Dimensions Oxfordshire & Warwickshire Domiciliary Care Office

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed 4 quality statements for this key question. Stakeholders had shared recent concerns regarding safeguarding, staffing levels and person-centred care. However, we found some improvements had been made since our last inspection and the required changes were in the process of being implemented with on-going regular monitoring of an improvement plan.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us that concerns raised were not always dealt with by the provider. One relative told us they recently emailed the registered manager to raise a concern but had not had any acknowledgement of the email. Other relatives said the provider had responded to them in a timely way.

The provider told us staff were having more regular one to one supervision where staff were encouraged to talk and raise questions to increase their level of learning. Staff training was reviewed and updated. Any accidents or incidents were discussed and lessons learned were shared with the staff team. Staff told us they had received training in all mandatory areas. Some staff told us there was a good training structure in place and they felt more confident having completed it. Some staff told us they were sent reminders well in advance to complete up-coming training and managers carried out spot checks on their practice.

Stakeholders who had visited the houses had concerns about staff knowledge and fully implementing professional guidance. For example, the consistency of some food and drink which needed to be blended was not as the Speech and Language Therapist had directed. One professional told us postural support plans were not always followed as directed.

As part of the on-going improvement plan, there was more management presence in the houses on a daily basis. The frequency of team leader meetings had increased where information of concern was discussed and actions to improve were agreed. The provider had introduced health team experts to help the staff learn about various medical and health conditions such as oral health, pressure area care and postural care.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

One person said the provider had not responded well to their safeguarding concerns. Another person told us the provider had responded appropriately when they had raised concerns of possible bullying behaviour.

The provider acknowledged the need for stakeholders to raise multiple safeguarding alerts. The information and feedback was difficult for all staff to hear. However, this had raised awareness and focussed the team to make the required improvements. Staff told us they knew how to recognise abuse and what to do about it. Staff told us there was a safeguarding matrix and process to follow. Staff told us they had mandatory safeguarding training which was regularly refreshed.

We saw people being safely supported which was in line with their care plans and risk assessments.

There was a safeguarding process and policy in place. This had been reviewed. Safeguarding training was mandatory and was refreshed annually. The provider told us they had learned from recent events and had more robust safeguarding practices in place.

We saw in people’s care plans some risk assessments required a review and updating. However, no concerns around risk were raised by relatives.

We were told all risk assessments had been reviewed and updated. This included correct guidance to follow for specific risks such as pressure area care and choking risk. Staff told us they were aware of individual people’s risks. They could view these in people’s care plans in paper form or the recently added digital system. Staff told us risk assessments were altered when the person’s circumstances changed and the updates were shared within the team.

We saw people being safely supported which was in line with their care plans and risk assessments.

Care plans reviewed had comprehensive information in them to enable staff to support people safely.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us there were not enough permanent staff working in some houses and they regularly used different agency members of staff who did not always know people well.

The provider had reviewed staffing and recognised some services had been reliant on agency. Some staff were also not performing to the level required. They had introduced a new staff team including a consistent agency team and were recruiting to ensure they had a full complement of staff. Most staff told us there were enough staff to meet the needs of the people they supported. This included regular support from consistent agency staff. The staff group was diverse and multi-cultural. However, one staff member told us one house needed more staff in the evening due to the support needs of 1 person.

We saw people being safely supported which was in line with their care plans and risk assessments.

Care plans reviewed had comprehensive information in them to enable staff to support people safely.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.