Dimensions 27 Sampson Avenue is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide accommodation and personal care for up to six people. There were five people using the service at the start of this inspection. The service specialises in the care and support of people with learning and physical disabilities. It is operated by a national care provider.

The service has a registered manager, which 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.

This was an unannounced comprehensive inspection, to make sure the service was providing care that is safe, caring, effective, responsive to people's needs, and well-led. It was the first time the service has been inspected under our ratings inspection process, having been dormant for a period until people moved into the service in the summer of 2017.

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.

At this inspection we found the service was not consistently safe. Equipment and premises were not consistently checked to ensure environment safety risks were addressed. We had to remind the service that a professional check of the electric wiring was a few months out-of-date. Staff checks of some safety matters including wheelchairs, emergency lighting and first aid boxes had not recently occurred, and the last fire drill had not been documented.

Training on the prevention of choking was not complete for all permanent staff, despite some people using the service being identified as at risk of choking. Systems to check agency staff had received this training had not been followed.

We identified a few infection control risks during the inspection visit. Comprehensive infection control audits were not occurring, to help identify and eliminate poor practices.

We found the decoration of some communal areas of the building to be worn or incomplete. The dining room was not adapted for people in wheelchairs to use easily. The main fridge-freezer had been faulty for over six weeks without remedy.

The registered manager sent us updates and action plans on the above concerns shortly after our visit. This helped to reduce the seriousness of our findings.

There had been good work at the service this year to identify and meet some people’s increasing care needs. There was effective co-operative working with community professionals in support of meeting people’s health needs. Staffing levels had been increased where needed. Equipment such as more suitable wheelchairs had been acquired where appropriate.

Feedback from people, their relatives, visitors and community professionals was highly positive on how staff treated people. Staff interacted well with people regardless of some people’s complex communication needs. There were established systems of providing people with personal care support where needed. People were encouraged to make choices where possible and their consent for care was sought in line with legislation.

People were treated as distinct individuals at the service, with care and support being offered accordingly. Staff supported people to follow their interests, have appropriate mental and physical stimulation, and maintain relationships that mattered to them.

The service supported people to eat and drink eno

At the time of our inspection there were five people using the service. We were not able to get verbal feedback from most people using the service but we were able to observe and interact with them to know about their experience of living at the home.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Staff were caring and respectful and we saw that, people being supported by them, responded positively. For example, we saw people responding to staff in a positive manner whilst they were preparing lunch.

There were appropriate arrangements in place to manage medicines safely. We saw that staff with responsibility for administering medication were qualified to do so. However, medication audits were infrequent and we noted several gaps in recording.

People were supported to access other health and social care services they needed, including a speech and language therapist for people with special dietary requirements for thickened drinks and pureed food.

Systems were in place to gather information about the quality of the service. Relatives confirmed that the service asked their views about the quality of care provided by staff.

People using the service were not all able to give verbal feedback but we were able to observe and interact with them to know about their experience of living at the home. We saw some positive interactions between staff and observed staff caring for people in a respectful manner, by involving them in their care. People appeared comfortable in staff presence. “I’m going to buy batteries for my radio,” said one person who was waiting to be taken out by staff. We contacted a number of relatives, but managed to speak with two relatives who told us that their relative was treated with dignity and respect. “Staff are absolutely fantastic,” commented one relative. “I’m very pleased with what I've seen," said another.

People were treated with dignity and respect. At the time of our visit we saw that staff were around to ensure that people were safe and received support that met their needs. People using the service were encouraged to make choices regarding their food and drink and where they wanted to sit. People appeared appropriately dressed and well cared for. This ensured people using the service were treated with respect and their rights upheld.

Systems were in place to ensure that people were protected from abuse and that they received the care they needed. There were systems in place to monitor medication and staff training.