Dimensions Lincolnshire Domiciliary Care Office

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People’s needs and preferences were fully assessed and included physical and mental health, social and cultural needs. Assessments included all people important to the person and liaison with relevant health professionals where required for guidance or equipment. Staff worked together with other agencies to ensure people were supported to live healthy lifestyles and access services. Health outcomes were monitored and regularly reviewed. Consent to care had been sought at point of initial assessment and was reviewed annually or when changes to people’s care arose.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us about how well the staff team and registered managers had worked with them to find out about their family member and took time to observe and be with the person to learn who they were before considering the right support. We spoke with a relative about the complexities of finding the right support and environment for their family member who had gone through many years of failed support packages, causing great distress. They had also written feedback to the staff team. The relative wrote, “Dimensions were different because unlike most other [care providers], they did not tell me that [my family member] had ‘bad behaviour’. They agreed with me that my [family member] did things because they were in pain or distressed…We’ve learnt from each other and even when things got difficult, Dimensions did not walk away. I can tell that staff really care and would never hurt [my family member]. Also, the [registered] managers listen to me.”

Staff told us about the process for assessing people’s needs and getting to know their likes and dislikes and abilities. One staff told us how they encourage people to use advocates and also ensure they consider a person’s mental capacity to make their own decisions in this process. The staff member told us, “When we first support a person their local authority assessment is shared with us and this will tell us if the person has capacity, we record a person's capacity in the capacity section of their support plan and on important information on [the computer system]. We review this each year in the person’s annual review with the local authority.”

There was a clear extensive assessment of people's needs reviewed and researched prior to them receiving support. All important people in each person's life were involved in that process to get as full a picture as possible. This was all successfully transferred to people's support plans resulting in person centred plans with very detailed guidance for staff to understand how the person wants and/or needs to be supported.

People and relatives told us they thought staff worked well their team and other health professionals to ensure any changes to their care were for the right reasons. One relative told us, “I can look at the [digital records] to see my [family member’s] care notes. Their physical health is challenging now. The care team are helping and look at his other needs to.” Another relative said, “[Staff] are in contact with the doctor, they work well together”

Staff told us how they monitor people’s health to be able to identify any changes or concerns that require action. A staff member told us, “[People] are weighed weekly and we monitor bowels etc. They are monitored daily for that and some people have medicines for that or a GP appointment made. Speech and Language Therapists (SALT) teams and dieticians have been out and are quite good.”

People and their relatives were supported to be involved in the planning of their care. Changes in care and support were put into place following discussions with the relevant health professionals when required. Care was delivered in line with current best practice guidance with a focus on hydration, nutrition and monitoring of bowel health.

People told us staff worked well together to share relevant information and ensure a smooth transition of care from other services and also when a person had to go into hospital. Relatives were happy they could be kept informed, where people had given permission for this. One relative told us, “Staff are very nice. If I want to know anything I ring them up.”

Staff were aware of people’s needs and where to find and share information. They knew how to access external health teams for advice if required. A staff member said, “We just follow the guidelines but we know [people] well so we know what they are capable of. SALT guidance is updated regularly and we can phone them as well if we need to.”

Professionals spoke positively about the staff teams and how they worked to support people. One professional told us, “Dimensions is one of my favourite care providers that I work with. This is because they provide homely and personalised support. They have always had the very best intentions for the people they support and always ask questions to ensure they understand the intervention we have advised. Generally, the people they support seem happy with their care and have good relationships with the support staff.”

Staff and registered managers worked well as a team including with other professionals when supporting people with transitions of care from or to other settings. Processes in place to guide staff on the best approach had resulted in people having an improved quality of life. For example, one person who was previously scared of needles was now able to have tests. Another person had reduced infections and less hospital admissions. This was due to the work staff did around sharing best practice and information of catheter care and person centred planning. The 4 registered managers had good methods for working together to ensure oversight and share concerns, success stories and ideas to ensure they have an understanding of all the people and staff they are responsible for.

People were encouraged to attend annual well-person checks and to access all and any health services they required. People told us the staff supported them to improve their health. They did this by encouraging use of sports facilities, getting active and being aware of ways to cook food that were healthier. People said they had access to health professionals such as doctors, dentist, opticians and chiropodists and were happy with the level of support to arrange and attend health appointments. A relative told us, “We have a good working relationship. [Staff] never hesitate to call me and ask me questions about my [family members] medical history.”

Staff told us how they worked with district nurses and GP’s to support people to get appointments when required. They also told us how they had supported a person who needed to lose weight for health reasons, to learn about slimming clubs after a suggestion from the district nurse. Staff checked the person had the mental capacity to make their own decisions about this and supported them to attend a local slimming group. The person has now lost a significant amount of weight, has learnt new cooking skills and made many friends amongst their fellow slimming club members’.

The provider has systems in place for information sharing with external professionals to ensure a good level of care and reduce the risk of people experiencing difficulties that may cause distress and/or delays to treatment. The provider had a proactive and innovative approach to highlighting health concerns and challenging health inequalities. For example, they promoted a better understanding of areas that might not be so openly spoken about such as sexual health, bowel health and checking for early signs of cancers. The provider had spoken about on a television channel for their work highlighting how autistic people and people with a learning disability struggle to find the right support when experiencing menopause. They held a competition for faeces artwork to encourage conversations about healthy bowel movements and gut health.

People experienced good outcomes and achieved ambitions with the staff support. We saw examples of how people’s quality of life had improved in areas of health and social wellbeing. People and relatives told us staff motivated people to keep achieving their dreams.

Staff were passionate about continuously improving people’s lives. They told us they sought people’s feedback and included them in all conversations about their care in order to ensure they could keep learning and growing.

There were systems in place that evidenced continual monitoring of outcomes for people's health and social needs and general wellbeing. There was an emphasis on learning from outcomes and actions added to plans where improvements have been identified. Results of outcomes were shared with people and their relatives.

People told us they were able to make their own choices and had agreed for staff to support them and had copies of their care plans. People or their representative had signed their consent to care in a care agreement prior to receiving support. For some people, their relatives helped them to make decisions, other people were supported by an advocate. A relative told us, “There are no restrictions, my [family member] can do what they want.” Another relative said, “My [family member] can verbally tell staff what they do and do not like.”

Staff understood the need to gain people’s consent. While not all staff were confident in explaining the principles of the Mental Capacity Act 2005 (MCA) and how this impacted their role, they did understand people’s preferences and the importance of choice and consent and how to apply these in practice.

Consent to general care and treatment and supervision where required was confirmed during people’s initial assessment. Where people were unable to give consent themselves this was sought via a best interest process involving all relevant others in the person's life, including the support of advocates. Where restrictions were required to support people's safety and well-being, these are either consented to or a community DoLS applied for. This process was reviewed annually and as and when the need for new restrictions applied. Some people were still waiting for a DoLS application to be processed through the Court of Protection due to a delay in the local authority processes. The registered managers were aware of this and in the process of conducting a full review of outstanding applications to refer back to the local authority.