About the service: Sainthill House is registered to provide accommodation for 19 people who require accommodation and personal care. The service provides care and support for up to 14 older people who may have physical and/or mental health needs. The service includes Sainthill Cottage, attached to Sainthill House, which provides care and accommodation for up to five younger people who have a learning disability. On the day of our visit fifteen people lived in the service.

People’s experience of using this service:

People were not all able to fully verbalise their views therefore they were not able to tell us verbally about their experience of living there. Therefore, we observed the interactions between people and the staff supporting them.

The management team and staff knew people well and understood their likes and preferences and health needs. Staff were caring and spent time chatting with people as they moved around the service. Relatives told us they were welcome at any time and any concerns were listened and responded to.

People and staff told us the service was well managed. People said they were treated with kindness and compassion and felt respected. Staff showed a true fondness for the people they cared for and there was a warm, friendly and welcoming atmosphere. People’s wellbeing was promoted.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for social interaction and activity with staff.

The environment was safe and people had access to equipment where needed. Staff had received appropriate training and support to enable them to carry out their role safely, including the management of medicines.

There were positive working relationships with external professionals and a passion for continuous learning and improvement.

People were kept safe and protected from avoidable harm and abuse, and people had their medicines safely managed. New processes had been put into place to ensure a more robust oversight. People lived in an environment which was fully assessed for safety.

People received personalised care and support, and had their human rights protected. Staff were competent in their roles and were well supported. Quality monitoring systems had been further developed.

Rating at last inspection: Good (Report published 13 October 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection, the service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 14 and 16 September 2016 and was unannounced. The previous inspection of the home was carried out on 23 and 26 October 2015 where we found breaches of regulations. These related to safe care and treatment, safeguarding service users from abuse and improper treatment, and good governance. The service was rated as ‘requires improvement’ and the provider was required to submit an action plan explaining what they were doing to meet the legal requirement to improve the service.

We carried out this inspection in September 2016 to check whether these improvements had been made. Sainthill House is registered to provide accommodation for 19 people who require accommodation and personal care. The service provides care and support for up to 14 older people who may have physical and/or mental health needs. The service includes Sainthill Cottage, attached to Sainthill House, which provides care and accommodation for up to five younger people who have a learning disability. At the time of the inspection there were five people in the cottage and 14 people in the main house, with three people coming in for day care.

There was a registered manager in post. 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.

The registered manager had kept us informed about progress towards achieving the provider’s action plan, and we found significant improvements in all aspects of the service since the last inspection. There had been input from the local authority Quality Assurance and Improvement Team (known as QAIT). QAIT had evaluated the quality of the support provided, highlighting what was going well and making recommendations where improvements were needed. The provider had further developed the quality assurance system, and used the findings to create a comprehensive service improvement plan. At the time of this inspection the majority of the improvements had been made. People were very positive about the service. One person told us, “It’s extraordinary…There is a family mentality. The staff have a good relationship with each other and I’ve got to know them all very well. It’s an ideal placement”. A member of staff said, “I’m very proud of what we have done at Sainthill”.

At the last inspection in October 2015 we found staff did not understand their role in relation to infection control and hygiene, which placed people at risk. At this inspection we found improvements had been made. Staff had received training, PPE (Personal Protective Equipment) were readily available and accessible for staff, cleaning hours had been increased and weekly and monthly housekeeping and infection control audits were carried out.

At the last inspection we saw medicines administration records (MAR) for the application of creams and topical medication were not always being signed by staff. At this inspection we found systems were now in place to ensure people received all of their medicines safely. MAR charts had been completed correctly, care plans contained clear guidance for staff and mandatory training was in place about topical medication administration. Regular medication audits ensured this improvement was maintained.

At the last inspection in October 2015 we found people’s rights were not always protected under the Mental Capacity Act 2005 (MCA). Staff did not have an understanding of the MCA or how the principles applied to their practice. People’s capacity to make particular decisions had not always been assessed and documented, or a best interest process followed. In addition, people had not been referred for assessment under the Deprivation of Liberty Safeguards (DoLS). This meant they were potentially being deprived of their liberty to rec

During our last inspection at Sainthill House Care Home on 31 January 2013 and 12 February 2013 we found that the provider had failed to meet compliance actions in relation to staff recruitment and records. As a result CQC took enforcement action and warning notices were issued in relation to staff recruitment and records.

The focus of this inspection was to review the action taken by the provider to meet the warning notices. We found improvements had been made. Work was on-going to ensure records were accurate to protect people against the risks of unsafe or inappropriate care and treatment. A review had been undertaken in relation to staff recruitment processes and records. We found the provider was compliant with these outcomes.

During this inspection we met with or saw a number of people. People living at the home told us that they were happy with the care provided to them.

At the time of this unannounced inspection there were 14 people living at Sainthill Care Home; nine older people were residing in the Sainthill House and five younger adults with a learning disability were living at Sainthill Cottage.

We spoke with six people living at the service to hear their views and experiences. Some people had limited verbal abilities but most spoken with were able to indicate whether they were happy or not. People told us that they were happy living at Sainthill, that their needs and preferences were met and that the staff were supportive. Comments included, “They listen to me…whatever I suggest they work to that as a rule”, “I have enjoyed my stay here…staff are considerate and helpful…”, “I get on with everyone”, and “I am happy here”.

People told us that they liked the food provided and that the home was usually clean and fresh. We were told that routines were flexible and that people could make choices and decisions about their care and how they spent their day. The people we spoke with said that they felt safe living at the home and that they knew who to speak with if they were unhappy about something.

We also spoke with three health and social care professionals as well as seven staff working at the service, including managers, care staff and catering staff. Visiting professionals told us that their overall impression of the service was good. One health professional told us, “Staff are managing well…they are able to make any changes to help people…” Another professional commented, “The staff are very caring and understand people’s needs…” A third professional said, “People seem happy and well cared for…”

There had been a number of changes to the management of the home, which had resulted in an unsettled period for people living at Sainthill and for the staff. One person living at the home said, “Things were working like clock work but then lots of changes. Things are settling now”. Another person told us, “There have been a few changes, I can’t keep up…” Staff also spoke about the changes and the impact on them saying that some staff had been ‘disgruntled’ and left, and that there had been an ‘uneasy’ atmosphere for a while. We were told that things had improved with the appointment of a new manager; staff said they felt well supported in their role and that the team was working well together.

During this inspection we found areas of concern relating to care records, the storage of food and staff recruitment.

We carried out an unannounced inspection on 29 November 2011. We spoke with five people that live at Sainthill and some of their relatives. Overall they told us that they were very happy with the care and support they receive and the staff are polite and easy to communicate with. Comments included:

“Staff are marvellous, do a wonderful job.”

“Staff do everything very willingly. Treat me with respect.”

“Staff are nice and they support me.”

“I feel really supported and involved in my care.”

“I am saying it from the heart, I am respected here and there is always help here if I need it.”

People commented that they were fully involved and supported to make decisions about their care. For example, plans of care are reviewed with people living at Sainthill involved and their needs and wishes are taken into account. People said that they are encouraged to maintain their independence and feel fully involved in their care.

We were told that staff supported people appropriately with daily living tasks, including personal care and meeting nutritional needs. During our visit, we observed staff supportively assisting people to meet their personal needs, such as transferring from one area of the home to another with the use of a walking frame. We also saw a staff member assisting a person to eat their meal, by placing food on the fork and then giving the fork to the person for them to eat. The staff member was not hurried, which allowed the time for the person to eat their meal at a pace which suited them.

People we saw and spoke with confirmed that they felt safe and supported by staff at Sainthill and had no concerns of their ability to respond to safeguarding concerns. They felt that their human rights were upheld and respected by staff.

People we spoke with said that staff were supportive and helpful. Staff knew how to respond to specific health and social care needs and were observed to be competent with such. Staff were able to speak confidently about the care practices they delivered and understood how they contribute to people’s health and well-being.

The inspection took place on 23 and 26 October 2015 and was unannounced.

Sainthill House is registered to provide accommodation for 17 people who require nursing or personal care. The service provides care and support for up to 12 older people who may have physical and/or mental health needs at Sainthill House. The service also comprises Sainthill Cottage, attached to Sainthill House, which provides care and accommodation for up to five younger people who have a learning disability. At the time of the inspection there were five people in the cottage and 13 people in the main house, including two people attending day care.

There was a new manager in post. A registered manager application had been submitted to the Care Quality Commission but the registration process was still in progress. 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. Everyone was positive about the new manager, and felt they were approachable, caring, and committed to the service and the well-being of people there. Staff commented on the improvements he had made at the service and told us,” “It’s amazing the things that have changed for the better”.

People were not always safe because the service was not consistently following safe practice around recording when giving people their prescribed creams, and staff did not always understand their role and responsibilities in relation to infection control.

The service was not fully meeting its requirements in relation to protecting people’s human rights, where people lacked the mental capacity to make certain decisions about their care and welfare.

The service did not notify the Care Quality Commission of all significant events which had occurred, in line with their legal responsibilities. This meant that the Commission was unable to monitor whether the service had responded to these incidents appropriately.

People received care and support in line with their individual care plans; however some people told us they had not been involved in their development. We have made a recommendation about routinely and meaningfully involving people in decisions about their care and ensuring their details are recorded accurately.

We saw that staff promoted people’s independence and treated people with dignity and respect. Written feedback from one person said,” I cannot speak more highly of the care and attention I am receiving at Sainthill House; I certainly recommend it to everyone”. A relative told us, “The staff couldn’t look after [the person] any better. This is a home from home”.

People’s relatives said they were made welcome and encouraged to visit the home as often as they wished. They said the service was good at keeping them informed and involving them in decisions about their relatives care.

Staff were well supported by the provider and manager. They were undertaking a new comprehensive training programme to help them meet people’s mental and physical health needs.

There were enough staff deployed to meet the diverse needs of people at the service and to care for them safely. People were engaged in a variety of activities within the home and in the community and there were sufficient numbers of staff to support people to go out regularly if they wanted to. This ensured people experienced a good quality of life.

The provider actively sought the views of people, their relatives and staff through staff and residents meetings and an ‘on line’ questionnaire to continuously improve the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We made a recommendation about the service routinely and meaningfully involving people and their advocates in developing care plans, and ensuring their details are recorded accurately.