This inspection took place on 13 and 14 March 2018 and was announced. We gave the provider short notice of our inspection due to the nature of the service. This was so the registered manager could be available to assist us with our inspection. We contacted family members and healthcare professionals by telephone on 12, 21 and 28 March 2018.

This service provides care and support to 58 people living in various ‘supported living’ settings, so that they can live in their own home as independently as possible. All of the people supported are living with either a learning disability and/or Autism Spectrum Disorders. 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 had a manager who has been registered with CQC since January 2012. 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.

At the last inspection in November 2015, the service was rated Good. At this inspection we found the service remained Good.

Risk assessments contained detailed information about the steps that should be taken to reduce the risks. Also staff ensured assessments and support plans were kept up to date.

Staff had received training in safeguarding adults and the registered manager understood their responsibilities to identify and report any concerns. Safe recruitment processes were followed to ensure only suitable people were employed. We found staff had received a wide range of training, which gave them the skills and knowledge to support the people they supported.

People’s care managers determined the number of hours of support required and we noticed that for some individuals this meant that in an evening and, at times, over the weekend one staff member stayed with up to four people in a house. People told us that this could mean that to go out into town or to events everyone had to agree to go. The registered manager was aware of this difficulty and was working with care managers to resolve this.

Medicines were managed safely and people received their medicines as prescribed. We found staff appropriately supported people to access health and social care professionals, when needed.

We found that people had formed strong, caring relationships with staff who worked with them. We saw that staff treated people in a dignified and respectful manner.

People were supported to have maximum choice and control of their lives. Policies and systems in the service support this practice. Consent to care and treatment was clearly documented and appropriate authorisations were in place when people lacked capacity to make decisions.

Activities were developed around people’s interests. People were supported to maintain relationships and access the local community.

The service had a clear process for handling complaints. The registered manager was aware of the Accessible Information Standard that was introduced in 2016. The Accessible Information Standard is a law which aims to make sure people with a disability or sensory loss are given information they can understand, and the communication support they need. They told us they provided and accessed information for people that was understandable to them and ensured information was available in different formats and fonts.

Effective management systems were in place to monitor the quality of care provided and to promote people's safety and welfare.

The inspection took place on 12 and 13 November 2015. The inspection was unannounced.

Dimensions is a domiciliary care service that provides personal care and support to people with learning disabilities who live in their own home. The service covers the Darlington and Teesside area and supported 100 people at the time of our inspection.

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.

We spoke with a range of different staff members; the registered manager, locality manager and care staff who told us that the registered manager was always available and approachable. We spoke to 3 people who use the service over the phone and 4 relatives of others who were unable to speak over the telephone. Throughout the day we saw one of the people who used the service in their own home and staff were comfortable and relaxed with the registered manager and each other. The atmosphere was relaxed and we saw that staff interacted with each other and the person who used the service in a person centred way and were encouraging, friendly, positive and respectful.

From looking at people’s care plans we saw they were written in plain english and in a person centred way and made good use of pictures, personal history and described individuals care, treatment, wellbeing and support needs. These were regularly reviewed and updated by the care staff and the registered manager.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary for example: their GP, mental health team and care manager.

Our observations during the inspection showed us that people who use the service were supported by sufficient numbers of staff to meet their individual needs and wishes. The recruitment process was safe and inclusive and people chose their own support staff.

At the time of our inspection the Darlington staff team were attending their team meeting and we were able to see the records for others that took place. When we looked at the staff training records we could see staff memberswere supported and able to maintain and develop their skills through training and development opportunities. Staff we spoke with confirmed they attended a range of learning opportunities. They told us they had regular supervisions with the registered manager, where they had the opportunity to discuss their care practice and identify further training needs. During the inspection we were also able to speak with an external trainer who was visiting the service who offered positive feedback. We also viewed records that showed us there were robust recruitment processes in place.

We observed how people stored and managed medicines safely in their own home. We looked at how records were kept and spoke with the locality manager about how staff were trained to administer medication and we found that the medication administering process was safe.

During the inspection it was evident that the staff had a good rapport with the people who used the service and we were able to observe the positive interactions that took place. Staff were caring, positive, encouraging and attentive when communicating and supporting people in their own home with daily life tasks, care and support.

People were encouraged to plan and participate in activities that were personalised and meaningful to them. People were supported regularly to play an active role in their local community, which supported and empowered their independence.

We saw that the service focused on supporting people to have a healthy diet. The daily menu that we saw was devised with the people who used the service and was pictoral and was used to help them to plan their shopping, manage their personal budget and plan their week ahead.

We saw a complaints procedure was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. People also had access to advocacy services and safeguarding contact details if they needed it.

We found the service had been regularly reviewed through a range of internal and external audits. We saw action had been taken to improve the service or put right any issues found. We found people who used the service and their representatives were regularly asked for their views via phone calls and also meetings for people who use the service called ‘everybody counts’. This took place locally and regionally to collect feedback about the service.

During the inspection we saw that the service had a clear service improvement plan in place that the registered manager implemented across all the different localities that aimed to drive standards and continually improve the care delivered to people.