This unannounced inspection took place on 29 August 2017.

Sandsground is a residential care home providing care and accommodation for up to five people with a learning disability. The primary aim at Sandsground is to support people to lead a full and active lifestyle within their local communities and facilitate their life-long learning and personal development. The service is located in a converted house, within a residential area, which has been furnished to meet individual needs of people. At the time of our inspection five people were using the service.

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.

Staff had completed safeguarding training and had access to relevant guidance. They were able to recognise whether people were at risk and knew what action they should take in such a case. People were also provided with information about safeguarding in a format that met their needs to help them identify abuse and respond appropriately if it occurred.

The provider had identified risks affecting people's safety and had put appropriate measures in place to reduce the risk of harm. The measures were to be used in situations where people's behaviour might cause harm or distress to themselves or others.

Medicines were administered safely in a way people preferred by suitably trained staff who had their competency assessed annually by the registered manager.

Staff were supported to undertake training to support them in their roles, including nationally recognised qualifications. They received regular supervisions and appraisals to support them to develop their understanding of good practice and to fulfil their roles effectively.

Where some people were unable to make certain decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.

People were supported to have their health needs met by health and social care professionals including their GP and dietitian. People were offered a healthy balanced diet and when people required support to eat and drink, this was provided in line with relevant professionals’ guidance.

For those people who needed support to manage their behaviour, behaviour support plans had been drawn up by the provider's assistant psychologist. Staff had received training in positive behaviour support, understood the triggers for people's behaviours and ensured people were sufficiently occupied during the day.

Staff supported people to identify their individual wishes and needs by using people’s individual methods of communication. People were encouraged to make their own decisions and to be as independent as they were able to be.

The provider promoted people’s personal interests and hobbies. Social activities were organised in line with people’s personal interests and there was a lively atmosphere at the service. The service maintained strong links with the local community. People and their relatives knew how to raise a complaint if they needed to and were confident in approaching staff about any concerns they had. Where concerns had been raised, they had been responded to according to the provider’s complaints policy.

A system to monitor, maintain and improve the quality of the service was in place. The provider had a clear commitment to driving up the quality of care by seeking views from people who used the service, their relatives and other professional stakeholders.

People, their relatives and staff felt the service was very well managed and praised the management team. The registered manager was perceived by people and their relatives as a very accessible person who listened to the views of o

We inspected Sandsground on the 2 September 2015.  Sandsground is a small care home offering accommodation and support to people with learning disabilities. There were three people being supported by the service on the day of our inspection. This was an unannounced inspection.  This service was last inspected in August 2014 and was meeting all of the required standards.

There was a registered manager in post at the service. 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 service had risk assessments in place that supported clear support plans. However there was an occasion when risks identified had not been risk assessed in relation to pressure care. Action in relation to incidents and accidents was not always documented in a way that prevented future incidents.

Medicines were managed appropriately and administered in line with the prescription guidelines. Staffing levels appropriately met the needs of the people who used the service and was adequate to cover sickness and absence.

The service was focused on adhering to the principles of the Mental Capacity Act (MCA) 2005. The MCA is the legal framework that protects people’s right to make their own specific decisions at a specific time. The service were using generic assessments with regard to assessing people’s capacity. However people were being supported using the appropriate best interest process and staff we spoke with understood the principles of the MCA. Deprivation of liberty safeguards (DoLS) applications had been applied for appropriately and was kept under reviews. DoLS are in place to ensure that people’s freedom is not unlawfully restricted.

Staff felt supported and were given adequate training and opportunities to develop professionally. Staff received regular supervision and appraisal to reflect on their practise and identify areas for development.

People benefited from a caring culture that involved people in decisions relating to their own care. We observed a number of caring and warm interactions and relatives we spoke with also told us the culture within the home was respectful and caring. The service also adapted to ensure people were supported in line with their own preferences regarding end of life care.

People were supported within a person centred culture that respected their wishes and preferences and identified goals and aspirations. People had access to activities that interested them and were supported to attend activities they enjoyed. There was an effective system in place to manage complaints and concerns.

The service was described by everyone we spoke with as ‘well led’. There was an effective system in place to monitor the quality and safety of the service and the culture within the home amongst the staff team was described as caring and supportive. This was acknowledged, when the service received an award from the provider for having the best staff retention record out of all the services.

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.

People were able to make decisions about whether or not to give consent to their care because they had information about alternatives and the risks and benefits of each.

We found that the provider had ensured that people experienced safe and appropriate care that met their needs and protected their rights. The relatives of people who used the service praised the quality of support provided by staff. One parent told us, "They have got a good staff ratio to meet challenging and complex needs and all the staff know the people they care for really well. I know he's safe there."

We observed people being given their medicines in a safe and calm way, in line with their care plans. Staff knew what medication people were taking and the reason for it. Relatives told us that they were involved in best interest decisions if a GP suggested a change of medicine.

We saw that people were cared for by suitably qualified, skilled and experienced staff because the provider had an effective recruitment process. We spoke with staff who told us that they had completed a robust selecion procedure and had not been appointed until all relevant checks had been completed.

We read the provider's complaints policy and procedure. This showed that the provider had a system for receiving, handling and responding to comments. Relatives told us that they knew how to make a formal complaint but had no reason to because the manager addressed small issues immediately.

We were not able to talk with people who use the service about their care. Two people were on holiday and one person was unwell.