The inspection took place on 8 January 2018 and was unannounced. Dimensions 1-2 Westbury Way 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. Dimensions 1-2 Westbury Way is registered to provide accommodation and support to six people. At the time of the inspection there were six people living there.

Rating at last inspection

At the last inspection, the service was rated good.

At this inspection we found the service remained good.

Why the service is rated good.

Processes and procedures were in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse and infection. Appropriate recruitment procedures were in place and sufficient staff rostered to ensure people’s safety. Medicines were managed safely within the service. Processes were in place to ensure learning took place from incidents.

Staff received training to maintain and develop their skills and knowledge in order to support people effectively. The registered manager had taken action to ensure staff received the provider’s required number of supervisions. People were supported by staff to eat and drink sufficient for their needs. Staff worked across organisations to ensure people received effective care which met their health care needs. The environment was purpose built for people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff had developed caring and kind relationships with the people they supported. People were supported by staff to be involved in decisions about their care wherever possible. Staff ensured people’s privacy and dignity was upheld during the provision of their care.

People’s care was based on support plans, which took into account people’s needs and preferences. People were able to take part in leisure activities, which reflected their interests. People and their relatives were provided with information about the provider’s complaints procedure.

There was a warm, friendly and home-like atmosphere. People’s relatives and staff were engaged with the service. Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided. The service has sustained the improvements they have made in the key area of well-led, which is now rated good.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 17 and 22 December 2015. We found people’s records were not fully completed to ensure they reflected people's care or decision-making. Documents held did not always demonstrate the most current servicing records. This had been a breach of Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) 2014.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 8 June 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this legal requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Dimensions 1-2 Westbury Way‘ on our website at www.cqc.org.uk.

Dimensions 1-2 Westbury Way is registered to provide accommodation and support for up to six people with learning and physical disabilities. At the time of our inspection six people were living at the service.

The service had a registered manager; they were away at the time of the inspection. We were supported during the inspection by the head support worker. 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.

At our focused inspection on the 8 June 2017, we found that the provider had followed their action plan which they had told us would be completed by the 31 March 2016 and legal requirements had been met. We will review our rating for well-led at the next comprehensive inspection.

Records demonstrated that risks to people had been identified, documented and addressed for their safety. Records showed that an activity which provided one person with pleasure, but was a known risk to their health, had been assessed and written measures were in place to safely manage the associated risks. Where people lacked the capacity to make a specific decision about their lives legal requirements had been met. All of the documents to demonstrate safety checks had been carried out as required in relation to utilities and equipment safety were readily available.

The inspection took place on 17 and 22 December 2015 and was unannounced. Dimensions 1 – 2 Westbury Way provides accommodation and care for up to six people with learning and physical disabilities. At the time of our inspection five people were living in the home. The home combines two conjoined bungalows, with sufficiently wide corridors and doorways to accommodate people’s wheelchairs.

The home had a registered manager. 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.

Records did not always fully document actions in place to protect people from identified risks, or demonstrate processes completed to support lawful decision-making. The registered manager was in the process of reviewing paperwork to ensure records were current, complete and accurate, with older records archived.

People were protected from abuse, because support workers understood how to identify and report concerns. Posters in the home reminded support workers of the importance of reporting any concerns.

Equipment and utilities were serviced regularly, and internal checks protected people and others from potential risks in the home. Risks affecting individuals had been identified, and measures put into place to protect them from harm.

People were supported by enough support workers to meet their needs and wishes. Rosters were planned to ensure people were supported to attend planned activities and appointments. Recruitment procedures ensured people were supported by suitable staff to deliver people’s care and support safely.

People were administered their prescribed medicines safely, because support workers had been trained and assessed to ensure they did this competently. Medicines were stored safely, and records and audits demonstrated that support workers ensured people took their prescribed medicines safely.

Support workers completed and refreshed training to ensure they maintained the skills required to meet people’s needs effectively. Training specific to individual’s needs ensured support workers were able to provide each person with support and care appropriate to their needs and wishes.

Support workers understood and implemented the principles of the Mental Capacity Act 2005. They supported people to make decisions about their care where possible, and followed people’s consent or refusal. They understood the process of mental capacity assessment and best interest decision-making where people lacked the capacity to make an informed decision about their care. Applications for Deprivation of Liberty Safeguards had been made appropriately when restrictions were in place to protect people from identified harm.

People were protected from the risks of dehydration or malnutrition because they were supported to maintain a healthy balanced diet. Risks and health conditions affecting people’s nutrition were understood and managed to ensure their dietary intake was supported effectively. People were supported to keep well through effective liaison with health professionals as required.

People were supported by caring and kindly staff. Support workers understood how people indicated their wishes, and provided care in accordance with this. People’s dignity was promoted and their privacy was respected.

Support plans reflected people’s preferences and needs, and were reviewed at least annually with those important to them to ensure changes were identified and adressed.

Relatives told us they had no reason to complain, because good communication effectively dealt with any concerns they raised promptly. Feedback from people and their relatives was sought to identify any improvements required for people’s care and support.

Support workers understood the provider’s ethos

On the day of our visit there were five people residing in the home, all of whom had profound physical disabilities and communication difficulties. The registered manager was on annual leave so we were joined by the assistant operations manager for the local area. Later in the day a manager from another home also joined us.

We found that although people who used the service were unable to give consent to changes to their care and treatment the provider would always carry out an assessment of their capacity to make decisions every time a such a change was needed, and if necessary a best interest meeting was arranged.

We found that relatives, speaking on behalf of people who used the service, were very satisfied with the level of care offered in the home. One said: ‘I could live here myself’. We also found that each person had an effective care plan which was kept updated, and that staff engaged caringly and sensitively with people.

We found that the premises was safe and suitable for its purpose. However, we did find an issue with a broken fence which presented a potential security risk.

We found that staff were properly supported, with a proper induction, regular training, supervision and appraisal, and opportunities for further development.

We found that the provider had effective systems and processes in place to monitor and assess the quality of the service, although relatives did not like the feedback questionnaire given to them.

We were unable to speak with persons using the service, however, we spoke with relatives of people using the service by telephone after the inspection.

People we spoke with told us that the home was well run, that staff were very caring and provided very good care to their relatives. One person told us that the care provided by the service was “Unsurpassed”.

All of those with whom we spoke told us that Dimensions, 1-2 Westbury Way provided their relatives with excellent care. One relative told us that the level of care was "unsurpassed".

The cleanliness, decor, management, communication, food and general level of care were all praised by those we spoke with.

We were told that the staff at the service were caring and loving and, when speaking to the staff themselves, many of whom told us that they had been at the service for many years, we were told that there was a family atmosphere. One staff member told us that they would not consider working anywhere else.