We undertook an inspection of the service on 26 and 27 September 2018. The inspection was unannounced. At our last inspection we rated the service good.

Dimensions 53 Cambridge Road is a care home for up to six people with a learning disability. The building was purpose built, has six bedrooms across two floors, a shared living room and a kitchen dining area. There were five people living in the home at the time of the inspection.

The care service has been developed and designed to meet the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion to help ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Since our last inspection, there had been a change of management at the service. The previous manager had left and a new manager had been appointed. The new manager had submitted an application to CQC to register as manager for the service. At the time of inspection, this application was still in progress. 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 this inspection we rated the service ‘requires improvement’. We found that the service was in breach of four regulations. You can see what action we told the provider to take at the back of the full version of the report.

People’s risks were not fully assessed and managed in the least restrictive way. One person was put at risk of serious harm from the inappropriate use of bed rails. Medicines were not stored securely and people did not always have guidance for the use of their medication.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. People’s capacity to make decisions was not always assessed when decisions were made on people’s behalf. The provider had not always applied the principles of the Mental Capacity Act, resulting in people being deprived of their liberty.

Records were not kept accurately and were not always up to date. We found that the provider did not have sufficient quality assurance processes in place to identify quality and safety issues and take action to rectify these.

People were protected from the risk of abuse or neglect by staff who knew what signs to look for and how to report issues. Staff openly reported incidents and the service took action to prevent re-occurrence.

There were sufficient staff during the day to meet people’s needs and enable people to take part in social activities as they wished. However, staff reported there was not sufficient staffing levels at night to safely support people.

Staff had access to training, and had the appropriate skills, knowledge and experience to support people. The service referred people to other professionals as required and enabled people to access health services, such as their GP and dentist.

The premises were adapted to meet people’s needs and preferences. People had a choice of food to meet their dietary needs and preferences.

Staff used different methods of communication to meet people’s needs and ensure they were able to express their views and be involved in conversation.

Staff respected people’s dignity and privacy. Staff valued people’s individuality and enjoyed working in the home.

Staff ensured people had access to social activities which they enjoyed. People were encouraged to maintain relationships with people who were important to them.

Further information is in the detailed findings below.

The inspection was carried out on 28 January 2016. Forty-eight hours’ notice of the inspection was given to ensure the registered manager and people were available.

Dimensions 53 Cambridge Road is a small service providing accommodation and support with personal care to a maximum of six people with a learning disability. At the time of our inspection, six people were living at the service.

The service 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.

People were well cared for and there were enough staff to support them effectively. The staff were knowledgeable about the complex needs of the people and knew how to spot signs of abuse. People felt safe and were supported by the care staff and registered manager. There were robust recruitment checks in place prior to staff commencing work. Medicines were administered as prescribed and stored safely within the service.

Care records and risk assessments were personalised, up to date and were an accurate reflection of the person’s care and support needs. The care plans were written with the person, who was fully involved in the planning and identifying of their support needs. The care plans included the person’s likes and preferences and were reviewed regularly to reflect changes to the person’s needs.

Staff had completed training appropriate to their role. There was an on-going training plan in place as well as additional group training sessions. Staff were observed being kind and caring and treated people with dignity and respect. They spoke to people in a kind, respectful and caring manner. There was an open, trusting relationship between them, which showed that staff and managers knew people well.

People were asked for their consent before care and support was given. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully.

People were supported to be part of the local community and were able to attend activities both within the home, as well as in the local community. They made choices about how they spent their time and where they went each day.

People and their relatives were asked for feedback about the service they received and any concerns were addressed promptly. Staff worked well as a team and said the manager provided support and guidance as they needed it. There was an open and transparent culture which was promoted amongst the staff team.

Staff felt the service was well-led and they were supported in their roles. Procedures were in place to learn from any r incidents and there were clear actions recorded.

We spoke with four of the five people using the service who were able to communicate verbally, three members of staff and a senior manager. We observed support given to all people living at the service. People told us they were happy at the service, were supported to do what they wanted, and were involved in decisions made about their care and support. They told us staff “do listen”, and that if they ever need anything staff “come quickly”.

We reviewed care plans for three of the five people using the service and they were detailed, up-to-date and person-centred. People living at the service and staff knew and got on well with each other. Support was observed to be person-centred, respectful and responsive to individual needs.

The service had identified a need for additional staff, but the staffing level did not compromise people’s health and welfare and plans were in place for recruitment. There were adequate systems for recording and responding to complaints, and an easy-read guide to the process was available to all people using the service. The service had effective procedures in place for safeguarding vulnerable adults and staff followed the appropriate local safeguarding process.

In this report the name of a registered manager appeared who was not in post and not managing the regulatory activities at this location. This was because they were still a registered manager on our register at the time of this inspection.

We spoke with three people using the service, three members of staff and the newly appointed manager. We observed support given to people using the service. The people spoken with were positive about the support they received from the service. One person told us everything was “alright,” and another person told us they were “happy.” Care and support were observed to be respectful and responsive to individuals’ needs.

People supported by the service and staff knew and got on well with each other. Staff ensured people were enabled to give their consent to care and support whenever possible. Where people did not have capacity to consent, effective systems ensured their rights and well-being were protected in line with legal requirements.

The provider’s recruitment and selection processes ensured staff were suitable and sufficiently skilled to provide effective care and support to vulnerable people.

People were given opportunities to feedback about the service, and their complaints and comments were taken account of to improve the service. Regular audits helped maintain standards as part of an ongoing quality assurance programme.