Background to this inspection
Updated
30 March 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at two domains and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by one inspector.
Service and service type
Dimensions Brambletye New Mill Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
Prior to the inspection we looked at all the information we had collected about the service including previous inspection reports and notifications the previous registered manager had sent us. A notification is information about important events which the service is required to tell us about by law. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with the registered manager and gathered feedback from three staff members. We observed interactions between staff and people living at the service and looked around the premises. We reviewed a range of records relating to the management of the service, for example, records of medicine management; people’s support plans and associated records; accidents and incidents; quality assurance system; and maintenance records.
After the inspection
We continued to seek clarification from the registered manager to validate the evidence found. We looked at further information provided including specific training, maintenance information, incidents/accidents, meeting minutes and five staff recruitment files. We received feedback from four relatives of people living at the service. We contacted five more members of the staff team. We contacted eight professionals who work with the service and received four responses.
Updated
30 March 2022
About the service
Dimensions – Brambletye New Mill Road is a residential care home which is registered to provide a service for up to five people with learning disabilities. Some people had other associated difficulties such as physical limitations or behaviours that may cause distress to themselves and/or others. All accommodation is provided on one floor in a domestic sized dwelling. At the time of our inspection there were three people using the service.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting most parts of the underpinning principles of Right support, right care, right culture. The model of care is satisfactory; it ensured that people could live their lives how they chose and as an individual member of society. The staff supported people to have choice and control in their life. The care was person-centred and promoted people's dignity, privacy and human rights. The staff and the registered manager worked in a positive way to ensure that people received good care. However, some improvements were required.
The management of medicines was not always safe. Not all staff were up to date with their training to support appropriate risk management. Risks to people's personal safety had been assessed. However, the plans were not always in place to minimise those risks. Effective recruitment processes were not followed to ensure, as far as possible, that people were protected from staff being employed who were not suitable.
Quality assurance systems in place were not effective in ensuring compliance with the fundamental standards and identifying when the fundamental standards were not met. The registered person did not inform us about notifiable incidents in a timely manner. The registered person did not ensure that clear and consistent records were kept for people who use the service and the service management.
We have made a recommendation about gathering and acting on people’s feedback.
Relatives felt their family members were kept safe in the service. Professionals also felt people who use the service were supported well. Relatives felt they could approach the management and staff with concerns and that communication was good most of the time. The staff members felt staffing levels were sufficient to do their job safely and effectively. When incidents or accidents happened, they were reviewed and people provided with the required support. The registered manager appreciated staff contributions to ensure people received the best care and support. Staff felt the registered manager was managing the service well. The staff felt they could approach the registered manager for any advice, help or support. The registered manager and staff understood their responsibilities to raise concerns. There was an emergency plan in place to respond to unexpected events and the premises and equipment were kept clean.
During the pandemic, the registered manager continued working with the staff team to ensure they provided caring and kind support consistently. People, their families and other people that mattered were involved in the planning of their care.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 30 April 2020) and there was one breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
At our last inspection we recommended that provider would seek advice and guidance on training that would support having competent assessors for medicine optimisation. At this inspection we found the provider had acted on the recommendation and they had made improvements.
Why we inspected
This was a planned inspection based on the previous rating.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.
We carried out an unannounced comprehensive inspection of this service on 2 March 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve notification of other incidents.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dimensions Brambletye New Mill Road on our website at www.cqc.org.uk.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to quality assurance; notification of incidents; record keeping; management of medicine; risk management, and recruitment. We have made a recommendation about seeking and using feedback from people, staff, others to improve the service.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.