We inspected Saint John of God Hospitaller Services – 22 Sandown Road on 9 March 2017. This was an unannounced inspection, which meant that staff and the registered provider did not know we would be visiting.

At the last inspection in December 2014, the service was rated 'Good'. At this inspection we found the service remained 'Good'.

The home 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.

Saint John of God Hospitaller Services - 22 Sandown Road is a single storey, bungalow style service providing residential care for nine adults who have learning disabilities and may also have physical disabilities. The service is situated in a housing estate and is close to local amenities. At the time of the inspection there were nine people who used the service.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. Medicines were managed safely with an effective system in place. Staff competencies, around administering medication, were regularly checked. Appropriate checks of the building and maintenance systems had taken place to ensure health and safety was maintained.

There were sufficient staff on duty to meet the needs of people who used the service. Staff were available to provide one to one support and with visits out in the community. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences. A comprehensive training plan was in place and all staff had completed up to date training. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were able to choose meals of their choice and staff supported people to maintain their health and attend routine health care appointments.

Care plans detailed people’s needs and preferences and were person-centred. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. People who used the service had access to a wide range of activities and leisure opportunities. The service had a clear process for handling complaints.

Staff told us they enjoyed working at the service and felt supported by the registered manager. Quality assurance processes were in place and regularly carried out by the registered manager and registered provider, to monitor and improve the quality of the service. The service worked with various health and social care agencies and sought professional advice to ensure individual needs were being met. Feedback was sought from people who used the service through regular meetings’. This information was analysed and action plans produced when needed.

We inspected Saint John of God Hospitaller Services - 22 Sandown Road on 15 December 2014. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

22 Sandown Road is a single storey, bungalow style home which provided residential care for up to nine adults who have learning disabilities and may also have physical disabilities. It is situated in a housing estate close to local amenities.

The home did not have a registered manager. A manager from another service in the organisation was acting as manager until a new manager takes up post in April 2015. 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.

People who used the service had complex needs and difficulty with communication. We spent time in communal areas to observe the interactions between people and staff. We did seek the views of relatives in respect of care provided.

There were systems and processes in place to protect people from the risk of harm. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed.

We saw that staff had received supervision on a regular basis; however staff had not received their annual appraisal for 2014.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Relatives and told us that there were enough staff on duty to meet people’s needs. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, showed compassion, were patient and interacted well with people. When people became anxious staff supported them to manage their anxiety.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. However, staff had not undertaken nutritional screening to identify specific risks to people’s nutrition.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. We found that the service had an excellent relationship with the doctor of people who used the service. Both the doctor and the service worked in the best interests of people to ensure that their health and treatments needs were met. We saw that people had hospital passports; however, hospital passports did not contain sufficient information on people who used the service to ensure that hospital staff would know about them and their health.

Assessments were undertaken to identify people’s health and support needs as well as any risks to people who used the service and others. Plans were in place to reduce the risks identified. Support plans were developed with people who used the service and relatives to identify how they wished to be supported.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Staff encouraged and supported people to access activities within the community.

The provider had a system in place for responding to people’s concerns and complaints. Relatives told us they knew how to complain and felt confident that staff would respond and take action to support them. Relatives we spoke with did not raise any complaints or concerns about the service.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the home had an open, inclusive and positive culture.

We decided to visit the home at 4pm to gain a wider view of the service provided. This was part of an out of normal hours pilot project being undertaken in the North East region.

We spoke with the deputy manager and four staff and engaged with the eight people using the service. During this inspection we spent time in communal areas within the home so that we could observe the interaction between staff and people who used the service. We saw throughout the inspection that staff treated people with dignity and respect. We observed staff knocking on people's bedroom doors prior to going in and heard them engaging positively with people.

We found that people had detailed well written 'Individual Life Plans', which provided person centred information about each person living at Sandown Road.

We found that people were provided with support and care by an experienced staff team and that staffing levels and skill mix were sufficient to meet individual needs. Staff said, “Sufficient staff, there are always two staff when we take people out.” “Staffing levels have been increased when this has been needed."

We found there were good systems in place for ensuring there was sufficient equipment, which had been regularly serviced.

We found that there were good systems in place for the ongoing monitoring of the service.

During the visit, we met five people who used the service. One person was able to speak with us but found it difficult to make direct comments about many aspects of the service. The other people experienced great difficulty in both expressing themselves verbally and through their body language. Therefore we spent time observing the practice.

We found that staff continually included people in their conversations and ensured people views were sought. We observed staff sensitively worked with people to reduce any their anxieties. Staff effectively assisted people who disliked meeting strangers feel a little more comfortable meeting us. Staff discussed people with a sense of genuine warmth and told us the home was run much like a large family. We found that staff had a good understanding of how to best meet each person’s care needs.

We found that staff valued and cared about all of the people who used the service and could readily tell us what each individual liked and how to enable them to lead ordinary lives. We spoke in depth with two staff about people’s ability to make decisions. We found that the staff used positive risk taking practices and understood the requirements of the Mental Capacity Act 2005. Staff actively involved family members in designing their relatives care and when appropriate sough the input of advocates.

The visit took place because we were following up concerns raised at the inspection in October 2011. The people who used the service experience great difficulty in both expressing themselves verbally and through their body language. Their complex needs also limit how much involvement they can have in making choices about how the service is run. The issues we were following up related to how staff made sure healthy eating guidance was used; developing effective quality assurance systems; making sure the landlord upgraded the external fabric of the building and provided minor adaptations, which would help people get around the home. People were unable to express an opinion about these aspects but we did spend time with the people. We found that staff continued to include people in their conversations and ensured people were treated with respect. Again there was a sense that the home operated like a family setting and all of the people were valued and cared about.

We spent time with all of the people using the service. People experienced great difficulty in both expressing themselves verbally and through their body language therefore we observed how staff interacted with people. Throughout the visit we saw staff include people in their conversations and discuss what was happening both in the home and in general. There was a sense that the home operated like a family setting and all of the people were valued and cared about. At times staff did share a little more information about how they were delivering people's care than others in the room needed to hear. Overall though staff were seen to be respectful towards people and constantly endeavoured to retain people's dignity. All of our observations showed care was predominantly delivered in a sensitive, caring manner and staff delivered care with a genuine sense of warmth.