Dimensions Somerset The Saplings

People's needs and their quality of life did not always form the basis of the culture at the service. Although staff were kind and caring, they did not always put people at the centre of their care. For example, staff levels and guidance were not always facilitating people to stay safe and meet all their needs. People were living in a service where there had been positive changes. For example, the current manager was promoting an open, transparent culture. Relatives of people felt they were kept informed of anything which happened. However, it was not clear whether these improvements were sustainable.

The provider had a culture of people receiving "active support" placing the person at the centre of their care. Leadership of the service had not always been consistent which meant improvements were required. However, examples were seen where staff made blanket decisions such as everyone having the same evening meal. Communication systems were not always empowering people to express their needs and wishes. Mixed opinions were heard from staff about how valued they felt.

● People were not always supported by enough appropriately skilled staff to meet their needs and keep them safe. Staff knew how to protect people from abuse and who to raise concerns to. ● People had opportunities for positive risk taking. People were starting to be involved in managing their own risks whenever possible. However, people's existing risks were not always assessed regularly. ● People's care and support was provided in a safe, clean, well equipped, well-furnished and well- maintained environment which met their sensory and physical needs. ● People were starting to be supported to be independent and have control over their own lives. Their human rights were being considered and this was led by a new manager. ● People received kind and compassionate care from staff who protected and respected their privacy and dignity. Staff members understood most of people's needs. However, people were not always having their communication needs met and information shared in a way that could be understood. ● People who could become distressed and upset resulting in behaviours towards others had proactive plans in place. However, these were not readily accessible to all staff working with them. Systems were in place to report and learn from any incidents although action could be delayed.

● People had opportunities to make choices with the limited communication strategies in place. They took part in activities which were part of their planned care and support. Staff were beginning to help people put aspirations and goals in place. ● People's care, treatment and support plans reflected their sensory, cognitive and functioning needs. However, there were times these plans contained contradictory details or lacked key information. ● People received support which met most of their needs and aspirations. Support tried to be focussed on people's quality of life and it was emerging that best practice was followed. Systems were not always in place for staff to evaluate the quality of support given, involving the person, their families and other professionals as appropriate. ● People received most of their care, support and treatment from trained staff and specialist able to meet their needs and wishes. Managers had not always ensured that staff had relevant training, regular supervision and appraisal. ● People and those important to them, including advocates, were beginning to be actively involved in planning their care. Where needed a multidisciplinary team worked together to provide the planned care. Although, there were times when reviews had been missed. ● People were not always being supported by staff who understood best practice in relation to learning disability and/or autism. Governance systems were being developed to ensure people were kept safe and received a high quality of care and support in line with their personal needs. People were not always equipped with tools to help them work with leaders to develop and improve the service. Although relatives felt involved.