This inspection took place on 30 October 2018 and was unannounced. The previous inspection took place on 4 August 2017. We found two breaches of the regulations in relation to medicines management and the governance of the service, and the service was rated as ‘Requires Improvement’. At this inspection the service was no longer in breach of the regulations in relation to medicines management and governance. However, improvement was still needed as we found staff recruitment was not always safe.

Sharon House is a ‘care home’. People in care homes receive accommodation and 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. Sharon House provides accommodation and care to a maximum of five adults who have a learning disability. On the day of the inspection there were four people living at 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.

At the last inspection there were insufficient audits in relation to medicines, cleanliness and managing people’s money. This meant the registered manager did not establish systems to assess, monitor and improve the quality and safety of the services provided. Although we found at this inspection there were some audits taking place in relation to care records, cleanliness and people’s money, there remained insufficient audits in relation to medicines.

At the last inspection we found there was a complaints process in place but it was not fully accessible to people living at the service. We made a recommendation in relation to the complaints process being accessible. At the time of this inspection visit there was no accessible complaints process at the service, at the time of writing this report the service now has an accessible complaints procedure.

Whilst the management of medicines had improved since the last inspection there remained some minor areas of concern.

Recruitment was not always safe as not all staff had a criminal check in place before working alone with people at the service.

People told us staff were kind and caring and we saw this was the case.

Care records were comprehensive, up to date and person centred. Risk assessments were in place to guide staff in supporting people and minimise harm.

People were involved in activities in the community and had recently enjoyed a holiday together.

The registered manager was well regarded by staff and service users. We could see that the registered manager learnt from accidents and incidents.

We have found one breach of the regulations in relation to recruitment.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 4 August 2017 and was unannounced. The previous inspection took place on 14 July 2015 and met the requirements of the regulations. The overall rating for this service was ‘Good’.

Sharon House is a care home that provides accommodation and care to a maximum of five adults who have a learning disability. On the day of the inspection there were four people living at 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.

There were insufficient audits in relation to medicines, cleanliness and managing people’s money. This meant the registered manager did not establish systems to assess, monitor and improve the quality and safety of the services provided.

Although there was a complaints process in place it was not fully accessible to people living at the service.

Administration of medicines was difficult to understand as the dates on the printed administration sheets were different to actual dates written on by staff. We were unable to check stocks of one medicine due to insufficient information and there was one error in stocks against records. There were no records of medicines returned to the pharmacist since February 2017.

We saw staff were kind to people living at the service. Although people told us they felt safe, one person clearly found the agitated behaviour of another person difficult on occasion. People living at the service told us the registered manager was always available and relatives confirmed they could easily discuss any concerns they had with them.

Staff understood safeguarding and knew what to do if they had any concerns regarding people’s safety. The registered manager told us all accident and incident forms were copied to the local authority although records could not always evidence this had always taken place.

The shed at the bottom of the garden was not safe for use although by the time of writing this report this had been safely fenced off.

People told us they enjoyed the food and staff knew what people liked to eat. The menu for evening meals was limited but following the inspection the service had expanded options for people’s evening meals taking into account their preferences. Food was not always safely stored.

Staff understood people’s needs and preferences and there was continuity of staff at the service which was beneficial for people living there.

People’s records showed they had access to health care as required, and a health and social care professional who has been working with the service over a long period of time noted that people’s behaviours have improved significantly since living at Sharon House.

Staff told us they felt supported in their role and understood training in key areas, however as only the most recent supervision records were kept the registered manager could not evidence supervision took place regularly. Similarly only the latest staff meeting minutes were retained. There were minutes of meetings for people living at the service.

Staff understood issues of consent when providing care to people. We saw people were supported to have maximum choice and control of their lives in the main. However one person was subject to restrictions on cigarette intake without the necessary safeguards in place. We also noted one person should be assessed under the relevant legislation to review whether they could safely leave the service unaccompanied.

We found a breach of the regulations in relation to the governance of the service and proper and safe management of medicines.

We have made a recommendation in relation to complaints.

You can see what action we told the provider to take at the back of the full version

This inspection took place on 14 July 2015 and was unannounced. At our last inspection in May 2014 the service met all the standards we looked at.

Sharon House is a care home that provides accommodation and care to a maximum of five adults who have a learning disability. On the day of the inspection there were three people residing at the home.

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.

People and their relatives told us they felt the service was safe and had no concerns about how they were being supported at the home. They told us that staff were kind and respectful and there were enough staff to meet their needs properly.

The registered manager and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks could be reduced.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment in the first instance. Staff told us it was not right to make choices for people when they could make choices for themselves.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians and any changes to people’s needs were responded to appropriately and quickly.

People told us staff listened to them and respected their choices and decisions.

People using the service, their relatives and staff were positive about the registered manager. They confirmed that they were asked about the quality of the service and had made comments about this. Staff, relatives and people using the service felt the registered manager took their views into account in order to improve service delivery.

A single inspector carried out this inspection. The focus of the inspection was 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. We also spoke to a Community Nurse and a Day Centre manager.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. The accommodation had been well maintained and was clean. There were risk assessments on each person’s record, with the following review date identified. This meant that the provider had identified risks and had set out guidance on how to manage and review these risks. Staff training records showed that staff had undertaken training relevant to their role. All staff were trained in how to administer medication in a safe manner. One person who used the service told us “I always get my tablets at the same time in the morning and in the evening.” This meant the provider demonstrated that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home. Staff demonstrated knowledge of the policies and procedures of the home and how they would respond to different emergencies. Checks had been carried out on the fire alarm and emergency lighting systems to ensure that they were fit for purpose.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they had developed a trusting relationship with them. One family member told us “There is a noticeable improvement in my relative’s behaviour.” Staff had received training to meet the needs of the people living at the home and were equipped to deal with the complexities of behaviours presented. A Community Nurse told us that “My overall impression is that it is a good service.”

Is the service caring?

People were supported by dedicated and attentive staff. We saw that support workers were patient and gave encouragement when supporting people. We observed how staff engaged with those who used the service and treated them with respect. We noted how staff were flexible in responding to the needs of a person who chose not to attend day centre. A person who used the service told us “The staff always listen to me.” Another told us how “Staff always ask my permission, I never do what I don’t want to do.”

Is the service responsive?

Records confirmed people’s preferences, interests, and diverse needs and care and support had been provided that met their needs. People had access to activities that were important to them and had been supported to maintain relationships where possible. A person who used the service told us that “Staff help me to plan my visits to my relative.” A family member told us “Without the support of staff, my relative would not be able to come and visit us and we are too disabled to go to see them.” A member of staff told us that “It is all about taking the time to make sure there is good communication, it prevents misunderstandings from escalating.”

Is the service well-led?

Staff had a good understanding of the ethos of the service and those whom they supported. Quality assurance processes were in place. People told us they were asked for their views on the service they received and we saw that they had also filled in a ‘Residents satisfaction survey’, with support from a person who was not a member of staff. A Community Nurse told us that “staff and the manager ask my view on service delivery satisfaction.” One member of staff told us they were clear about their roles and responsibilities and that the manager was very “Involved and approachable.” Another told us that “The manager always responds to my requests.”

Sharon House is small home, owned and managed by a sole provider. Four people currently live there and are supported by staff with their personal care and to be as independent as possible.

The house is in need of redecoration but the people living there seemed to be well cared for. People go out to a day centre twice or three times a week and are accompanied out on other days for shopping or to eat out. Care management is provided by care managers who commission services for each person individually. Staff are supportive and caring and meals are of a high quality.

Whilst we had no immediate concerns about the safety of people using the service we found that the policies, procedures and systems required to ensure quality and safety were underdeveloped or not fully in place and requirements from previous inspections by the CQC and other bodies had not been implemented. This could result in risks to people living there.

People said they felt supported by the staff team and that they were included in decisions about their care as far as possible.

They told us that staff were kind and respected their privacy. Comments included, “They make sure my bedroom is private” and “I’m happy”.

They told us that staff listen to them and involve them in aspects of their care and the general activities in the home. One person told us, “Sometimes I help out, I ask them if they need help”.

People gave us examples of how they are given choices about their care and what they like to do. They confirmed that the management and staff included them in some decisions about the running of the home. They also told us that they had good contact with the local community.

People told us that staff talk to them about their care needs and let them know how and why they are supporting them. One person commented, “They ask you if you’re OK with everything”.

People told us they were happy with the food at the home and that they were given a choice of menu.

A person commented, “I like the food and everything”.

They told us they get enough to eat and that they can have snacks outside of meal times.

People who use the service we spoke to told us they were satisfied with the way the service communicates with the doctor and other health care professionals.

One person commented, “I’ve been seeing the doctor”, and, “They take me to the optician to have my eyes done”.

People who use the service told us they felt safe at the home and that they would talk to the manager or staff if they were concerned about anything.

A person commented, “I can talk about my worries”.

They told us they were happy with the general environment of the home and their rooms. One person told us, “I like my bedroom”.

People told us they felt safe with the staff working at the home.

A person commented, “I know them”.

They told us that they had confidence in the staff team and that staff responded to their needs appropriately. One person commented, “They do a good job”.

People told us they had no complaints about the service. Everyone we spoke with said they knew how to make a complaint and who they would talk to if they needed to.

People were generally positive about the care and support provided at the home. Staff we spoke with knew the care and health needs of the people they supported. People told us and healthcare records showed that they had good access to healthcare professionals such as doctors, dentists and chiropodists. One person told us, “they always take me to my appointments.”

People told us that they felt safe. They said they had no concerns or complaints about their care but would speak with their relatives, the manager or the care worker if they needed to. One person told us, “I feel safe, yes.” The complaints policy had been developed in a pictorial format and was appropriate to the communication needs of people using the service.

Staff told us that the manager was very supportive and we saw that staff received regular supervision. Some staff training certificates were seen to be out of date. The registered manager booked refresher training for all staff at the service and sent the details of these training courses to the Commission.

People confirmed that the management and staff often asked them for their views about the quality of care they received and if there were any suggestions for improvements. There was a formal quality monitoring system in place at the service which included a satisfaction survey in an appropriate pictorial format.