Dimensions Portsmouth Domiciliary Care Office

Updated 16 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection site visit activity started on 23 November and ended on 24 November 2017. It included visits to three locations and the central office. We visited the office location on the morning of 23 and all day on 24 November to see the manager and office staff; and to review care records, policies and procedures.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The provider was given 48 hours’ notice. This was so that we could be sure the manager or senior person in charge was available when we visited and that consent could be sought from people to a home visit from the inspector. The inspection was carried out by a single inspector on day one and an inspector and expert by experience on day two. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their experience related to supporting people with learning disabilities and autism.

Before the inspection we reviewed all the information we held about the service. This included notifications the home had sent us. A notification is the means by which providers tell us important information that affects the running of the service and the care people receive.

We had not requested a Provider Information Return (PIR) from the service. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We collected this information as part of the inspection.

We spoke with four people who used the service and eight staff. We had telephone conversations with 10 relatives and one professional who had experience of working with the home.

We spoke with the operations director and four locality managers. We reviewed five people’s care files, policies, risk assessments, health and safety records, consent to care and treatment, quality audits and the 2017 satisfaction survey results. We looked at four staff files, the recruitment process, complaints, training, supervision and appraisal records.

We visited three supported living locations and observed care being delivered to people some of whom were non-verbal.

We asked the operations director to send us information after the visit. This included policies and the staff training record. The operations director agreed to submit this by Tuesday 28 November 2017 and did so.

Updated 16 January 2018

The inspection took place on 23 November and was announced. The inspection continued on 24 November and was again announced.

Dimensions Southampton & New Forest Domiciliary Care Office is based on the outskirts of Southampton and provides care and support to people with learning disabilities and autism. At the time of the inspection the service was delivering personal care to 68 people.

This service provides care and support to people living in 26 ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service also provides personal care to people living in their own houses and flats in the community. It provides a service to disabled adults with learning disability and autism.

Not everyone using Dimensions Southampton & New Forest Domiciliary Care receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The operations director was in the process of becoming the registered manager. The application had been received by our registration team. 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’s needs were holistically assessed and reflected choices and preferences which in turn ensured that people were supported to achieve life changing outcomes. The service had worked closely with people to ensure that additional specific personalised goals were set. Families told us that they felt the service had made a real difference to their loved ones lives.

The service worked in partnership with local GP’s and other health professionals to regularly review and assess medicines in line with Stopping over medication of people with learning disability, autism or both (STOMP). STOMP is an NHS-led campaign and is about making sure people get the right medicine if they need it. It encourages people to have regular medicine reviews, supporting health professionals to involve people in decisions and showing how families and social care providers can be involved. The service was able to show us how this had had positive life changing impacts on people’s lives.

People’s independence was promoted through the effective use of equipment and technology. This enabled people to access areas of their home, community and complete personal care tasks independently.

People were supported by staff who received regular training specific to their needs. An inclusive and innovative appraisal system was used. 360 appraisals took place across the service. This meant that feedback was gathered from people and the families about staff performance and the delivery of care.

Personalised care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they chose to live their lives. Each person had a care file which also included outcomes and guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received safeguarding training. People were provided with information about how to keep safe and were asked their desired outcomes following any alert made.

Effective positive behaviour support plans had been completed and were up to date. These gave staff clear guidance on how best to support people which had led to positive outcomes.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. People’s records contained assessments of their capacity and where decisions had been made in people’s best interests around their care and treatment these were recorded.

Medicines were managed safely, securely stored in people’s homes, correctly recorded and only administered by staff that were trained to give medicines. Medicine Administration Records reviewed showed no gaps. This told us that people were receiving their medicines.

There was an infection control policy in place and regular cleaning took place in locations to prevent and control the risk of infection.

People were supported with shopping, cooking and preparation of meals in their home. The training record showed that staff had attended food hygiene training.

People told us that staff were caring. During home visits we observed positive interactions between staff and people. This showed us that people felt comfortable with staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. Information was available in various easy read and pictorial formats. This meant that people were supported by staff who knew them well.

People, staff and relatives were encouraged to feedback. We reviewed the findings from quality feedback questionnaires which had been sent to people and noted that it contained positive feedback.

There was an active system in place for recording complaints which captured the detail and evidenced steps taken to address them. We saw that there were no outstanding complaints in place. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.

People, relatives and staff felt that the service was well led. The management team encouraged an open working environment. People and staff alike were valued and worked within an organisation which ensured a positive culture was well established and inclusive. The management had good relationships with people and delivered support hours to them.

The service was aware of their responsibilities under the Health and Social Care Act 2008, Duty of Candour, that is, their duty to be honest and open about any accident or incident that had caused, or placed a person at risk of harm. They also understood their reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.

Quality monitoring visits and audits were completed by the management team and an internal quality team. Internal Quality Checkers also visited locations and completed quality reports. These Quality Checkers were people who received services from Dimensions and had direct experience of using services and know what to ask and where to look to find answers.