This inspection took place on the 18 and 19 April 2018 and was unannounced. Sesame is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Sesame is registered to provide personal care and support for up to four people living with a learning disability and/or autistic spectrum disorder. Some people also had long-term health conditions, complex communication needs, or behaviours that may be seen as challenging.

Sesame had a registered manager, however at the time the inspection they were on a period of planned leave. An interim manager had been appointed by the provider to oversee the home in the registered managers’ absence. 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 home is run.

Sesame had been developed and designed prior to Building the Right Support and Registering the Right Support guidance being published, we found it followed some of these values and principles. These values relate to people with learning disabilities being able to live an ordinary life.

We looked at the home’s quality assurance and governance systems to ensure procedures were in place to assess, monitor, and improve the quality and safety of the services provided. Although some systems were working well, others had not been effective, as they had not identified the concerns we found during this inspection.

The provider did not have a systematic approach to determine the number of suitably qualified and competent staff required to meet people’s needs at all times. We raised our concerns about people’s safety at night with the nominated individual who took immediate action and increased the staffing levels at night from one to two waking night staff.

People were not always protected from the risk of harm because the systems in place to manage/ mitigate risks were not always effective. We looked at how the home managed people medicines; we found the system in place to manage people medicines, when they left the home placed people at risk. Following the inspection the interim manager confirmed that they had changed the system and reduced any associated risks. Other risks were managed well. People's care plans contained detailed risk assessments and clear guidance for staff on how to ensure people's safety was maintained, while encouraging people to be as independent as possible.

We checked whether the home was working within the principles of The Mental Capacity Act 2005 (MCA). Whilst we saw staff obtaining people’s consent, we found where a person’s capacity to make complex choices or decisions was in doubt. Records did not show staff had assessed the person’s capacity or where decisions had been made in a person’s best interests, these were not always being recorded properly. We have recommended the home reviews all documentation relating to MCA and best interests decisions

We looked at the induction and supervision records for three staff. None of the staff files contained a completed induction. Staff we spoke with told us they did not feel supported and records confirmed that staff were not receiving regular supervision in line with the home’s policy.

Staff told us people were involved in identifying their needs and developing their support. We found people’s records contained out of date information; lacked detail and were not provided in a way that supported people to be involved in their care for example in a pictorial format. We have made a recommendation in relation to care planning.

People told us they were happy living at the home and liked the staff that supported them. Re

This inspection took place on the 24 February 2016 and was unannounced. The last inspection of Sesame was carried out in January 2014 where no concerns were identified.

Sesame is a care home without nursing, providing support for up to four people living with an autistic spectrum disorder or learning disability. Some people also had long term health conditions, complex communication needs, or behaviours that were challenging.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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.

Best interests decisions made under the Mental Capacity Act 2005 (MCA) had not always been recorded in accordance with the MCA, although we did not find that the decisions made had been inappropriate or unduly restrictive We found that staff had taken appropriate actions in people’s best interests, such as providing an epilepsy monitoring system for one person’s room, but that these had not been recorded in accordance with the framework for decision making under the Mental Capacity Act 2005. Applications for the Deprivation of Liberty Safeguards had been made appropriately, and outcomes of the decisions were awaited. We recommend the provider takes advice from a suitably qualified person on the Mental Capacity Act 2005 and code of practice in relation to best interests assessments.

Care plans were personalised to each individual. They were up to date, detailed and contained sufficient detailed information to assist staff to provide care in a manner that was safe and respected people’s wishes. People had individual activity programmes which were followed unless the person chose otherwise. Opportunities were explored to maximise people’s involvement in the local community, and people were encouraged to be active and follow healthy lifestyles. They were supported to attend clubs and groups that interested them, including drama and crafts.

We saw examples of positive and supportive care and relationships. Staff were creative and reflective about how to help people develop new skills, positive about people’s progress, and were actively involved in raising funds for the charity and the home. People were valued as individuals and there was a focus on maximising people’s abilities for self-care and independence. For example, people were supported to have increased independence with their meal choices and be involved more in meal preparation. Healthy eating was encouraged and some people were supported to lose weight and others gain weight in accordance with their needs. People were involved in making choices about their meals and were involved in food shopping and meal preparation. Information was presented wherever possible in ways people could understand, and plans helped ensure staff understand how people communicated.

People were supported to develop new skills and have new experiences through the taking of appropriate risks. Risks to people were assessed and actions taken to minimise them where possible. We saw evidence that staff were involving people in strategies to manage some risks through positive intervention plans. Staff understood what they needed to do to keep people safe or report concerns about potential abuse. Systems were in place to manage complaints and ensure people with communication difficulties were able to raise any unhappiness or distress to staff and be understood.

There were enough staff on duty to support people, as staffing levels were adjusted each day to meet people’s needs and the activities they wanted to undertake. This meant that staff shift times varied for example where people wanted to take part in activities in the evenings. A full recruitment procedure was followed aimed at identifying and minimising risks from

There were four people living at the home at the time of our inspection. We were able to communicate with three of the people who live at the home. We looked at people's care plans, daily activity records and pictorial planners to help us to better understand their views.

We observed daily life within the home and spoke with two staff members and two agency workers. We also spoke with one staff member from the organisation who supports a person living at Sesame to go to college and access other community facilities.

We noted that one person's daily pictorial chart and care plan both reflected the persons daily schedule. We were able to ascertain by communicating with a person, that they were looking forward to a trip to Cockington village to walk and see the horses. Another person told us that they were visiting the 'Mare and Foal Sanctuary' before going shopping to buy ingredients for some soup they had chosen to make the following day.

One person was unwell on the day of our visit and was being cared for in their room. Throughout the time we were in the service we noted that staff stayed with the person. Staff recorded every visit and observation.

We noted that people were offered choices and were given time to process the information before being prompted to provide an answer.

There were four people living at the home at the time of our inspection. We were able to get the views of two people and one person's relative about the care provided. Some of the people living at the home were limited in their abilities to communicate verbally so we also observed the care provided to help us to understand their experience.

Everyone we spoke to was complimentary about the home. One relative told us "they are very warm, welcoming. It's somewhere (person) feels comfortable. We were concerned that (person) would become settled and content and this has happened".

We observed staff offering people choices consistently through the day. Staff adjusted the way they offered choices according to the person's communication needs to ensure they acted in accordance with their wishes.

We found people's care plans to be an accurate reflection of their support and people told us "we (staff and people) do go through the file together".

People told us they got on well with staff and staff had time to support them with activities they enjoyed. One person told us "we do shopping, go to market. Drama last night".

There was a safeguarding procedure in place. People told us they could raise concerns with staff. One person told us "if I worry about something I talk to staff".

The quality of the service was monitored and incidents in particular were recorded in a detailed, reflective manner in order to implement changes to people's support where needed.