Sapphire House is a residential care home for up to seven people who may be living with a learning disability, autistic spectrum disorder and a mental health condition or complex needs. The property is a detached house on a residential street which has been converted to self-contained flats and bedrooms with communal areas. There were five people living in the home when we visited.

At our last inspection on 27 and 29 January 2016 we rated the service good. At this inspection on 12 and 13 December 2018 we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

There were good systems in place to protect people from abuse and avoidable harm. All risks to people were assessed individually and there was detailed guidance available for staff. There were enough suitably trained and safely recruited staff to meet people’s needs. Medicines were received, stored, administered and disposed of correctly. Staff understood how to prevent and control infection and all the necessary health and safety checks were completed to ensure a safe environment. Accidents and incidents were recorded, analysed and reviewed to identify any trends and to prevent future reoccurrence.

People’s needs had been assessed before they moved into the home and people received personalised care which was responsive to their needs. Support plans were person centred and focused on outcomes for people and the support they needed to meet these outcomes. People had enough to eat and drink, were supported with their dietary needs and were offered choice around their food. People had access to the healthcare they needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by caring staff who respected them and promoted their independence. People’s needs around their communication were met and people were encouraged to be involved with all aspects of their day to day support. Staff protected people’s privacy and dignity and supported them to keep in contact with their families who could visit whenever they wanted.

The service had 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 could live as ordinary a life as any citizen. These values were seen in practice at the home. For example, the building was like any other on the road with no signs to show it was a care home. Staff did not wear uniforms and people lived their lives in the ways they wanted.

People and relatives told us they could raise any complaints they had with the registered manager. The complaints procedure was available and the provider actively sought feedback from people and their relatives. The registered manager reviewed any complaints to ensure the appropriate action had been taken and any learning identified.

People and staff told us the home was well managed and all our observations and evidenced gathered during our inspection supported this. Staff understood the vision and values of the home and felt supported by the management team. The managers promoted a positive, person centred and professional culture, had good oversight of the quality of the home and managed any risks. There was good record keeping and monitoring to ensure people received the support they needed. The provider promoted continuous learning by reviewing all audits, feedback and accidents and incidents.

Further informat

The inspection was carried out on the 27 and 29 January 2016 and was unannounced.

Sapphire House provides accommodation for up to a maximum of eight young adults who may have a learning disability, autistic spectrum disorder, sensory impairment or physical disability. Some may also present with some challenging behaviour. The accommodation is set over two floors with a communal living room and kitchen. There are also two flats in a self-contained area of the building. Outside there is a good sized garden that people can use and enjoy.

A previous inspection had taken place on 4 August 2014 and we found the provider was in breach of Regulations 13 and 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. We asked the provider to make improvements to protect people against the risks associated with the unsafe use and management of medicines. We asked the provider to make improvements in relation to the records kept around people’s care. At this inspection we found the provider had made improvements and was meeting the requirements of the regulations.

At the time of inspection, the home had a manager in place who was still going through the process of becoming the registered manager. The home had been without a registered manager for some months and the area manager and a peripatetic manager were looking after the service. The manager told us that they felt supported by the provider and senior management and were enjoying their role. 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 told us that they felt safe at the home. There were safeguarding policies and procedures in place that were being followed and staff were aware of their responsibilities.

There was a recruitment policy in place which was being followed by the management team. References had been sought along with DBS checks and gaps in employment history had been explored.

Staffing levels were worked out on a one to one basis and staffing rotas evidenced that there were enough staff for the level of dependency. However, there was a heavy reliance on the use of agency staff due to difficulties recruiting to the service.. The manager told us that the recruitment of staff was a priority.

People and their families had been involved in planning for their care needs. Care plans provided information and guidance for staff on how to support people to meet their needs. These included behaviour and sensory support plans. Risk assessments clearly identified risks and what to do to mitigate those risks.

There were environmental risk assessments in place and people had personal evacuation plans in the event of an emergency. There were a high number of accidents and incidents but these were recorded and responded to appropriately.

There was a medication policy in place but this was not always being adhered to. Audits from a local pharmacy had identified this resulting in the booking of more training for staff and the checking of competencies.

Staff had been through an induction process and had received regular training that was appropriate for the needs of the people living in the service. Staff received regular supervision and appraisals and were being supported in their role.

Staff had completed training in the Mental Capacity Act 2005 and this training had been embedded in every day practice of caring for people. Staff had received training in Deprivation of Liberty Safeguards (DoLS).

People were encouraged to maintain a healthy diet and were able to eat their preferred choices. People were involved in food shopping and

One inspector conducted this inspection. We used a number of different methods to help us understand the experiences of people using the service. Some of the people who lived there had complex needs which meant they were not always able to tell us about their experiences. We spoke with two people who lived at the service. We looked at records including three people’s care records. We spoke with five staff members and one relative of a person who lived at the service. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service caring?

The atmosphere at the service was busy and friendly. People appeared relaxed in the company of staff. We saw that staff spent time dancing to music with one person and how this person appeared to enjoy this. Another staff member told us that this person enjoyed using a particular aspect of public transport. We saw that the person displayed behaviour that showed they were happy when staff told them they were going on this mode of transport that day. Two people we spoke with told us that the staff knew how to meet their needs. One person added that the staff looked after them well, the staff were nice and they were polite and respectful towards them.

We spoke with a relative who told us that they were “Very pleased with the way they are looking after [their relative]”. They were happy that their relative was taken out to the cinema and to a library. Their relative added that the staff were “Quite nice” and provided them with feedback about their relative’s progress.

Is the service responsive?

People’s needs were assessed before they moved into the service. We saw examples of assessments of people’s needs. This meant that there was a process in place to ensure people’s needs could be met by the service before people moved in.

People had their health needs met. For example, the regional manager told us about a health matter that occurred the previous day for one person. We saw records that showed that this matter was being monitored and followed up with relevant health professionals.

The service sought support from relevant professionals to meet people’s needs. We saw a record that showed that an appointment had been made for a mental health professional to visit the service in the near future and review people’s support plans and medication needs.

Is the service safe?

There were systems in place to ensure staff were competent in being able to meet people's needs safely and effectively. We saw that new staff received an induction to the service.

However, at the time of our inspection, there was no written guidance for staff to follow for one person to show what steps should be taken before giving them medication to manage their challenging behaviour. The chart used to record when this medication was given showed it had been given nine times between the end of July and early August 2014. Records showed one occasion when the person was given this medication after they had become calm. The regional manager confirmed that such medication should not be given to this person once they were calm. This meant that this person was given a medication unnecessarily by staff.

Following the inspection we were provided with a document that set out what steps staff should take before giving this person this specific medication.

There were systems in place to monitor health and safety within the service. These checks included water temperature checks and fire safety checks. There were arrangements in place to deal with foreseeable emergencies.

Is the service effective?

People were involved in making day to day decisions about their care. We saw one person chose a specific staff member to support them to wash their hair that morning.

The service had taken steps to address the staff shortages. The regional manager told us that staff covered vacancies between themselves. Records showed that recruitment was underway and interviews had been scheduled for several applicants. This meant that people’s needs were met because there were arrangements in place to cover staff vacancies.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Records showed that risk assessments had been completed to promote people’s independence and minimise risks to their safety.

People’s health needs were met and staff recorded health information on people’s records. We saw that people’s appointments with health professionals were recorded.

Is the service well led?

The service had been open for approximately three months at the time of our inspection. Management cover was in place whilst the permanent manager was no longer in post. A new manager had been recruited and was due to start in the near future.

Overall, staff told us they were supported in their role. One staff member told us that they “Definitely” felt supported in their role. Another staff member told us that “The staff are all supportive” and “The managers are easy to approach”.

There were systems in place to monitor the quality of service delivery. We saw that one person had been involved in making changes to a plan about a specific aspect of their care. We saw an example of a record of a telephone discussion with one person’s relative discussing their relative moving into the service.

There were systems in place for staff to be given the opportunity to provide feedback about the service. We saw that staff attended staff meetings held at the service.

There was a process in place for managing complaints. There was one complaint currently being investigated.

We saw records that showed staff documented incidents that took place at the service. The regional manager told us these incidents had led to a referral to a mental health professional to review people’s needs.

However, not all records could be located promptly when needed. We saw one example where written guidance in place was not up to date to reflect the care that staff provided to meet one person’s needs. There was no written guidance in place for staff to follow about supporting one person who may display inappropriate behaviour towards staff. Following the inspection we were provided with a document that showed guidance was now in place for staff to be able to respond to such behaviours consistently.