Sandsground is a small care home offering accommodation and support to three people with learning disabilities. On the day of our inspection there were three people living at the home. We spoke with one person who used the service and conducted a Short Observational Framework for Inspection (SOFI) due to not being able to communicate with the other two people who used the service. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We also spoke with two people's relatives and looked at all three people’s care files. We spoke with six care staff which included the registered manager and looked at four staff files. We also reviewed information made available to us by the registered manager in relation to the day to day running of the service and quality assurance.During the inspection evidence was gathered to answer five key questions; is the service safe, effective, caring, responsive and well-led?
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
Is the service safe?
All staff received safeguarding training and were able to explain the types and signs of abuse. There was also a clear policy and procedure for care staff to follow when abuse was suspected. Care staff were able to tell us about this procedure. Care staff were also able to tell us where they would go outside of the service such as the local safeguarding team and the care quality commission.
Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We looked at the care record of one person who had multiple complex needs. We saw that the service was working closely with other professionals and changing support plans to reflect professional’s guidance.
The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was aware of the recent Supreme Court judgement in relation to the Deprivation of Liberty Safeguards and would take appropriate action if a person required a DoLS.
Is the service effective?
People were supported in promoting their independence and community involvement. Each person in the home had access to activities that ensured they maintained their social links.
People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at the file for one person with complex needs who could also present behaviour that could be perceived as challenging. We saw that the service had developed a positive behaviour support plan with support from a psychologist. Behaviour monitoring showed that in the last six months this person’s behaviour had improved. This meant that people were supported in a way that ensured positive outcomes.
We saw that care staff received regular supervision and appraisal. We saw in people’s supervision records that they were supported to discuss their progress and any identified areas for development. We also saw they were able to discuss the people they supported and additional support they may have needed . We saw that supervision occasionally had themes. For example, we saw that in some records that the supervision meeting had been used as a refresher around the key principles of mental capacity. We saw that the emotional impact of the role was supported through group supervision where staff were able to discuss their concerns openly.
Is the service caring?
People’s relative’s felt the service was very caring, one relative told us, “they are very warm towards them, they pick up on what they needs quickly and they are always looking clean and tidy”. We saw people were supported to attend regular health checks such as dentist and optician. One person’s relative told us, “people always comment on how beautiful my relative’s teeth are”.
People who used the service understood the care and treatment choices available to them. People who arrived at the service were given an information booklet which contained information about the service and care people received. Before arriving at the home people who used the service were also supported by a referral team that designed a personalised transition process that was led by the person or their relatives on their behalf. This means people’s needs were understood and choices respected to ensure a comfortable transition to the service.
People’s care and treatment was planned and delivered in a way that protected them from unlawful discrimination. We saw that people who could not communicate had communication plans in place to ensure that people could understand their preferred methods of communication. This includes pictures, adapted Makaton and understanding sound and gestures. Makaton is a form of communicating using signs and symbols to help people to communicate. We also saw that there were risk assessments in place to prevent unlawful discrimination when out in public.
Is the service responsive?
People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. People and their relatives were involved in regular meetings and care reviews. We saw that relative’s involvement was encouraged and their views were taken into account.
Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We looked at the care record of one person who had multiple complex needs that were changing regularly. We saw that the service was working closely with other professionals and changing support plans to reflect professional’s guidance that supported these changing needs. We saw that a ‘changes to condition alert’ had been developed for care staff to alert the nurses to specific changes to this person condition. Care staff we spoke with understood this guidance.
Is the service well-led?
The provider had an effective system to regularly assess and monitor the quality of service that people received. The service had a compliance review every six month that covered a number of areas. We saw that the most recent audit had identified updates needed on people’s files. We saw that these updates had been completed.
There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. We reviewed the incidents and accidents book and saw that they were recorded clearly. We saw the service also recorded near misses.
We saw that there were regular team meetings that were used to ensure there was a culture where good practise could flourish. We saw in meeting minutes that ideas to improve performance were discussed. We also saw that any gossiping that threatened to impact on the culture were challenged.