About the service: Dimensions 123 Calmore Road is a residential care home providing personal care to three people who had a learning disability or autistic spectrum disorder at the time of the inspection.

People’s experience of using this service:

• Staff received safeguarding training and regular updates and would not hesitate to whistle blow if their concerns were not listened to.

• Risks were assessed in areas such as environment, care and behaviours and actions were taken to mitigate any identified concerns.

• Staff were safely recruited and participated in an in-depth induction and mandatory training before commencing working with people.

• Sufficient staff were deployed to support people in the service however some staff needed additional guidance in how to support and occupy people.

• Staff turnover was high and more staff, who had significant knowledge and experience of the people they cared for, would be leaving in the weeks following our inspection. Recruitment was underway to fill vacancies.

• Medicines were safely managed however the medicines cabinet had patches of chipped paint inside which exposed bare metal which was an infection control risk. The provider was planning to replace the cabinet.

• The premises were clean and an infection control audit annually ensured that safe hygiene levels were achieved and maintained.

• Staff supervisions had been regular however were now all slightly overdue. The locality manager had plans to address this. • People were supported with nutrition; a photographic menu was in use and staff knew how to best support people to eat at mealtimes.

• Peoples rooms were personalised and in one bungalow, people also had a living room which had been personalised with their belongings, art work and photographs.

• People were supported to access GP’s and other medical professionals as required.

• Deprivation of Liberties Safeguarding authorisations were applied for and though one person’s authorisation had expired, a new application had been submitted and the provider was awaiting a response.

• Staff were caring and respectful most of the time. We saw one staff member who was less respectful which we discussed with the locality manager.

• Staff could interpret people’s communication well, they understood when words were used that had a different meaning for people and could understand what non-verbal sounds meant.

• There was an activity plan each day however this was minimal. The provider told us they were reviewing the provision of activities and would be introducing a fuller in-house activity provision.

• Several changes to the management team of the service had unsettled staff members who had felt unsupported as indicated by high staff turnover and high staff sickness levels. A new management team had been put in place a week before our inspection and, though staff morale was not high, it had improved already.

• Monthly staff meetings had not taken place as planned in 2018, only two had been recorded.

The service met the characteristics of Good in most areas. More information is in the full report.

Rating at last inspection: Good. Report published 29 September 2016.

Why we inspected: This was a scheduled and planned inspection based on the previous rating.

Follow up: We will continue to monitor the service and will re-inspect according to our re-inspection schedule for services rated as Good.

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

The inspection took place on 23 and 24 August 2016 and was unannounced.

123a and 123b Calmore Road provides care and support for up to six people with a learning disability and autism. At the time of our inspection five people were using the service. The home is in a residential area close to local amenities. The home has a large accessible garden with parking to the front.

There was a registered manager in place. 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 and their relatives told us that they felt safe. Staff had received training in safeguarding and were able to explain what they would do if they suspected that someone was being abused.

Recruitment and selection procedures were in place and appropriate checks were carried out before staff started work.

There were enough suitably trained staff to meet people's individual care needs. Staff spent time with people and provided assistance to people when they needed it.

People living at the home had detailed care plans which included an assessment of risk. These were subject to regular review and contained sufficient detail to inform staff of risk factors and appropriate responses.

Medicines were managed safely and people had their medicines at the times they needed them.

Staff followed the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) to ensure that people's rights were protected where they were unable to make decisions.

Staff had a good knowledge of people's individual needs and wishes and their likes and dislikes. This enabled staff to support people appropriately while promoting their independence. People were supported to take part in a range of activities both within and outside of the home.

There were effective systems in place to monitor and improve the quality of service through a programme of audits and checks.

The registered manager encouraged an open culture and showed effective leadership. Staff spoke positively about how the registered manager worked with them and encouraged team working.

During a scheduled inspection in June 2014 we found the provider had not ensured that people who use the service, staff and others were protected against the risks of unsafe or unsuitable premises. This was because some areas of the home were either not adequately cleaned or required some maintenance. The provider sent us an action plan telling us what action they would take to ensure they met the required standard. The purpose of this inspection was check whether the provider had made the necessary improvements. We therefore looked at the safety and suitability of the premises to answer the question is the service safe? On the day of the inspection there were four people living at the home.

This is a summary of what we found –

Is the service safe?

The provider had taken some action to help ensure that people who use the service were safe. A meeting with the housing association had taken place and a programme of essential repairs to both bungalows had been agreed. Whilst some of these repairs and improvements remained outstanding, we saw evidence that the provider was actively working with the housing association to ensure that this work was completed.

A range of both external and internal repairs had been completed. This had helped to create a more comfortable and pleasant environment which was more likely to be enjoyed by people using the service.

We found however that some improvements remained outstanding and we also noted additional areas which required maintenance or repair. We were shown evidence of the home’s maintenance records and saw that these improvements and maintenance issues had already been identified and reported to the housing association. We saw from these records that essential maintenance such as repairs to broken equipment were generally carried out promptly to ensure the home remained safe. However we noted that other repairs appeared to take some time to address. This meant that whilst the service had measures in place to identify and report maintenance issues, records showed the housing association had not always responded promptly to these requests. Improvements are therefore needed to ensure effective arrangements are in place with the housing association which ensure that repairs are completed in a timely manner and that all areas of the home are kept in good decorative order, are safe, homely and comfortable for people to live in.

At the time of our inspection there were three people living at 123a Calmore Road and two people living at 123b Calmore Road. The properties are large semi-detached bungalows sharing a garden. The people using the service had complex needs which meant that they could not clearly share their experiences of and views about, their care. We used other methods to help us understand their experiences including observation of their support and speaking with eight support staff and the registered manager. We also spoke with one relative who was visiting the home. We reviewed people’s care and support plans and other relevant records.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People’s care records contained assessments which covered the risks associated with staff providing the care and support they needed. This helped to ensure that people who use the service were safe because action had been taken to identify and assess the risks to their health and wellbeing.

Appropriate checks were undertaken before staff began work. This meant that staff employed to work at the home had been judged safe to work with the vulnerable people who used the service.

The provider had not ensured that there were arrangements in place to maintain the property which provided improvements to the environment and ensured that all areas of the home could be enjoyed by people using the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that all areas of the property are adequately maintained so that people are protected against the risks of unsafe premises.

Is the service effective?

People’s needs had been assessed and care and support was planned and delivered in line with their individual support plans. Support plans were detailed and reviewed to ensure that they remained up to date.

Staff we spoke with were informed about people’s needs and were able to tell us about the care they provided. This information was consistent with that recorded in people’s support plans.

We observed good interactions between staff and people using the service, and we also observed that staff were confident to positively challenge inappropriate behaviour and reinforce boundaries regarding people's personal space.

Is the service caring?

People were supported by kind and attentive staff. Staff treated people with dignity and respect. We saw that support was delivered in a manner that encouraged people to be as independent as possible. A relative told us, [Their relative] is happy here, they can do more for him than I can do…they go out to lots of different things”.

People’s preferences, likes and dislikes had been recorded and we saw that support was provided in accordance with peoples wishes.

Staff were able to tell us how they tried to anticipate people’s likes and dislikes. For example, staff had taken steps to ascertain the preferred music style of one person who was unable to verbally communicate. This had enabled more positive interventions with this person and allowed staff to more effectively manage their anxiety.

Is the service responsive?

The service had measures in place to review people’s needs on a regular basis to ensure that their support plans remained up to date. The service had taken action to try and respond appropriately to the challenge faced by the differing needs of two of the people who shared one of the bungalows. This had included the introduction of a sensory room which provided a safe and calming space for one of the people. Arrangements had also been put in place to ensure that this bungalow was staffed by a consistent group of staff who were familiar with the needs of each of the people and therefore able to more successfully divert or manage any incidents of agitation between the two people.

Is the service well led?

The service had a consistent management structure that maintained oversight of the home but were not present every day. One staff member told us “[The registered manager] is one of the best managers I have met, they have a feel for the job…if you have a problem you can go and ask, there are never any excuses, they will resolve it”. Another staff member told us, [The registered manager] is always very positive in their approach, they give me confidence to do my role”. A relative told us that they were confident that if they had concerns the registered manager and the management team would address these.

The registered manager was able to demonstrate a good knowledge of the needs of people who used the service and their care and support needs.

We saw that there was an easy read complaints leaflet available and a leaflet on the notice board which contained photos of the registered manager encouraging people to speak with them if they felt unhappy or angry.

The service had taken action to ensure that it had some quality assurance systems in place to assess the quality of the service and identify where improvements could be made. However some of these needed to be further embedded to ensure that they provided an effective system for monitoring the quality and safety of the service people received.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us about their experiences. We observed that staff communicated well with people who used the service. We spoke to a relative, who told us that they were included in reviews of the care that was provided and that staff treated the person well. They said that staff respected people’s choices.

We spoke with the three members of staff. We saw that accurate and appropriate records were maintained and that suitable arrangements were in place for supporting people with medicines. There were enough qualified, skilled and experienced staff to meet people’s needs. Staff we spoke with had a clear understanding of the care planning process and of the outcomes they were supporting people to achieve. However, while care and support planning was mostly person centred, it did not always take into account all aspects of an individual’s circumstances, and their immediate and longer-term needs.

During this visit we met some of the people who used the service and spoke with the registered manager and four members of staff. We used different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We observed the care and support being given and how staff interacted with people.

We saw that staff communicated well with people who used the service and promoted a supportive environment. There were opportunities offered throughout the day for people to take part in home or community based activities. We saw how the service had developed and updated strategies and approaches for supporting people, based on consultation and observation of people’s needs.