Dimensions 4 Matlock Close

About the service

Dimensions 4 Matlock Close is a care home for up to 8 people with learning disabilities and/or autism. At the time of our inspection, 7 people were living at the service.

People’s experience of using this service and what we found

The service was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. However, they needed to make improvements to fully meet these.

Right Care

People received care that was kind and staff respected their privacy.

Staff understood and responded to their individual needs. They communicated with people in ways that met their needs. The service gave people care and support to meet their sensory and physical needs, but some areas of the environment was not always kept sufficiently clean or safe at all times.

The service had enough staff to keep people safe. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Support

Staff supported people with their medicines, but the medicines management arrangements were not always effective.

Staff enabled people to access health and social care support. Staff helped people to participate in activities at home and in the community.

The provider follow appropriate recruitment procedures to ensure only suitable staff were recruited to work at the service.

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.

Right Culture

The provider's monitoring processes were not always effective in helping to ensure people consistently received good quality care and support.

There was a culture of supporting people to receive compassionate care that was tailored to their needs. Staff were supervised and felt supported by registered manager and deputy managers they could approach for advice and help. The service involved people and relatives in planning and reviewing people’s care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 1 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dimensions 4 Matlock Close on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care, medicines management and governance at this inspection. 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.

The home can accommodate up to eight people in a large, purpose built bungalow. At the time of our inspection eight people were using the service. The people living at the home had learning disabilities and a range of other needs such as autism, physical impairments and complex health needs.

We found the following examples of good practice.

The service had implemented effective infection prevention and control measures to ensure people, their relatives and staff were protected from infections.

Relatives were able to visit their loved ones safely and had access to appropriate Personal Protective Equipment (PPE) and rapid testing on-site if they were unable to do their own tests.

Premises which were cleaned and disinfected daily were also well ventilated and spacious. People were socially distanced and had their health monitored routinely by the staff.

Staff were provided with appropriate training, PPE and had access to COVID-19 testing in line with national guidelines. The registered manager sought advice from relevant authorities when needed. Infection prevention and control policies were up to date.

Dimensions 4 Matlock Close is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home accommodates eight people in a large, purpose built bungalow. At the time of our inspection there were no vacancies. The people living at the home had learning disabilities and a range of other needs such as autism, physical impairments and complex health needs.

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 home had a registered manager. A registered manager is a person who has registered with CQC 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 living at the home were protected from the risk of harm or abuse. Staff members had received training in safeguarding adults and demonstrated an understanding of their roles and responsibilities in ensuring people were safe. Detailed and person-centred risk assessments had been developed which included guidance for staff members on the management and minimisation of risks.

The home had developed person centred care plans for people. These were detailed and included guidance for staff on meeting people’s need and choices in accordance with their preferences. However, some care plans had not been updated to reflect changes in people’s needs and social activities. In addition, some daily care notes had not been fully completed. This meant that we could not be sure if people always received the support they required.

People’s medicines were managed and administered to them safely. Medicines administration records were appropriately completed and regular audits of records and stocks of medicines had been undertaken. Staff members had received training in safe administration of medicines and their competency in doing so had been assessed.

The staff records that we viewed showed that the provider had carried out checks to ensure that staff were of good character and suitable to work at the home. New staff members received an induction which included the completion of the Care Certificate which provides a set of nationally recognised standards for staff working in health and social care services. All staff were required to undertake a range of mandatory training courses to ensure that they were competent in supporting people. Additional training courses associated with the specific needs of people had also been provided.

During our inspection we observed that staff members supported people in a gentle, kind and respectful way. People appeared familiar and comfortable with the staff who were supporting them. The staff members we spoke with were knowledgeable about people’s needs and preferences.

Staff members supported people living at the home to participate in a wide range of activities. These included meals out, theatre and cinema visits and music and craft sessions. People had also been supported to take annual holidays. Some people also attended a local day centre on a regular basis. Arrangements had been put in place to ensure that staff understood how to ensure that people’s specific cultural needs were met, along with other needs and preferences.

The home was meeting the requirements of the Mental Capacity Act (MCA) 2005. People’s capacity to make decisions had been assessed and Deprivation of Liberty (DoLS) authorisations had been sought and obtained from the local authority. DoLS authorisations are required where people lack capacity to make decisions to ensure that any restrictions put in place for their safety are legal and in their best interests.

The provider and registered manager undertook regular quality assurance monitoring and audits. The outcomes of these were shared with staff members at team meetings and any required actions were addressed. Although we found that there were failures in relation to the quality of some care plans and daily notes, these had been identified and action was underway to address them. However, at the time of our inspection there remained the need for further action in relation to these failures.

We wrote to the provider, who confirmed that the registered manager had returned to their post. The manager is now registered at 4 Matlock Close, and another nearby service Dimensions service, located at 46 Julian Close. We have seen rotas and guidelines for the assistant managers which confirm there are sufficient management arrangements in place for both services.

Many people in the home did not have capacity, and this was appropriately assessed and arrangements for obtaining consent were in place. Care planning reviews took place regularly with involvement from people, and relatives were regularly involved in this process. We found that the staff understood people's care needs. Equipment in the home was regularly assessed and maintained. The provider had systems in place to ensure that the quality of the service was routinely monitored.

We found some concerns that the home was not always being maintained and in some cases posed a danger to people using the service, as we found worn and broken furniture and furnishings and incomplete repairs. At the time of the inspection, the home did not have a registered manager in post and the provider had failed to inform us of this change. The registered manager had moved to another role in the organisation. The assistant managers were responsible for the running of the home. We have written separately to the provider and asked them to address this.

Staff received appropriate training and support to enable them to deliver the care to people that they needed. All staff had received regular individual supervision and annual appraisals from a manager. The provider had ensured that staff were appropriately supported to deliver care safely.

The provider had an effective system in place to regularly assess and monitor the quality of service that people receive. This meant that people were protected and received safe care and treatment.