Dimensions Lincolnshire Domiciliary Care Office

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff supported people to reduce the risk of avoidable harm while still encouraging them to take informed risks where appropriate, to further develop their skills or independence. Any restrictions were implemented in-line with the mental capacity act principles and used a best interest approach to ensure they were the least restrictive. However, we found some staff would benefit from refresher training on awareness of how to identify restrictions and understand how they impact people they are supporting. People were supported to safely manage and review prescribed medicines including reductions in-line with guidance to stop the over prescribing of medicines for people with learning disabilities (STOMP). The provider had recruitment and induction processes in place to ensure there were sufficient numbers of skilled staff employed who had a good awareness of people’s needs and how to raise concerns. People’s homes were kept safe and measures were in place to reduce the risk of infection.

This service scored 78 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they were involved in the development of any improvements and could see where improvements had taken place. The staff team were open and honest in the event of an incident or accident; people told us they were informed straight away.

Staff and leaders told us there was a positive culture of encouraging learning in everything they did. They were supported to reflect on incidents in staff meetings and supervision but the provider also took that learning and shared it across the organisation to drive improvements in all departments and regions. Staff told us about a scheme called ‘aspire’ where the provider encourages people to ‘test out’ any role in the organisation with a view to upskilling people and helping them identify their preferred carer and development path and any further qualifications they would like to attain. Feedback to senior leaders about their experiences and ideas are shared as part of this programme for wider organisational learning. They told us they produced tailored workshops so that each staff member can think about their strengths and areas they wished to improve on. They provided coaches and champions trained in specific areas of interest to help guide staff.

There was a good culture of learning, especially following incidents and accidents or from information shared from training courses and across the organisation. Staff received a good induction with reflection on areas for improvement. However, there were some areas where some staff would benefit from support to build their understanding. For example, people’s health diagnosis and The Mental Capacity Act 2005 (MCA) and The Deprivation of Liberty Safeguards (DoLS). This would ensure they were confidence about how people's rights and health conditions impacted their daily support. The provider understood the requirements of the Duty of Candour and ensured they were open and apologised to the relevant people when things went wrong.

People told us they were happy living in their home and had been able to choose who they lived with. A relative wrote to the provider to thank the staff for successfully supporting their family member to move home. They wrote, “I just wanted to say a massive thank you to [registered manager] and your team for transforming my [family member’s] lives into one of optimism and joy…We really appreciate everything that has been done over the last few months to get them moved. The difference is so obvious already.” Relatives also told us how staff had ensured they knew people’s preferences prior to moving and receiving support. A relative told us, “Staff know all of [my family member’s] likes and dislikes. We let them know when [my family member] first went there. Staff help them to be involved in helping with daily tasks. They enjoy baking and washing up.”

Leaders told us how they ensure people are involved in planning their care to ensure continuity of care during a transition process. Relevant people in a person’s life supported them where they were unable to make decisions for themselves. A senior manager said, “For the people we support who can tell us about their care and support they are very much involved in developing their support plan, their views, needs and preferences are recorded. If the people we support wish to change something about their care and support the changes would be made in their support plan, these are a live document. We would also ask the people we support in their annual review if they are still happy with how their support is provided and what they would like to change.”

Professionals who worked with the service told us they had seen how happy people were after moving into new services due to a high quality of care.

People were supported to liaise with other services and external professionals to access care and treatment and move between services in ways that meant minimal distress for them.

People told us they felt safe due to the staff and how they treated them in addition to knowing what they needed and always being for there for them. Relatives also felt their family members were safe and trusted the staff share any concerns.

Staff told us how they worked to reduce the risk of developing a closed culture. A staff member said, “We have our quality improvement coaches and they will go out to homes and do training. The [senior manager] has a report on culture they can complete when they go out and about and record any cases in the organisation where culture was a big thing. We have had some issues over the years with restrictive practices and investigated that and I was able to think whether or not I could be certain that it is not happening elsewhere.” Staff also told us how they ensure any restrictive practices are reviewed annually to ensure they are the least restrictive method and still needed. They told us this is done in collaboration with the local authority. Staff demonstrated they knew what to do if they ever had concerns. One staff member told us, “If you walk past something without saying then you are just as bad, you need to challenge and ask questions. It would get reported if there was any abuse suspected. I look for marks and bruises, people looking uncomfortable and scared or frightened, also even people’s tone of voice and how they talk to others. I would report to my team leader or the manager and higher up the chain, CQC, social workers and safeguarding team. We also have WB helpline."

There was clear learning from safeguarding events and shared learning across the organisation. The organisation did a lot of work around understanding how closed cultures develop and how to prevent them. This learning was shared throughout the staff teams reducing the number of incidents.

Where possible, people were involved, along with their advocates or relatives, in understanding risks and agreeing how to reduce them. Relatives told us how staff ensure their family members are safe when they become distressed. The relative said, “As my [family member] is non-verbal, staff are very good at observing [body language] for signs they are anxious. [Staff will distract them and talk to them.” Another relative told us how emergency admission to hospital are managed for their family member who can become distressed by crowds and noise. The relative told us, “There is a passport in place for when my [family member] goes into hospital. There is guidance for them to have a quiet room.”

Staff understood risks related to people’s health conditions or social wellbeing. They were able to recognise early indicators of distress and how to respond to them to prevent the person’s distress escalating while still enabling people to express their emotions and feelings. Staff and leaders told us how they monitor and manage risks. One staff member told us, “We have monthly locality manager meetings and the assistant managers often come also, we look at what the data is telling us and incidents for that quarter. Lessons learnt are built within [the IT system] called analytics, you can see if [there are patterns] such as weekends. We talk about compliments, complaints, CQC notifications and take 3 ‘hot topics’ for safety and prevention to focus on for the next quarter.”

The providers policies encouraged staff to enable people to consider positive risk taking. This had been successful and benefited people resulting in them being able to live successfully in their own homes in the community for the first time. Due to risk assessments and support plans, people were also able to begin to safely meet with friends for drinks and meals and other social events in ways that promoted their self-esteem and upheld their dignity.

People's homes had been adapted to suit their needs including consideration of long term needs due to deteriorating health conditions. People told us they liked their homes and had chosen their own decorations and furniture. A relative told us they liked that the environment was safe due to good security. They said, “[Staff] are with my [family member] 24/7. Front door is kept locked. Back door is kept unlocked so they can go into the secure garden.”

Staff and leaders told us how they supported people to keep their homes and gardens tidy and repaired and supported people to contact their landlords for repairs where needed. Staff checked equipment was safe and where required and that it had been serviced before use.

Fire safety checks were completed and monitored. Devices were used in some people’s homes to enable doors to be held open safely. Risks in relation to the environment were being managed well without the need for restrictive practices.

People and relatives were happy with the staff practice and skill levels and were involved in the process to decide which staff they felt comfortable with to provide their support. A relative told us, “My [family member] has never seen the staff rush off once the shift is over. They normally stay behind 10 or 20 minutes to do a handover.” Another relative said, “It’s different things that [staff] do or say, and I know they have been trained well.”

Staff were happy working for the organisation and felt they received a good induction and good training and support. They told us how they were encouraged to go for further qualifications and reflect on events and practices. A senior staff member told us, “Staff [supervisions] are really focused more on learning and developing a positive culture of giving and recognising received compliments and appreciation of each other. They look at what the staff member has learnt since the last meeting and what they could get better at, what they want to do next and how they can be better supported in relation to equality and diversity and inclusion. It looks at how they are feeling at work and how they want the company to respond to those feelings. They then set objectives with deadlines and clear direction.”

The rota planning ensured there were sufficient staff on duty to meet people's needs. Recruitment checks took place to ensure staff were suitable for the role and this included checks on agency staff and follow up observations of staff competence. Staff received a thorough induction, involving training, shadow shifts, time to read care plans and policies and opportunities to provide feedback on the process. The provider also had a team trained as mental health first aiders to support people and staff who were struggling with their mental health.

People told us staff supported them to keep their home clean and tidy. One person told us, “It’s nice and clean. I help to polish and hoover.” Relatives were also happy with the level of cleanliness. A relative said, “The home is always immaculate. The [staff] look after my [family member well.” Another relative told us, “The home is clean, all [the people] have little jobs to do.”

Staff told us how they support people to keep their homes clean and prevent infection. A staff member said, “[People] are supported to do their cleaning themselves, but we do extra around the toilet and bath. They wash their hands a lot and wear gloves and we do as well and we have aprons. We were wearing masks but not needed now. We have plenty of supplies of equipment.”

Staff had received training on infection prevention and control and monitored areas of risk such as food temperatures and cleanliness and function of fridges and freezers. There were cleaning schedules in place to ensure all daily cleaning was completed as well as for deeper cleaning. The provider had detailed contingency plans in place should there be any infectious outbreaks to ensure everyone’s safety and reduce the risk of infections spreading, this included for COVID-19.

People were happy with how they were supported with their medicines. They were not aware of any errors occurring or any other concerns. We saw extremely positive examples, where people had been supported to reduce various medicines and in some cases they had been able to work with staff and their GP to stop taking most medicines altogether. This had resulted in a dramatic increase in the quality of their life due to feeling better. One person became more settled, had a better sleep pattern, appeared happier as they started to laugh and smile more and the frequency of times the person showed signs of distress was greatly reduced.

Staff told us they received training in medicines administration and were regularly checked for competence in theory and practice. They demonstrated a good understanding of how to ensure medicines were not overused. One staff member told us, “There are 2 online courses then the manager comes in an watches you and goes through it with you ask questions, once or twice a year as an ongoing thing.” Another staff member said, “Everybody who is prescribed a psychotropic medicines has a STOMP plan not necessarily to reduce. We get everyone to review it and send to a practitioner and a family member that we all agree with that process. We have found GP's have been wanting to just take them off rather than review if appropriate.”

The provider had systems in place to ensure people received their medicines safely. Protocols were in place for ‘as and when required’ medicines and these were reviewed by an appropriate health professional. Agreements were in place for the use of covert medicines, again signed by a health professionals and using the best interest process to ensure this was the safest approach. The provider and staff had a pro-active approach to promoting STOMP, this is an initiative led by NHS England asking providers to sign up to reviewing how psychotropic medicines were being used for people with a learning disability to ensure they were appropriate and not over or incorrectly used. The provider had monitoring processes in place to review everyone’s medicines and involved relevant health professionals in this process. Plans were in place or had already succeeded in reduced or completely stopping a variety of medicines for people who no longer required them.