Dimmingsdale Bank provides accommodation with personal care for adults with learning disabilities, autistic spectrum disorder or mental health needs. At the time of our inspection the service was supporting six people. At the last inspection, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

People we spoke with told us that they felt safe in the home. Assessments identified how staff were to support people from any risk of harm presented by their conditions. People were protected from abuse by staff who knew how to recognise if a person was experiencing or at risk of abuse. People were supported by enough suitable staff to meet their care needs and keep them safe. People were supported to take their medications safely. There were effective practices and policies to prevent and control the spread of infection. Staff maintained records of harmful incidents such as falls. This enabled them to identify any trends and how the risk of them happening again may be reduced.

People we spoke with told us that staff were good at meeting their needs. People’s needs had been assessed and plans were in place to provide safe and effective care. People had been involved in developing their care plans to ensure they reflected their needs and wishes. The needs of people were met consistently by staff who had the right knowledge and skills. People were supported to receive food and drinks they enjoyed. Staff communicated effectively between themselves and with other organisations. People were supported to live healthier lives and have access to other professionals. The premises were suitable to meet the needs of the people who used the service. Staff demonstrated an understanding of people’s rights to choose how they lived their lives and respected their decisions.

People who used the service told us that staff were caring. Consistent staffing had enabled people to develop meaningful relationships with the staff who supported them. People were supported to express their views and staff were skilled at giving people the information and explanations they needed and the time to make decisions. This helped people to feel listened to and included in how the service was run. People were supported to lead as independent a life as possible while remaining safe. Staff respected people’s privacy and were discreet when people required support with personal care.

Staff responded promptly to people’s needs and were knowledgeable about the activities that people enjoyed. People’s changing care needs were identified promptly and regularly reviewed with the person. There was a range of ways for people to feed back any concerns they may have. Staff took action in response to information shared in order to improve the support people received. People had the opportunity to discuss their end of life wishes if they wanted.

People we spoke with, and their relatives, told us that they felt the service was well run. The registered manager could explain the principles of promoting an open and transparent culture in line with their required duty of candour. The provider monitored the quality of care people received and had taken action when necessary to improve how people were supported. Systems were in place to ensure regular auditing of the service and reviews were conducted to identify trends and when further improvements were necessary. The provider had worked in partnership with other agencies so people experienced continuity of care when they visited other services.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 14 June 2016. During that inspection we found that although the provider was not breaching any regulations the service required improvement. This was because we had concerns about how staff were deployed to support people engage in activities they enjoyed, medication reporting, risk management and how people were being supported to choose how they make decisions about their care. As a result we undertook a focused inspection to check whether the provider had made those improvements. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection in June 2016, by selecting the 'all reports' link for Dimmingsdale Bank on our website at www.cqc.org.uk”

The focused inspection took place on 20 March 2017 and was unannounced. Dimmingsdale Bank is a care home for up to seven people who have learning disabilities. At the time of our inspection, six people were using the service.

There was a registered manager in place who was present during our 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

All the people we spoke with said they liked living at the home. People’s relatives said the service met the needs of the people who use it and spoke very highly of the care staff and registered manager.

People told us that they felt safe in the home. Staff had received training and could explain the actions they would take if they felt a person was at risk of or experiencing abuse.

Staff knew how to support people to take their medication as prescribed however records were not always completed consistently. There were clear instructions for staff about how to administer ‘as and when required’ medication. There was no clear guidance on the temperature at which medication was to be stored.

There were enough staff to support people to participate in activities they liked. People engaged in a wide range of activities in the home and community. Staff responded promptly to people’s requests for support or to offer reassurance.

People and, where appropriate, their relatives, were consulted about their preferences during care reviews. The registered manager took action to ensure that people’s views were respected.

Staff working in this home knew how to meet the needs of the people who lived there. We saw that staff communicated well with each other.

The registered manager consulted people in the home, their relatives and visitors to find out their views on the care provided and used this information to make improvements, where possible.

This unannounced inspection took place on the 14 June 2016 and was carried out by one inspector.

Dimmingsdale Bank provides care and accommodation for up to seven people with learning and or physical disabilities. At the time of the inspection six people were living at the service. The service has a registered manager who was present throughout the 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.

We last inspected this service in January 2015 and found that the provider was breaching regulations in relation to seeking consent from people and ensuring risks to people were recorded and monitored. Following that inspection the provider sent us an action plan detailing the action they would take to address the breach. At this inspection we found that whilst some improvements had initially been made, in some cases these improvements had not been sustained. The provider had identified risks to people and put measures in place to minimise the risk for the person. We found that systems put in place to monitor these risks to people were not consistently effective.

People living at the home told us they felt safe. People were supported by staff who were aware of the signs of abuse and action to take should they have concerns. We found that although there were sufficient staff to meet people’s daily needs, there were not always enough staff available to meet people’s requests for activities of their choosing.

People received their daily medicines safely and the provider had put systems in place to ensure monitoring of medicines administration took place. We found there was a need to improve some aspects of the management of medicines given on an ‘as required’ basis.

People were supported by staff who had the necessary skills and knowledge to support them. Staff told us they received regular supervisions and felt supported in their role.

Staff had an understanding of the Mental Capacity Act (2005) (MCA) and described how they supported people to make choices. We found that the service had not always followed the principles of the MCA when assessing a person’s ability to make a decision.

People had access to healthcare and support from healthcare professionals was sought when required.

People told us they felt cared for and relatives were complimentary about the caring nature of staff. Staff knew people well and we observed staff supporting people in a calm and unhurried manner. The interactions between people and staff demonstrated that people felt comfortable and relaxed with the staff team.

People had a plan of care that detailed their individual preferences. Staff could describe how they followed this plan to ensure people received care that was centred on their likes and dislikes.

People had been encouraged to maintain their independence and took part in all aspects of the running of the home. People had their dignity and privacy respected.

People had their care reviewed with them on a regular basis. We found that where actions had been identified from these meetings it was not always clear what had been done to resolve this for the person.

Activities took place based on people’s preferences. Staff told us that at times there was not always sufficient staff available to enable some activities to take place.

There were systems in place for people to raise any concerns they may have. Relatives felt able to raise concerns and gave examples of when the service had responded appropriately to concerns they had raised.

People, their relatives and staff were happy with how the home was managed. There were systems in place for people to feedback their experience of care and to suggest changes to service provision.

The inspection was undertaken by one inspector. We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Because of their complex needs, not all the people who used the service were able to tell us their opinion of the care they received. We spoke with one person who used the service, relatives and representatives of four people who used the service, the manager and five members of staff.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe. However we saw that the provider did not always adequately investigate or learn from incidents. This meant that the provider did not responded appropriately to concerns in order to keep people safe.

Care records showed that risks to people had been identified. However not all care records were up to date or contained sufficient information to ensure that staff were able to provide care which kept people safe from the risk of harm.

The provider conducted regular maintenance checks and audits. However, these were not always fully completed. We saw that several fittings were worn or damaged. The provider did not conduct robust cleaning audits or take action when infection control risks were identified. This meant that there was a risk people were cared for in an environment that was not safe, clean and hygienic.

We found that there were generally sufficient numbers of staff on duty. However there was evidence that staff were not supported to complete mandatory training or their probationary period in a timely manner. Therefore there was a risk that staff would not have the skills and knowledge to provide care safely. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people’s safety.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We saw that people living at the home regularly visited people that were important to them and made trips into the community. Information was provided to people in ways which met their communication needs.

Risk assessments had been undertaken and care plans contained information and guidance about people’s specific conditions. However this information was not always updated as people’s care needs changed. Therefore care records did not always enable staff to provide appropriate, safe and consistent support to people living in the home.

People who used the service were asked to comment on the service provided, this included questions about the support they received. The relatives of several people who used the service told us that they had not been involved in reviewing the care their relative received to ensure that personal care was delivered in accordance with people’s specific needs and wishes. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the service is effective.

Is the service caring?

Through observation and from speaking with staff it was apparent that they genuinely cared for the people they supported. We saw staff speak to the people with warmth, dignity and respect. When a person asked for something or support with their care needs we saw that staff responded quickly and effectively.

All the people we spoke to told us that they felt the staff were very caring and feedback from people was positive. For example, one person told us, “The staff who have been there a long time are brilliant.”

People were supported to engage in the local community and maintain the relationships which were important to them. However people were not always supported to live in an environment which respected their dignity. Several fittings in people’s bedrooms and bathrooms were broken or worn.

Is the service responsive?

The service worked well with other agencies and services to make sure people received care in a coherent way. People were supported to attend doctors, dentists and other health appointments when needed. During our visit one person was supported to be visited by a speech and language therapist and we noted that staff had received information and guidance from other professionals to help them meet a person’s changing communication needs.

People were generally supported to comment on the care they received at regular meetings and were given information in a format which met their communication needs. However, there was evidence that some monthly care reviews had not been completed since last year and individual care plans were not always updated as people’s care needs changed.

Relatives of three people who used the service told us that they had not been approached to attend review meetings. One person told us, “They only contact me when [person’s name] has gone into hospital”. This meant that the provider did not regularly seek the views of people’s relatives to review the quality of the service.

The provider conducted several audits to monitor the quality of the service provided but they did not always act on information of concern. At our inspection we noted that no action and been taken by the provider to resolve concerns they had identified as a priority by the provider. A member of staff told us, “We ask for improvements but nothing gets done”. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the service is responsive.

Is the service well-led?

The provider regularly sought the views of the people who used the service. We saw evidence that they had introduced changes to how people were supported in response to comments received. However they did not actively seek the views of people’s relatives and representatives.

Staff had a good understanding of the ethos of the home and had been supported to communicate effectively with people. Staff were not fully aware of the provider’s quality assurance processes that were in place. Audits were not always conducted or fully completed to enable the provider to accurately assess the quality of the service people received. Completed audits were not always signed by the manager to say that they were aware of any concerns raised.

The service had a quality assurance system. However the provider had failed to respond appropriately when these systems had identified there was a risk that the care and welfare needs of the people who used the service were not being met. These included a lack of detailed notes in people’s care records and a failure to respond to health and safety concerns with the home’s environment and fittings. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the service is well led.

People were supported to be able to eat and drink sufficient amounts to meet their needs. We were unable to ask most people about their experience of the service as they had gone out for the day. One person who was at home told us that they liked the food provided by the home. We saw that they were supported by staff to make their own drinks and to make lunch. They told us that they liked to do these things them self.

Staff told us about the range of support needs that people had for food and drink and the agreed methods for managing any risks presented by people's conditions. The service kept up to date with good practice in supporting people with complex needs and conditions to have a healthy and balanced diet and to eat and drink safely.

People told us that their specialist furniture was comfortable. We found that there was enough equipment to promote the independence and comfort of people who used the service. People had equipment that was specific to their needs and for their sole use and it was maintained in good order. The service had a system for regular inspection and servicing of all lifting equipment and portable electric appliances. This protected people from accidents and reduced the risk of fire in the home. Staff were regularly trained and assessed for their competence in moving and handling people safely.

There was a statement of purpose that is kept under review, and a copy had been given to the Care Quality Commission.

When we visited the service on 20 June 2012 we met the five people who were living in the home at that time. Many people were not able to give us their views on the service because of their complex needs and conditions. We used a variety of ways to understand people's experience of the service.

We spent two and a half hours in the dining room/lounge area of the home observing how people were supported and cared for. We saw workers and managers treat people with respect and dignity. People were at ease with workers and responded to their good humour.

People told us that they had a key worker. They said that the staff were very good and always there to help them. Care workers helped them to go shopping and to go out for leisure and educational activities regularly. They said that they were comfortable and happy living at the home.

This inspection took place on 27 and 28 January 2015 and was unannounced.

Dimmingsdale Bank is a residential home which provides personal care for up to seven people with learning disabilities. At the time of our inspection six people were receiving personal care from the service. There was a registered manager at this location. 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.

At our last inspection in May 2014, we found that the provider had breached regulations relating to how people using the service were supported and kept safe. At that time we raised concerns about staff skills and knowledge, how people were supported to make decisions, the provider’s practices to reduce the risk of infection and the quality of the provider’s record keeping. The provider sent us an action plan to tell us the improvements they were going to make to ensure the service would comply with the regulations.

At this inspection we found that the provider had completed actions they had promised in respect of improvements to the premises, maintenance tasks and training updates for staff. The provider had taken action to ensure people were cared for in a home that was properly cleaned and well maintained. We found that the provider had repaired some of the fittings in the home and had ensured that where necessary equipment and furniture had been replaced. Action to address other issues had been delayed due to the absence of the manager for some months whilst on maternity leave. The care and support provided to people in the home had been maintained and people, relatives and staff told us that stability and improvements were being established since the manager’s return. This was not reliably reflected in all records of care provided or in the plans for ensuring care was personalised for each person. People were still not supported to make decisions about the care they received and the quality of the provider’s records had not improved. These issues had not been identified by the providers own system. You can see what action we have told the provider to take at the back of the full version of the report.

All the people we spoke with said that they felt people at the service were safe. However risk assessments of people’s care needs did not consistently contain information and guidance staff required to ensure they supported people safely. Staff could explain the support people required to take their medicines safely but they did not always follow the provider’s medication administration policy.

The provider had ensured that there were enough suitable care staff available to meet the needs of the people who used the service. Staff knew how to meet the care needs of the people they supported and the provider had a training programme for all staff which ensured they had the skills and knowledge they needed to meet people’s individual needs.

The provider did not always follow their responsibilities under the Mental Capacity Act 2005 (MCA) because there were no capacity assessments completed for any of the people who used the service. The provider did not conducted assessments to identify if the care provided was in line with people’s wishes or if less restrictive care options were available. When people lacked capacity, the provider had not taken action to seek that the care and treatment people received restricted their movement and rights under the MCA. You can see what action we have told the provider to take at the back of the full version of the report.

People who used the service were supported to maintain a balanced diet and received the appropriate food and drink to keep them well.

People who used the service and their relatives told us that they felt members of staff were caring. Relatives we spoke with said they were made to feel welcome when they visited and that the registered manager and care staff were approachable.

Staff knew people’s preferences in how they wanted to be supported, however we saw that people were encouraged to pursue group activities instead of being supported to engage in their individual interests. Meetings to support people to express their views were not conducted regularly. The provider’s system for reviewing and learning from incidences was not robust.

People were confident in the provider’s ability to manage the service to meet people’s needs. All the staff we spoke with said the service had improved since the registered manager had returned from maternity leave. The provider shared their views and vision of the service with staff.

Staff did not have access to information about potential risks that could compromise people’s quality of care because the provider did not maintain accurate records of how people needed to be supported.

The provider had not ensured that they had regard to all their responsibilities to the Commission. They had not responded to our request to complete and submit a provider information return (PIR).