CQC report explained · a residential care home
What the CQC found at Dimensions Somerset The Saplings
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found unsafe infection control practices, staffing levels that were sometimes too low, and gaps in assessing and managing risks. They found no evidence that people had been harmed, but said people were placed at risk.
- Effective?
- Good
- This question was not rated in this inspection.
- Caring?
- Good
- This question was not rated in this inspection. Inspectors did find that staff were kind and compassionate, although people's communication needs were not always met.
- Responsive?
- Good
- This question was not rated in this inspection. Inspectors found that people had choices and activities, but communication methods and some care information did not always support people's needs and wishes.
- Well-led?
- Requires improvement
- The new manager was visible, approachable and promoting an open culture. However, leadership had not always been consistent, governance systems were still developing, and inspectors were not sure improvements would be sustained.
What inspectors found, February 2022
Dimensions Somerset The Saplings was rated Requires Improvement; inspectors found risks with staffing, infection control and care planning.
This was an unannounced inspection carried out on 13, 17 and 19 October 2021. Inspectors spoke with staff, relatives and health professionals, observed people's care, and reviewed care, medicine and management records.
The home was not always safe. There were problems with staff numbers, the safe use of protective equipment, and recognising and managing people's health and care risks. Some care plans were out of date, contradictory or missing important guidance.
Staff were described as kind and caring, and the home was clean, well equipped and maintained. Medicines were generally managed safely. A new manager was making positive changes, but inspectors were not yet sure these improvements would last.
The overall rating was Requires Improvement. Safe and Well-led were both rated Requires Improvement, and the home breached regulations about safe care and treatment and staffing.
Kind and respectful care
Staff were described as kind and compassionate. They protected people's privacy and dignity.
“People received kind and compassionate care from staff who protected and respected their privacy and dignity.” from the report
Safe and suitable environment
The home was clean, well maintained and equipped to meet people's sensory and physical needs.
“People's care and support was provided in a clean, well equipped, well-furnished and well-maintained environment.” from the report
Medicine systems
Inspectors found that medicines were generally ordered, stored, administered and recorded safely. Medicine reviews were also taking place.
“Staff followed systems and processes to safely order, receive, administer, record and store medicines.” from the report
Safeguarding awareness
Staff knew how to recognise abuse and how to report concerns. The service worked with other agencies to protect people.
“People were safe from abuse. Staff understood how to protect people from abuse and the service worked well with other agencies to do so.” from the report
Staffing levels
seriousThere were times when too few staff were available to meet people's health, personal care and observation needs safely. This was a breach of Regulation 18.
“People were not receiving a safe, meaningful quality of life because staff numbers and deployment was not in line with their needs and wishes.” from the report
Infection control
seriousStaff did not always use or dispose of protective equipment correctly, and some infection control guidance was not followed. This was a breach of Regulation 12.
“People were placed at risk of infections spreading because staff were inconsistently wearing and disposing of PPE and were not wearing PPE in line with government guidance.” from the report
Risk information
seriousCare records sometimes contained old, contradictory or missing information. Inspectors found risks involving catheter care, choking and aspiration that were not always properly covered or managed.
“The provider had failed to robustly assess and manage risks relating to the health safety and welfare of people.” from the report
Inconsistent leadership
needs fixingThe new manager was making changes, but the home had experienced several managers and its systems for checking quality and safety were still developing.
“The provider had a history of multiple managers at this location. Therefore, it was not clear yet whether these improvements would be maintained.” from the report
- 01How many staff are planned and actually on duty for each shift, especially when people need two staff for personal care or close observation?
- 02What refresher training and checks have been introduced to make sure staff put on, remove and dispose of PPE safely?
- 03How do you make sure every person's care plan is current, consistent and available to all staff?
- 04What guidance is now in place for catheter care, choking risks and following speech and language therapist advice?
- 05What has been done to make sure the improvements introduced by the new manager continue over time?
This was a focused follow-up inspection of Safe and Well-led, including infection prevention and control; the other key questions were not rated in this report. This explanation was written from the published report of 1 February 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2019
Dimensions Somerset The Saplings was rated Requires Improvement; inspectors found kind care but weaknesses in medicines records and leadership.
This was an unannounced inspection on 25 June 2019. One inspector met everyone living in the home, observed care, spoke with staff, relatives and health professionals, and checked care, medicines, staffing and management records.
People appeared comfortable and relaxed with staff. Inspectors rated the home Good for effective, caring and responsive care. People had access to healthcare, received support with food and drink, and were treated with kindness, dignity and respect.
The home was rated Requires Improvement overall, with the same overall rating as the previous inspection in May 2018. Medicines management had improved, but some records were unclear, fridge temperature checks were missed, care records were difficult to follow, and quality checks did not always find problems.
Safe and well-led were both rated Requires Improvement. The home had no registered manager at the time, and staff were not clearly assigned to lead shifts or manage emergencies. CQC said it would continue to monitor the home and could inspect sooner if concerning information was received.
Kind and respectful care
Inspectors saw staff being attentive and thoughtful. People were supported with dignity and were asked about their wishes and wellbeing.
“People looked comfortable with staff and we saw that staff were attentive to their needs.” from the report
Access to healthcare
The home supported people to see a range of health professionals, including GPs and the community learning disability team.
“The service made sure everyone living in the home had access to the healthcare they needed.” from the report
Personalised choices and activities
People were supported to communicate using pictures, photographs, signs and gestures. Activities and outings were arranged around their needs and abilities.
“Activities were arranged according to people's individual needs and abilities.” from the report
Staff safeguarding knowledge
Staff had safeguarding training and understood how to recognise and report concerns about abuse.
“Staff had received training in safeguarding and knew how to recognise signs of abuse.” from the report
Medicines records and storage checks
seriousSome medicine records were unclear or inaccurate. Required fridge temperature checks were missed, and action was delayed when temperatures were above the safe maximum.
“The planned daily temperature checks were not completed for eight days in May 2019 and for five days in June up until the day of our inspection.” from the report
Unclear shift leadership
needs fixingWhen the manager was absent, no staff member was formally in charge of each shift. Staff did not have clear guidance about their responsibilities during an emergency.
“When the manager was not on duty, there was no allocated member of staff in charge of each shift.” from the report
Care records were difficult to use
needs fixingInformation was spread across many files and folders, with duplication and some outdated records. This made it harder to check that records were complete and current.
“There was no clear reference or guide as to what records should be in place, some information was repeated in different files, so it was difficult to check for completeness.” from the report
Quality checks missed shortfalls
needs fixingThe home's audits and monitoring systems did not consistently identify problems with records, monitoring and medicines management.
“They had not identified the shortfalls we found, for example, with record keeping, monitoring records and with medicines management.” from the report
- 01What changes have been made to ensure every medicine administration record is clear and accurate?
- 02How are medicine fridge temperatures now checked, and what happens immediately if a temperature is outside the safe range?
- 03Who is formally in charge of each shift when the manager is not present, and what are their emergency responsibilities?
- 04How have the care records been organised so staff can find the current information quickly and identify outdated records?
- 05Have all staff now completed catheter care training, and how is their competence checked?
This was an unannounced comprehensive inspection covering all five key questions, including the care and the premises; the inspection was planned because the previous rating was Requires Improvement. This explanation was written from the published report of 3 August 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Dimensions Somerset The Saplings
3 rated inspections over 4 years: the service has held its Requires improvement rating throughout.
- February 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Dimensions Somerset The Saplings →
- August 2019Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
Read what inspectors found at Dimensions Somerset The Saplings →
- June 2018Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2017
Registered with the Care Quality Commission on 3 April 2017.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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76 live-in carers within about two hours of Somerset
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,370 a week. 62 can care for a couple. 12 years' experience on average.
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