knew about the changes. The management team worked well together and developed systems so they continued to be effective and responsive in assessing and monitoring the quality of the service provided.

This inspection took place on 4 December 2015 and was announced. We gave the registered manager 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their homes and we needed to be sure that someone would be available at the office.

The provider registered this service with us to provide personal care and support for people with learning disabilities who live in their own homes. At the time of our inspection 21 people were being supported by the provider.

There was a registered manager in post. 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 this service were kept safe as the provider, registered manager and support staff had a clear understanding of risks and how to manage them effectively. There were sufficient staff employed to meet the needs of the people they support, enabling them to enjoy activities of their choice. The provider had procedures in place to ensure people received their medicines as prescribed and to effectively and safely meet their health needs.

Staff had been recruited following appropriate checks on their suitability to support people in their own homes and the community. People felt the support staff knew them well and respected their preferences. Before supporting people staff asked people’s consent, but were aware of what procedures to follow if a person didn’t have the mental capacity to make their own decisions.

People were happy that staff supporting them assisted them to keep their independence and gave them choices. People were assisted by staff to stay healthy and access health and social care services as required.

Staff were trained and understood the best ways to communicate with people using a variety of communication aids.

People’s needs were assessed and staff understood these needs and responded appropriately when people’s needs changed. People’s interests and preferences were documented and they were encouraged to pursue social events and areas of interests. Social activities were an important priority for people and the staff who supported them.

The provider actively sought people’s opinions about the quality of the service they received through satisfaction questionnaires and workshops.

Leadership of the service at all levels was open and transparent and supported a positive culture committed to supporting and enabling people with learning disabilities.

When we carried out our inspection the provider provided personal care for 13 adults. The majority of people who received personal care had learning disabilities. Many of the people who received personal care did so in supported living schemes where people had 24 hour care. Other people lived in their own homes or with family members. Due to people’s complex needs and communication difficulties we were limited in the number of people we could speak with. People’s complex needs also reduced the extent to which we could discuss with people who used the service their experience of the service.

During this inspection we spoke with the service manager and the deputy service manager. We also spoke with three support workers and two people who received personal care who came into the office during the inspection.

Following our inspection we spoke with one person who used the service on the telephone and with two relatives of people who used the service. We also spoke with another two members of staff who visited people to provide care.

People we spoke with were complimentary about the care and support they or their relative had received. We were told that consent was gained prior to the provision of care. One relative told us that they were: “Confident” in the care provided and that they were: “Very happy with the situation”. Another relative described the staff as: “Excellent”. A member of staff told us that the provider: “Tends to get staff who match the support people need”.

Staff had been recruited in an appropriate way and checks had been undertaken to make sure that they were suitable to care for people who used the service.

We saw that staff had received training and support which enabled them to care for people who used the service. One member of staff described the service manager as: “Very approachable”.

The provider had systems in place to enable them to monitor the quality of the service provided. This was to make sure people received appropriate care. The registered manager was aware of where improvements in the service were needed.

The agency supplied care workers to a limited number of people. We spoke on the telephone with one person who used the service and met one person face to face who used the service. We were not able to speak with many people who use the service because they were unable to communicate verbally to us. People we spoke with told us they were able to express their views and had been involved in making decisions about the care and treatment required.

People were treated with dignity and respect in their own homes. People who used the service told us they expressed their views on how they wanted to maintain their independence and care workers we spoke with told us how they supported people in their choice.

People were complimentary about the care and support people received. One person we met had limited communication, however he used positive gestures when asked questions about his care. Another person said, “I find them very friendly”.

People were safeguarded as the provider had taken steps to ensure any potential instances of abuse could be identified and reported. Care workers we spoke with told us they felt supported by the manager to take appropriate action where required.

People were cared for, or supported by a sufficient number of care workers who could meet their care requirements.

We checked the provider had systems in place to measure the quality of the service being provided.