Our inspection of Dimensions 4 Matlock Close took place on 17 and 21 August 2018. This was an unannounced inspection.

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 h

This inspection took place on 21 July 2015 and was unannounced. Dimensions 4 Matlock Close provides care for a maximum of eight adults with learning and physical disabilities.

There was a registered manager in post at the service. A registered manager is a person who has registered with the 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.

We last inspected this service in July 2013, and carried out follow up inspections in October 2013 and February 2014. During the current inspection we found that people were able to participate in a wide range of activities within and outside of the home. They were supported to maintain social contacts and go on holiday with support. The home environment was comfortable and purpose built to meet people’s needs.

There were appropriate systems in place for recording people’s consent, or best interest decisions made on their behalf to ensure that their rights were protected. There was an accessible complaints procedure in place for the home.

People were content and well supported in the home. They had good relationships with staff members who knew them well, and understood their needs. They and their health care professionals spoke positively about the service. People and their family members, where relevant, had been included in planning the care provided and they had individual plans detailing the support they needed.

The service had an appropriate recruitment system for new staff to assess their suitability, and we found that staff were sensitive to people’s needs and choices, supporting them to develop or maintain their independence skills, and work towards goals of their own choosing, such as planning a holiday. People were treated with respect and compassion. They were supported to attend routine health checks and their health needs were monitored within the home. The home was well stocked with fresh foods, and people’s nutritional needs were met effectively.

Staff in the service knew how to recognise and report abuse, and what action to take if they were concerned about somebody’s safety or welfare. Staff spoke positively about the training provided and this ensured that they worked in line with best practice. They received regular supervision and felt supported by the home’s management.

There were systems in place to monitor the safety and quality of the home environment and to ensure that people’s medicines were administered and managed safely. Quality assurance monitoring systems were in place, to ensure that areas for improvement were identified and addressed.

On 22 July 2013 we inspected the service and found that the premises was not always safely maintained and we asked the provider to address our concerns. When we inspected on 17 October 2013, we found that the provider had mostly addressed the concerns related to the safety of the premises, and had planned for the work required to be completed by the end of the year.

Most people in the home used non verbal communication. One person's view was representative of others when they said, "it's great." Another person smiled at us and nodded when we discussed their involvement with their key worker and activities they took part in. Relatives we spoke with told us that staff were respectful and involved them in making decisions in relation to the care provided. One said, "the service does keep me up to date."

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.

Most of the people who used the service communicate through non-verbal methods. In relation to the care provided, one person's relative told us "staff always go above and beyond to help". We found that care plans and assessments of risks to people who use the service were regularly reviewed. Staff demonstrated the knowledge and skills needed to protect people from abuse.

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.