The inspection took place on 10 January 2017. The provider was given 48 hours’ notice, because we wanted to make sure that the relevant people we needed to speak to would be available.

The service had a registered manager who also managers another service that is owned by the provider. 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.

Dimensions 87 Hazel Avenue provides accommodation and personal care for up to five adults with learning disabilities, physical disabilities or both. At the time of the inspection four men were living at the service, who were over the age of 55. The environment was safe and had been purpose built to suit the needs of people who were wheelchair users or who had restricted mobility, as it provided level access throughout.

People who lived at the service had their own individual ways of communication through eye contact, gestures or noises. Throughout the inspection we saw staff responding to people’s needs and providing care and support in a person centred manner. Staff were able to immediately recognise when people needed or wanted help or support, however the need was expressed. However, not all the recording of people’s needs was being done in a person centred way and not all guidance for staff was clear in order to demonstrate how changes in some people’s needs had been addressed.

People were encouraged to make decisions about their daily care and support. We saw how well staff understood people’s communication needs which enabled staff to support people to make choices. Where people needed to have a legal representative or relative represent their views then these were sought and acted upon. A relative/legal representative told us: “Plenty of opportunity to change things about [person’s name] care if I wanted” and they went on to explain how staff then acted on what they had said to further improve the person’s support.

People were kept safe because staff understood their responsibilities in protecting people and knew how to report any concerns. People were enabled to take positive risks as part of a person centred lifestyle.

People were supported by staff who consistently demonstrated kindness, compassion and a genuine interest in the people they supported. People showed us positive signs that they were relaxed and at ease with staff and their surroundings. A relative/ persons representatives told us: “He is very well and settled and very happy there, he has a really good relationship with staff and they have a good understanding of his communication needs”.

There were sufficient skilled staff to meet people’s individual needs in a timely and safe way. A staff member said “There is now much more of a focus on staffing levels designed to meet the needs of the residents as they have just recently changed the shift patterns in the morning, it makes it much better”. Many of the staff were new to the service but had previously worked in the provider’s other services and they told us about their positive induction into the service. One staff member said: “I was given time to get to know people, it gave me the confidence I needed to know what I was supposed to be doing”. Staff spoke enthusiastically about recent ‘active support training’ which is a method of enabling people with learning disabilities to engage more in their daily lives. A staff member said “It has changed the way we support and now get people more involved”.

People were supported to maintain good health and to access healthcare services as and when required.

People were engaged in individual meaningful occupation and activities and were supported to take part in wider community activities. Staff told us: “Lot more interaction here

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 their experiences.

During the inspection we observed that the house was clean and that people using the service were involved in maintaining the cleanliness. One member of staff told us "we keep them involved in the housekeeping as much as possible".

We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis.

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas reading books, watching television and interacting with staff. We observed staff spending the majority of their time with people who used the service, going shopping, listening to music, attending the library and bowling. They frequently checked on them to ensure they were alright when spending time on their own.

The manager told us "we try to involve as many professionals as possible to ensure that people's dietary and nutritional needs are met".

One member of staff told us "the residents are all great here. We have fun, a joke and a laugh - we make it as much fun as possible. It is nice to leave work knowing you have made a difference and made someone smile".

Four people live at this service and no one was able to verbally communicate with us.

People used noise, gesture, body language and facial expressions to express themselves. The staff knew people well enough to interpret their choices, moods and feelings.

We used a variety of methods to gain an understanding of people's experiences including observing the interactions between staff and people who used the service, talking to staff and reviewing the records.

We observed that the staff spoke to people with respect and they offered them choices. Staff supported and assisted people to attend their chosen activities and to take part in activities in the home.

The care plans gave an extremely detailed picture of the individual support each person required to meet all aspects of their health and care needs.

The staff were able to describe people’s needs and how these were met.