The inspection took place on 23 November and was announced. The inspection continued on 24 November and was again announced.

Dimensions Southampton & New Forest Domiciliary Care Office is based on the outskirts of Southampton and provides care and support to people with learning disabilities and autism. At the time of the inspection the service was delivering personal care to 68 people.

This service provides care and support to people living in 26 ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service also provides personal care to people living in their own houses and flats in the community. It provides a service to disabled adults with learning disability and autism.

Not everyone using Dimensions Southampton & New Forest Domiciliary Care receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The operations director was in the process of becoming the registered manager. The application had been received by our registration team. 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’s needs were holistically assessed and reflected choices and preferences which in turn ensured that people were supported to achieve life changing outcomes. The service had worked closely with people to ensure that additional specific personalised goals were set. Families told us that they felt the service had made a real difference to their loved ones lives.

The service worked in partnership with local GP’s and other health professionals to regularly review and assess medicines in line with Stopping over medication of people with learning disability, autism or both (STOMP). STOMP is an NHS-led campaign and is about making sure people get the right medicine if they need it. It encourages people to have regular medicine reviews, supporting health professionals to involve people in decisions and showing how families and social care providers can be involved. The service was able to show us how this had had positive life changing impacts on people’s lives.

People’s independence was promoted through the effective use of equipment and technology. This enabled people to access areas of their home, community and complete personal care tasks independently.

People were supported by staff who received regular training specific to their needs. An inclusive and innovative appraisal system was used. 360 appraisals took place across the service. This meant that feedback was gathered from people and the families about staff performance and the delivery of care.

Personalised care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they chose to live their lives. Each person had a care file which also included outcomes and guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received safeguarding training. People were provided with information about how to keep safe and were asked their desired outcomes following any alert made.

Effective positive behaviour support plans had been completed and were up to date. These gave s

We spoke with four people that used the agency, one relative and five staff. People told us that they liked the agency and that they felt safe. Staff we spoke with all told us they felt well supported in their roles.

We found people were respected and treated with dignity; their independence and involvement was promoted. When asked about their role, one staff member told us "We give people more independence, we don't just do things for people we guide them to do things for themselves".

We found people felt the service was delivered safely and people felt protected from harm. A relative commented to us, "I feel confident (my relative) is safe".

We found that staff had regular meetings and supervision with their line manager. We saw that staff were being supported to achieve qualifications that were relevant to their roles.

We saw regular audits were carried out to enable the provider to assess and monitor the service.

During this visit we spoke with three people who were using the service, three members of staff and the registered manager.

People using the service told us that they discussed their care and support with staff and that staff respected their wishes. They told us that they received the care and support they needed. One person said: “staff know what I need and work to that” and: “staff supported me all the way”. Appropriate arrangements were in place to protect people against the risks associated with medicines. A person using the service told us how staff had supported them to be more independent in managing their own medicines.

People told us they were supported by a consistent team of staff, which meant there was continuity of care. One person said: “I get on well with all of them. They are all very kind to me”. Another person told us that staff had “been very supportive, I’m really happy with that”. They said they trusted staff, “they keep their word”. People were made aware of the complaints system. One person using the service said if they had any problems they would speak to their support workers, who would “sort things out”. Another person told us they had not needed to make a complaint because “things get resolved quickly”.

We spoke to some people over the telephone to seek their views. People expressed a high degree of satisfaction with the help and support and were complimentary about the staff. They told us that they were happy with the care provided and that they felt safe and well looked after.

People commented that the staff were ‘very kind and helpful’. We were told that the staff always arrived at the planned times for their visits. They told us that they had regular staff during the week and at the weekends.

They said that the staff had carried out an assessment to ensure that the agency could meet their needs prior to providing care. They also said that care was tailored to their needs and that the staff had involved them or their relatives in the planning and delivery of their care.

We were told that the staff were always kind and courteous and respected their privacy and dignity when providing care. A person commented that their relative got on very well with the staff and there were no concerns. Another person said that they were ‘more than happy’ with the care and would like to keep to their current support worker.

Relatives told us that the staff always arrived on time as agreed with the agency. They said that staff would inform them if there were any changes such as when the regular staff were not available.

The staff said that there was good team work and they felt supported in their roles.

The inspection took place over two days on 9 and 10 February 2015. The inspection was announced which means that we gave the provider 48 hours’ notice of the inspection to ensure key staff were available to speak with us.

Dimensions are a specialist provider of a wide range of services for people with learning disabilities and people who experience autism. They are a not-for-profit organisation, supporting around 3,500 people and their families throughout England and Wales. This service provides care and support to 57 people across a wide geographical area from a registered office in Southampton. In Hampshire, the services spread between Portsmouth and Southampton and in Dorset, the service provides support at locations in Poole, Bournemouth and Dorchester. All of the people being supported by the service lived in their own home. Some people lived alone, whilst others lived in shared houses or supported living settings. The levels of support provided varied. Some received just a few hours support a week whilst others received 24 hour care and had complex health and social care needs.

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 and associated Regulations about how the service is run. The registered manager was supported by a number of locality managers who had delegated day to day responsibility for managing the delivery of care within people’s homes.

Some areas required improvement. Mental capacity assessments had not always been undertaken to establish if a person was able to make decisions about and agree to their support plan.

Staff had not always maintained an accurate record of the medicines they administered and some medicine administration records (MARs) did not contain adequate information to ensure people’s medicines were administered safely.

People told us they felt safe and there were systems and processes in place to protect them from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team.

Safe recruitment practices were followed and appropriate checks had been undertaken which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.

People told us the service provided them with effective care. One person said, “They care for me properly and if I’m ever not well, they care about me…they know about my problems and they have let me make suggestions, they take things on board....I have become more independent than ever since I have been here.”

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS); however, these only apply to care homes. In other settings such as people’s own homes or in supported living settings, depriving a person of their liberty can only be authorised by the Court of Protection. The registered manager had identified the service was depriving a number of people of their liberty in order to protect them from harm. They had taken action to notify the Local Authority so they could act to seek the relevant authorisations from the Court of Protection.

Staff received a comprehensive induction which involved learning about the values of the service, the needs of people using the service and key policies and procedures. Staff were supported to provide appropriate care to people because they were trained, supervised and appraised.

People were supported to have enough to eat and drink and their care plans included information about their dietary needs and risks in relation to nutrition and hydration.

People told us they were happy with the care provided and said they had good relationships with staff. One person told us the staff were, “Nice and lovely…I can rely on them”. A relative told us, “[the person] is given a lot of specialist care and attention…I know they are very happy and have a very full life”.

Staff had a good knowledge and understanding of the people they were supporting. Staff were able to give us detailed examples of people’s likes and dislikes which demonstrated they knew them well.

People told us they received personalised care and were supported to follow their interests, passions and make choices about how they spent their time. One person said, “I’m happy, I can have a lay in some mornings and go to bed early or late, I can go out on my own, I’m all over the place”. Another person told us, “I like to go shopping and we go out for a meal and sometimes, we go swimming”. People felt the service listened to their concerns or comments. One person said, “I’ve had no complaints, but would speak up and tell about things if I wasn’t happy, things that are not what we want get sorted, and most things we do want get done”.

People spoke positively about how well organised and managed the service was. They were keen to tell us about how they felt well supported by a service which had high standards and demonstrated a commitment to make their lives better.

There was an open and transparent culture within the service and the engagement and involvement of people and staff was encouraged and their feedback was used to drive improvements. There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving the best possible support.