Suillean House 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. The service is registered to provide accommodation and care for nine people who have a learning disability. At the time of the inspection there were nine people living in the service. Some of the people living in the service had special communication needs and used a combination of words, signs and gestures to express themselves.

This inspection took place on the 23 May 2018, was announced and completed by one inspector.

We had previously inspected this home and it was rated ‘Good’. At this inspection, we found the evidence continued to support the rating of 'Good' and there was no evidence or information from our inspection and on- going 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 our previous inspection the rating related to Caring was ‘Outstanding.’ However, this was in February 2016 and following changes in standards of care and regulation, this section is now rated as ‘Good.’ This does not indicate a change in the quality of care and support provided by the service, but purely reflects changes across the care sector.

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 are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the polices and systems in the service support this practice.

Our observations at this inspection showed that staff were caring and supportive to people. Staff talked with people living at he service and shared jokes with them which were enjoyed.

People were safe living at Suillean House and staff knew how to provide support in a safe way. All areas of the home were clean, tidy and fresh. Effective systems and checks were in place to make certain the premises were safe. There were sufficient staff to meet people’s needs. Medicines were safely managed and given to people as prescribed.

People’s needs were assessed prior to them moving into the service to ensure that staff were able to fully meet their needs. The staff were skilled, knowledgeable and experienced and had the necessary training to support them in their roles.

People chose their meals and then decided where they wanted to eat that meal. Staff encouraged healthy choices for a balanced diet but people chose and ate the foods they enjoyed. People had regular access to healthcare professionals when needed, full records of such visits were recorded.

People were encouraged to make decisions about their care, daily routines and preferences. Staff worked within the principles of the Mental Capacity Act and there was documentation to support this.

Staff encouraged people to follow their interests and regular outings and visits were discussed with people living at the service. Family contact and visits were also supported and planned. The culture of the home was caring, person centred and inclusive.

There were effective systems in place to monitor the quality of the service. People living at the service and their relatives had the opportunity to comment on the quality of the support and care that was provided. Any required improvements were undertaken in response to such suggestions.

Further information is in the detailed findings below.

This was an announced inspection carried out on 18 February 2016.

Suillean House can provide accommodation and care for nine people who have a learning disability. There were nine people living in the service at the time of our inspection. Most of the people living in the service had special communication needs and used a combination of words, signs and gestures to express themselves.

There was 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.

Staff knew how to respond to any concerns that might arise so that people were kept safe from harm. People had been helped to stay safe by avoiding unnecessary accidents. Medicines were managed safely, there were enough staff on duty and background checks had been completed before new staff were appointed.

Staff had received training and guidance and they knew how to support people in the right way including how to respond to people who had special communication needs. People had received all of the healthcare assistance they needed.

The registered manager and staff were following the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the MCA and to report on what we find. These safeguards are designed to protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had taken all of the necessary steps to ensure that people’s rights were protected.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, were imaginative when promoting people’s dignity and respected confidential information.

People had received all of the support they needed including people who could become distressed. People had been consulted about the support they wanted to receive and staff supported people to express their individuality. Staff had supported people to pursue a wide range of interests and hobbies and there was a system for resolving complaints.

Regular quality checks had been completed and people and their relatives had been consulted about the development of the service. Staff were supported to speak out if they had any concerns because the service was run in an open and inclusive way. People had benefited from staff acting upon good practice guidance.

The inspection was carried out by a CQC inspector. During our inspection we met and spent time with four young adults who received a service. One of these people was able to answer direct questions and tell us about the care they received. We gained information about the service from reviews of care records and discussions with; three relatives, two care workers, two senior care workers, the trainee manager and a visiting manager of a partner care home. Below is a summary of what we found.

Is the service safe?

All of the relatives we spoke with told us they trusted service staff and management. They were confident any concerns or complaints they might raise would be managed appropriately and effectively. All three told us how reassured and confident they felt because they had noticed their relatives, who could not communicate verbally, always responded positively on returning to the service from holidays or trips out.

Staff understood how to recognise and report concerns they had about people’s safety and understood the role of the local authority and police in investigating adult abuse. We saw staff received training in adult safeguarding and in safe and least restrictive ways of managing behaviour that could cause harm to the person or others. We noted staff members learning and competence in safeguarding practice was assessed during one to one supervision meetings with senior staff.

We looked at systems to ensure people’s health and safety including incident reporting and management, cleaning schedules and the management of fire and water safety. We saw these issues were carefully monitored and reviewed on a regular basis.

The manager understood their legal duty and knew how to refer people who might be at risk of receiving inappropriate care, for independent assessment under a law called the Deprivation of Liberties Safeguards (DoLS).

Is the service effective?

Relatives told us they were happy with the service provided. They said they felt encouraged by staff to be involved in the planning of their relatives care. Two of the relatives we spoke with told us the care provided was far better than in other care settings where their relative had lived. Another relative commended the way staff had gained rapport and trust by treating their relative with warmth and respect.

We noted from records, observations and conversations that people had access to a wide range of activities that were appropriate to their age and experience and recognised their individual interests and abilities.

We saw from care records people received effective care in relation to their health and social care needs. Professionals involved in supporting people included psychologists, social workers and speech and language therapists.

People’s plans of care were well written and highlighted their strengths and abilities as the basis for effective and co-operative care work. During our inspection we noted staff working with people in the kitchen and the laundry room to help them make choices, learn skills and meet their own needs.

Is the service caring?

Relatives told us personal care was provided in a way that respected people’s privacy and dignity. Records we looked at, and conversations with staff and relatives, confirmed personal care was delivered skilfully and sensitively by staff in the privacy of peoples’ own rooms.

Throughout our inspection visit we observed warmth, caring, reassurance and shared enjoyment in the interactions between staff and the people they supported. All of the staff we spoke with described a care and commitment to their work with people. Each described examples of extra hours worked to support the service and in particular people’s opportunities to take part in community activities.

Relatives spoke of the positive attitudes of service staff. One told us they were, “Quite special.”

Is the service responsive?

Staff told us about work they did to identify and address challenges in meeting people’s care needs. We saw that specialist support was organised to help staff work more effectively with one person who was feeling distress and discomfort associated with their experience of learning disability.

The trainee manager told us about ways the service was checked to ensure people received good quality care. We saw that audits of care quality and environmental safety were carried out regularly. Following these audits improvement plans and actions were noted and confirmed as carried out in monthly manager’s reports.

All of the staff and the managers we spoke with told us they were happy and able to work extra hours at short notice if necessary to provide extra care for people and to cover staff sickness.

Is the service well-led?

Relatives we spoke with told us good quality care was provided by skilled, committed and well managed staff. Staff we spoke with told us they enjoyed working for the service. They felt the training and support they received to do their jobs was of a good standard.

While we did not speak with the registered manager during our visit the trainee manager told us about an initiative they had introduced to enhance staff skill and confidence in ensuring the safety and wellbeing of people who used the service. The acting manager and senior staff told us about specialist areas of interest and responsibility senior care workers enjoyed which improved service quality while recognising the skills and interests of senior staff.

Service manager’s and seniors regularly reviewed and evaluated a range of health and safety systems to ensure the care home was clean, well maintained and safe for people to live and work in. We saw from records that improvements were planned and carried out following these reviews.

Due to the complex needs of the people using the service we used a number of different methods to help us understand their experiences when we undertook our visit.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with four care workers and the registered manager. We also looked at some of the records held in the service including the care files for two people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people gave consent to their care where possible and the provider acted in people’s best interests when needed. The care and support people received met their needs. We found that suitable arrangements were in place to manage people’s medication and ensure they received any medication they needed.

We found the staff team were supported through training, and the records in use protected people from the risk of unsafe or inappropriate care and support.

During our visit we spoke with three care staff, the manager of the service and a senior adult homes manager who was visiting the service on the day our visit. It was not possible to speak directly with people using the service due to them having particular communication needs. We spoke with the relatives of three people currently using the service.

All of the relatives we spoke with told us they were happy with the care and support their family members received. One relative told us, “Staff are very caring and really good at keeping you informed”. Another told us, “I trust the staff implicitly with the care of my family member”. Another said, “I’ve been really impressed with the activities they organise and I’ve seen my family member make great progress”.

Relatives told us that staff supported their family member’s health and personal care needs and took prompt action to get them medical attention when it was needed. They also said that staff always treated their family members with respect.

All of the staff we spoke with said the provider was very good in terms of ensuring that staff training was up-to-date and that they really enjoyed working at the service, some of which had worked there for a number of years.

Relatives told us they were happy with the care and support they had witnessed on their visits to the service. One relative told us “I think staff have a difficult job, but they seem really committed and go out their way to do their best”.