About the service:

Dimensions Yorkshire and Humberside Domiciliary Care office is based in Sheffield city centre. The service provides home support and personal care for people with learning disabilities and complex care needs in their own home. Some people live in supported living accommodation. The service primarily supports people living in the Sheffield and Barnsley areas.

There were 138 people being supported by the service at the time of our inspection: 97 of these were through the domiciliary care service and 41 in supported living accommodation.

People’s experience of using this service:

Assessments and care plans were developed with people and relatives and people’s needs and choices were paramount. There was a strong focus on people’s outcomes.

Risk assessments were detailed and specific to each individual; consideration was given to people’s independence.

Staff were knowledgeable about the people they supported, their preferences and their communication needs. Interactions were warm and caring.

The service had a strong vision of high-quality care and staff were committed to this.

Processes were in place to safeguard people from abuse and staff were knowledgeable about these.

Staffing received regular training and their competency was checked.

There was a strong governance framework. Managers had good oversight. Accidents and incidents were recorded, monitored and used to evaluate and improve the service.

Rating at last inspection:

Dimensions Yorkshire and Humberside Domiciliary Care was rated Good at the last inspection (report published 10 November 2016).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people 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 we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 26, 28, 30 September 2016 and the 5 October 2016. The registered manager was given short notice before our inspection that we would be visiting the service. We did this because the registered manager is sometimes out of the office and we needed to be sure that they would be available. We also wanted to ask people’s permission to visit them in their supported living accommodation or in their own home. The service was last inspected on 3 December 2013 and was meeting the requirements of the regulations we checked at that time. This was the first rated inspection of the service.

Dimensions Yorkshire and Humberside Domiciliary Care is based in Sheffield city centre. It has offices on the first floor. The office is accessible to wheelchair users via a lift. The service provides home support and personal care for people with learning disabilities in their own home. At the time of the inspection the service was supporting 58 people. Some people lived in one of the ten supported living accommodation sites or in their own home.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

During the inspection we were not able to speak with some people using the service because we were unable to communicate verbally with them in a meaningful way.

Staff were respectful and treated people in a caring and supportive way.

People received care from the same group of support staff and were introduced to any new staff who would be supporting them. If agency staff were used to cover for staff absences the operations director had directed locality managers that agency staff were not be engaged in any lone working situation unless they were well known, tried and trusted.

We received mixed views regarding the on call system staff used to request assistance if there was an unexpected staff absence. Staff supporting people in their own home felt the system needed to be improved so the level of support they received reflected that they were often working on their own. We shared this feedback with the registered manager [the operations director].

The registered provider had appropriate arrangements in place to manage medicines so people were protected from the risks associated with them.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

People had personalised their rooms and they reflected their personalities and interests. We saw the signage in one of the supported living sites could be improved to help people navigate around the building. Some people at the site were living with dementia and they may need such signs to aid them to move around a building.

The service enabled people to carry out person centred activities within the service and in the community and encouraged them to maintain hobbies and interests.

People spoken with told us they were satisfied with the quality of care and support they had received and made positive comments about the staff.

The locality managers sought advice from other professionals and implemented this to improve their own knowledge and practice.

There was evidence of involvement from other professionals such as doctors, opticians, tissue viability nurses and speech and language practitioners.

People’s nutritional needs were monitored and actions taken where required.

Staff told us they enjoyed caring and supporting people using the service. Staff were able to describe people’s individual needs, likes and dislikes.

Staff received

We visited two people in their home. We found that some people who used the service had complex needs and we were not able to verbally communicate with them so that they could share their views and experiences with us. We observed staff interactions with people and we saw that staff treated people with respect and had professional, positive relationships with them. We spoke with one person at the main office. They told us that they were very satisfied with the support they had received. Their comments included; "They do a really good job." "They speak to me with respect." "I picked my support workers."

All the relatives we spoke with were satisfied with the quality of care their relative had received. Their comments included: "Staff are very courteous and respectful." "Staff are very good." "They support him to be as independent as possible."

We found that staff were clear about what their roles and responsibilities were and what action they would take if they saw or suspected any abuse.

The provider had a recruitment and selection procedure in place to ensure that staff were appropriately employed. We found that staff had received training.

We saw that the service had provided people with information about how to complain. One person told us that if they had any concerns they would speak to staff. All the relatives we spoke with had no concerns but most felt confident that if they had a concern it would be handled appropriately.

We found that some people who used the service had complex needs and we were not able to verbally communicate with them so that they could share their views and experiences with us. We observed staff interactions with people and we saw that staff treated people with respect and had professional, positive relationships with them. We spoke with three people at the main office and they gave us a “thumbs up” to confirm that they were treated with dignity and respect. They also told us that they were involved in decisions and that their choices were respected.

We attended the provider’s service user meeting "everybody counts". People told us how they decided what support they received. People's comments included: "my manager and myself, I get to see who will support me before they start supporting me" and "I interview my own staff with the manager".

People spoken with told us that they felt "safe" and if they had any concerns they would speak to staff or a family member. All staff spoken with were clear about what their roles and responsibilities were and what action they would take if they saw or suspected any abuse.

We saw that there was a robust process in place to ensure that staff received training to support them to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people received.