What life is like for people using this service:

•People using this service benefitted from an outstanding caring, responsive and well-led service. People were consistently observed to be treated with kindness, compassion and respect. People told us they very well cared for and our observations confirmed this. People’s relatives spoke overwhelmingly of the positive outcomes their relatives had achieved and how the service went “Over and above” their expectations in supporting people to achieve a good quality of life.

•In line with Registering the Right Support guidance, people were placed at the heart of the service, their views, opinions and wishes were sought and acted on to deliver person centred care tailored to their needs and aspirations. People had achieved excellent outcomes based on a robust care planning approach to meet their changed needs. People’s independence was promoted and valued enabling people to maintain and develop skills and abilities to meet their desired outcomes.

•The service continued to provide safe and effective care. People were supported to live as independently as possible and to manage risks to their health safety and wellbeing. Staff continued to complete training that supported them to provide effective care and this included training to meet the specific needs of the people they supported. People experienced positive outcomes in their health due to the prompt and thorough approach in managing people’s healthcare needs.

•The service was exceptionally well led. The registered manager was passionate about providing a high standard of care and committed to challenging discrimination which impacted on the rights, choices and needs of the people they supported. This had resulted in improvements to people’s care and treatment and an improved quality of life. Staff consistently fed back they were well supported in their role and told us the leadership was “Excellent”. There was a strong emphasis on continuous improvements which were identified through a robust approach to quality assurance, incident analysis and an inclusive ‘can do’ culture and ethos.

•More information in detailed findings below

Rating at last inspection: Good (the date the last report was published was 11 January 2016)

About the service: Sanctuary supported living – 26 Tilmore Gardens is a residential care home that was providing accommodation and personal care to 10 people living with a learning disability. Personal care was also provided to four people living in a supported living household. Both services were managed by one registered manager with separate staff teams.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Why we inspected: This was a planned inspection based on previous rating, the service has improved to Outstanding.

Follow up: We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated as Outstanding.

This inspection took place on the 8th and 9th October 2015 and was unannounced. Sanctuary Supported Living - 26 Tilmore Gardens is a service registered to provide accommodation and personal care for nine adults with a learning disability. At the time of our inspection there were eight people using the service. Accommodation was provided within a large detached house including a garden and single ensuite bedrooms. The service was located close to the town centre of Petersfield.

The service 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.

People who lived in the home told us they felt safe and people’s relatives we spoke with said their family members were cared for safely. There was a positive, engaging and open atmosphere in the home and people were confident in talking to staff about their needs and concerns.

Staff completed training in safeguarding people from abuse and they had access to information and resources to enable them to act on concerns. People were given information on abuse and how to stay safe. People were supported to understand and assess risks to their safety and wellbeing and they were involved in planning how these could be managed safely. Records showed that people’s individual risks were identified and staff we spoke with were knowledgeable about how to support people safely.

People understood how to act in the event of an emergency such as a fire and individual and service plans were in place to protect their safety if an emergency occurred.

There were sufficient staff available to support people and people had a choice of staff that supported them. Staff were recruited safely and people were involved in the recruitment process.

Medicines were administered safely by staff who had been trained and were assessed as competent to do so. There were procedures in place to ensure the safe handling and administration of medication. People were supported to understand their medicines and these were regularly reviewed by a GP.

Staff completed training relevant to their role and to the specific needs of the people they supported. People’s needs were central to the process of staff supervision and this ensured staff were supported to deliver effective care that met individual needs. Staff had plans in place to help them develop their knowledge and skills and to achieve recognised qualifications in health and social care.

People were supported to make decisions about the care and support they received. Where people did not have the capacity to consent to care and treatment the provider acted in accordance with the Mental Capacity Act 2005. People’s mental capacity was assessed and decisions were made in their best interest involving the relevant people.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005. The application procedures for this are called the Deprivation of Liberty Safeguards (DoLS).The Care Quality Commission (CQC) monitors the operation of the DoLS which applies to care homes. Applications for DoLS had been made on behalf of people living at the service appropriately;

People were involved in the preparation and cooking of meals and choice of menu. People were encouraged to eat a healthy balanced diet. Where people had support needs in relation to eating and nutrition these were assessed and met.

Information about people’s healthcare needs was clear and recorded in accessible formats such as easy read and pictures. People were supported by a range of healthcare professionals and this included specialist treatment providers as required. The registered manager acted promptly to ensure people’s healthcare needs were met. People told us and records showed people were supported to achieve good health outcomes.

The home had been extensively refurbished and improvements had been made to ensure the environment met people’s needs.

The atmosphere in the home was joyful and we observed people and staff having fun together and enjoying each other’s company. People were supported by caring and compassionate staff who responded to people with kindness and understanding. There was a person centred culture in the home which focused on people’s individual preferences and diverse needs.

People’s rights to dignity, confidentiality and privacy were respected by staff.

People were involved in their care planning. Care plans were regularly reviewed with them and others involved in their care to ensure their changed needs were met. People were supported to maintain their independence and to achieve improvements in their health and wellbeing. People participated in a range of activities to meet their needs. This included new and exciting activities to meet their aspirations.

When people experienced health concerns prompt action was taken to ensure these were investigated and treated. People’s individual health needs were thoroughly assessed and documented. Records showed that people’s health needs were acted on and that clear information was available for other treatment providers as required. People experienced good health outcomes because there was a consistent and proactive approach to their needs.

There was a complaints system in place and complaints were acted on appropriately and learning followed to ensure these events were not repeated.

The registered manager promoted a person centred, open and inclusive culture in the home. The staff team were confident in the leadership of the registered manager and worked together to ensure the home provided a happy, caring and responsive environment for people.

People’s needs and wellbeing were central to the way care was organised and delivered. The registered manager inspired the team to deliver a quality service through example and in their management approach. They used systems and processes to ensure a high quality service was delivered. For example; staff meetings, supervisions and training, spot checks of service delivery, feedback from people, relatives and other professionals.