Dimensions Lincolnshire Domiciliary Care Office

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Care was planned to promote people’s aspirations and ensure staff understood people’s preferences. People’s rights to choice and independence were supported in line with the principles of CQC’s Right Support, right care, right culture policy. Staff used a flexible approach to care to ensure people had access to all relevant services and local facilities. People were listened to and their views reviewed and used to drive improvements. Information was provided to people in a way they understood using a variety of methods. Staff recorded people’s wishes for planning their health needs, including their preferences in the event of serious illness or at the end of their life.

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 those who were important to them were involved in assessing and planning care and reviewing any changes. People and their relatives told us they were very happy with the support provided and the level of detail in guidance that meant care was tailored to some very specific needs and routines, which helped reduced times of distress for people. One relative told us, “If my [family member] doesn't want to go, they won’t. [Staff] will try to encourage them but understand if they don't want to go.” Another relative said, “Staff know what my [family member] wants. They point to things and the [staff] respect her.” People were supported to be in control of their care and utilised advocates where required. This way of working promoted the principles of CQC's policy, Right support, right care, right culture and enabled people to make choices about how to spend their time, such as, shopping, going to the pub, meeting up with friends, going on holiday, getting a job or learning skills. Good news stories from people were shared with all monthly, they included descriptions of what happened, who was involved and photos to go alongside them all. This included things like celebrating people's birthdays, friends’ parties, trips out to various community events and places of interest, meeting up outside with friends. The provider also shared, with permission, stories of successful achievements across the organisation so that other services can get ideas and learn. For example, 1 person had received an award from their local dance group, others had gone on holiday or joined a gym. People had been supported to vote in the local election, attended concerts or parties and went horse racing. One person had a job in a charity shop and another person in a local café. Another person shared a video of their hospital experience to help other people not be afraid if they need treatment of an operation.

Staff shared how they supported a person through the grieving process after losing a relative at the same time as losing a person they lived with. Also, how they found new ways of supporting another person to continue their passion of baking after a deterioration of their sight. A staff member told us how they ensured care was delivered in a person centred way. They told us, ”The people we support tell us about their care and support and they are very much involved in developing their support plan, their views, needs and preferences are recorded. If the people we support wish to change something about their care and support the changes would be made in their support plan, these are a live document. We would also ask the people we support in their annual review if they are still happy with how their support is provided and what they would like to change.” Senior leaders told us about plans in progress that were being tested for people to create their own digital care plans so they can tell new staff in their own words, what support they need and all about themselves. They told us they were hoping this would also be useful for demonstrating on video how to complete any very specific care needs related to people’s physical and mental health to ensure a consistent approach where the person remains in control.

People felt they received continuity of care. Some people were supported by their relatives to ensure they paid their bills and/or sought the appropriate fundings. One relative said, “If I needed to speak to anyone regarding paying the bills [staff] get back to me straight away. They are very responsive” Another relative told us, “[Staff] are helping me to get social services to do the paperwork to deal with his things.”

Staff and managers understood the need for joined up working to ensure the diversity of people's health needs were met utilising local services. Staff were flexible in their approach and worked well with external professionals and advocates to ensure people go the right care at the right time and reasonable adjustments and any required equipment were in place.

A professional we spoke with told us, “Dimensions work very well with myself [and other professionals]. They are very open, honest and willing to work together. I find their service/care to be of a higher standard than other community supported living providers. The properties are also to a good standard.”

The provider has processes in place to ensure people’s funding is agreed at the start of providing care and support. They hold regular meetings with the local authority to discuss any concerns and regular reviews with professionals and people to ensure continuity of care and agree any changes. The provider manages its own finances and budgets appropriately and recruits staff in local areas to ensure service availability.

People were provided with information in ways they could understand. They were happy with how staff and the provider communicated with them. Relatives also felt staff communicated well. One relative told us, “My [family member] is treated very well. Staff speak to them on their level. [Staff] all have a great sense of humour.” Another relative said, “Communication is good with staff and my [family member]. [Staff] know them very well. Even (how to communicate) when my [family member] is frustrated.”

Staff were taught a variety of tools to use in order to communicate with people. This included Makaton (a systems of signs, symbols and pictures to aid speech). Some people created their own version of signs and staff understood what each one meant. Staff were able to support people to communicate with others and have a voice.

Each person had detailed communication profiles to help staff understand how best to support them and their preferred language. Where required, people had been assessed by SALT to review their preferred language and develop an awareness of other aspects that might impact their ability to communicate well such as environmental factors. Information was developed using a variety of methods such as pictorial, symbols, easy read, forms of sign language and simple English to try and ensure people could understand what was being shared with them. This was in line with the accessible information standard and GDPR.

People and relatives all felt listened to and happy to raise concerns if they had them. For those who had, they told us complaints were addressed quickly and they were kept informed of outcomes. One person told us, “I never feel worried, I can talk to someone.” A relative said, “I wouldn't have any worries if I needed to speak to [staff] about my [family member]. I would call at any time if needed.” Other relatives told us, “Staff are excellent.” “There is nothing [staff] can do better. I can’t fault them.” And, “The [staff] really involve my [family member] in the conversation.”

Staff told of the ways they listened to people and understood the importance of being open and honest if someone had a complaint. Staff were able to recognise unspoken complaints such as a person pushing food or drink away or showing signs of distress when asked to do something. They were able to act quickly in these cases to ensure the person knew they were heard and prevent further distress.

The provider used various methods to seek feedback from people using their services and those important to them. This included complaints and compliments systems, listening events and training relatives to act as 'family consultants' who were a part of many decisions that shaped the way care was provided. Outcomes of feedback were collated, summarised and shared. These were used to help inform and improve the quality of care provided.

People told us they could see a doctor or dentist when they wanted to. They were happy with the way staff supported them to attend appointments or access local services. A relative told us about the experience they had when trying to arrange for their family member to have medical tests that were difficult for them to cope with. They gave written feedback about this and said, “I wanted to share with you how much we have appreciated the [registered managers] support and determination in affecting an appropriate management plan to meet my [family members] needs. Today, this has culminated in in them being referred for [treatment]. So often we hear about poor practice and communication, so I wanted to inform you of an example where I feel there has been very good joint working.” Another relative told us, “The [staff] go the extra mile. All of them. They are determined to get the GP sorted.”

The staff told us they used a tool called DIS/DAT which helps them to try and identify when someone who does not communicate with words, was either distressed or in pain by understanding their non-verbal cues. A staff member also said, “[People] have communication and hospital passports in their grab bags so they can be taken straight away. We also stay in the hospital all the time with them for reassurance otherwise they would refuse their medicine/treatment.”

Professionals spoke positively about the way the acted on advice and promoted good health. A professional told us, “I have a good rapport with the care provider and can easily contact the management teams if needed. They often contact me to request input if they have a concern about something. They are quick at implementing advice and interventions and providing information and feedback.”

The managers and staff worked well with various services to ensure people could access the health and community services they wish or need to. This included working with health professionals to agree a joint reasonable adjustments care plan for people going into hospital for treatment. The provider also did work promoting equity in health care nationwide, in particular in relation to bowel health, menopause awareness and breast screening.

People and relatives were able to give their views following accessing health care and local facilities about what had been positive and what would help next time. They were happy they felt listened to. Some of the comments made by people and relatives during audits of outcomes gathered by the provider, included, “I like living here.” And, “I’m happy.” Relatives said, “My [family member] couldn’t be in better hands…I could live there myself.” And, “My [family member] is so happy here compared to where they were in the past”.

Staff told us they reflected on outcomes regularly and used these to help make improvements for the future. A staff member told us, “We do reflect on what is working and not working in staff meetings.” A written comment by another staff member said, “We have an excellent team, and we all work well together.”

Barriers to good care were identified and monitored and these were taken for discussion to regular meetings with the local authority and for individual cases with the health teams involved such as learning disability health liaison professionals or GP's. This information was used to tailor care and ensure people's rights to good health care were promoted. The provider had systems in place for carrying out quality reviews of outcomes, including that of healthcare. The reviews were carried out by a lead reviewer, a person receiving care and support and a family consultant. One review received very positive feedback from people, relatives, staff and external professionals. One professional wrote, “It was an absolute pleasure to work together. I couldn’t justify any extra hours because the staff were just too efficient”. A health professional wrote, “Continuity of care is excellent; whoever you speak to they understand the [person] and the team speak with the same voice. The standard of care is exceptional.

People who were happy to do so, were supported to identify their wishes in the event of illness or plans about their future, including for the end of their life. Where appropriate, their relatives were also involved in these decisions. A health professional gave complimentary feedback about the quality of care given to a person while at the end of their life. They said the whole [staff] team were kind and caring and confirmed the support the [person] was getting towards the end of their life was the best. They thanked staff for all the hard work and care and said they believed without the amazing support provided by the [staff] team the [person] may not have made it to the age they did.

The registered managers and staff team were all aware of the importance of LeDeR and had reported to them when someone had died. This resulted in a compliment from LeDeR following a review of the palliative care given to the person due to the quality of support. LeDeR is a national service improvement programme looking at the lives and deaths of people with a learning disability and autistic people. The programme aims to improve care, reduce health inequalities and prevent premature mortality.

The registered managers ensured staff had all the relevant training required to support a person at their end of their life. There were systems in place to review people’s wishes for illness and end of life support. These were recorded in people’s care plans for staff awareness to ensure people’s wishes were respected.