Rating at last inspection: Requires improvement (published 12 December 2017).

About the service: The service is a care home for up to 13 people with mental health issues some of whom had additional needs due their learning disability and/or autism. When we inspected 12 people lived in the service.

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

People’s experience of using this service:

The registered manager had worked to recruit, coach and develop the staff team in the past year. This had led to a motivated group of staff who worked to provider person centred care to people.

People told us they were happy and felt staff had a good understanding of their needs and preferences. That staff listened to what they wanted and acted quickly to support them to achieve their goals and aspirations.

People had good community networks which were personal to them. This included supporting to connect and maintain contact with family and friends.

Staff were well trained and skilled. They used their skills to protect people and promote their independence and rights.

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.

The registered manager and staff team worked together in a positive way to support people to achieve their own goals and to be safe. Checks of safety and quality were made to ensure people were protected. Work to continuously improve was noted and the registered manager was keen to make changes that would impact positively on people’s lives.

The values of the organisation of offering choice, inclusion and respect were embedded. This supported people to receive the positive service described.

The service met all the values that underpin the 'Registering the Right Support' and other best practice guidance such as 'Building the Right Support' apart from the recommended size of a service. However, the values including choice, promotion of independence and inclusion were seen and people did receive a person-centred service. People with learning disabilities and autism using the service lived as ordinary a life as any citizen.

A full description of our findings can be found in the sections below.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We inspected Sunningdale House on 2 and 19 October 2017. The inspection was unannounced on the first day and we told the provider we would be visiting on the second day.

At the last inspection in July 2016 we found the provider had breached three regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and was rated Requires Improvement. The breaches related to the safe delivery of care and treatment, staff supervision and appraisal and overall governance of the home. The provider sent an action plan following the inspection to outline how they were going to approach making improvements.

Although improvements had been made we found continued breaches in two areas relating to safe care and treatment and good governance.

This is the second time the service has been rated Requires Improvement. We will discuss this outside of the inspection process with the provider.

We discussed with the provider and the registered manager areas which still required improvement and they were open about challenges they had faced since the last inspection. This had involved a turnover of staff and slow recruitment, a new registered manager, a programme of complex change and refurbishment. Following the inspection the registered manager provided regular updates about action they had taken to continuously improve. We had confidence the provider was committed to making the improvements still required.

Sunningdale 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 care home accommodates 13 people who have mental health issues and or a learning disability/ autism in one adapted building.

The service had a registered manager in place. The registered manager had been recruited since our last inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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.

Systems in place to monitor the service provided had not consistently highlighted concerns which affected safety and quality. The issues we noted around refurbishment, cleanliness, responsiveness of staff to promote wellbeing for people were linked to the lack of resources and staffing levels the provider had implemented. The provider listened and immediately put plans in place to make improvements.

Risks to one person’s safety had been assessed but detailed plans had not been implemented to guide staff how to keep the person and other people safe. This had impacted negatively on the person’s wellbeing. For other people we saw appropriate risk assessments, care plans were in place which contained person centred detail about how the person preferred to be supported. People had been involved in developing their own care plans and we saw they were regularly reviewed.

There were systems and processes in place to protect people from the risk of harm. This included safe recruitment and selection processes carried out before staff began employment and appropriate checks of the building to ensure health and safety. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Appropriate systems were in place for the management of medicines so people received their medicines safely.

We saw staff had received supervision on a regular basis and an appraisal. Staff had received appropriate training to enable them to fulfil their role. They understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capac

This inspection took place on 27 July 2016 and was unannounced.

Sunningdale House is registered to provide personal care and accommodation for up to 13 adults who have mental health problems. The property is located in a pleasant residential area of Harrogate, close to local amenities. The property is made up of two adjoining older terraced houses that have been converted into one property and adapted for use as a care home. The accommodation is arranged over three floors. There is a garden to the front of the home and a courtyard to the rear. At the time of our inspection there were 13 people using the service.

The service is required to have a registered manager as a condition of their registration. 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 time of our inspection there was no registered manager, as the previous manager had left in January 2016. A new manager had started four weeks before our inspection but had not yet registered with the Commission.

We found that the absence of a registered manager since January 2016 had impacted on some management and governance systems. Quality assurance systems were in place and a range of audits were conducted, however some actions identified in audits and the service’s improvement plan had not been addressed.

We found that people’s needs were assessed and some risk assessments were in place to reduce risks and prevent avoidable harm. However not all risk assessments were up to date, and risks in relation to fire safety had not been adequately assessed or system tested.

Staff received an induction and completed a range of training to help them carry out their roles. The majority of training was completed on-line. Not all staff had received additional specialist training in order to further develop their understanding of the specific needs of some of the people they supported, such as mental health, autism and diabetes. The registered provider advised us they had additional specialist training booked to take place within the next three months. Staff had not received regular formal supervision in line with the registered provider’s policy and procedure.

The registered provider had an infection control policy and cleaning schedules were in place. Most of the home was clean, but we found some areas that were not clean and appropriately maintained and we have made a recommendation in our report about this.

Staff had completed Mental Capacity Act (MCA) training and were able to demonstrate an understanding of the importance of gaining consent. However some care files lacked recorded evidence about people’s consent to particular restrictive decisions taken. We have made a recommendation about this in our report.

There were policies and procedures in place in relation to the management of medication, but these were not consistently followed and improvements were required in relation to the storage of medication. We have made a recommendation about this in our report.

The provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff we spoke with understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns.

The provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers, although there was some inconsistency in how recruitment records were stored. On the day of our visit here were sufficient numbers of suitable staff to keep people safe and meet their needs, but there had been some staff sickness and turnover in recent months so the provider was taking action to recruit more permanent staff in order to ad

Our inspection team was made up of one inspector. During the inspection we asked five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

On the day of the inspection we met six people living at Sunningdale House. We spoke with four people about their experience of care. We spoke with three staff and looked at records. We subsequently spoke with the relative of one person by telephone following the inspection. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff and people we spoke with told us that they felt safe. Staff had received training in safeguarding and understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risk to people and helped the service to continually improve.

People were cared for in a service that was safe, clean and hygienic. Risk assessments were in place in individual support plans in relation to activities of daily living. Staff personnel records contained all the information required which meant that the provider could demonstrate that the staff employed to work in the home were suitable and had the skills and experience needed to support people living there. Staffing levels were appropriate to meet the needs of people living in the service.

Is the service effective?

People told us that they were happy with the care they received and felt that 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 they knew them well. Staff had received training to meet the needs of the people living in the home. People's health and care needs were assessed with them and they were involved in writing their plans of care. Staff spoke with pride about the progress that individual people had made whilst they had been living in the service. People were supported to cook their own food and staff also provided a cooked meal each day for people who chose to eat together. One staff member told us about the progress that one person who lived in the service had made. "He's recently made his own drinks with the help of staff, another resident has helped with cleaning. I feel happy when that does happen".

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were supported to be as independent as possible. Where shortfalls or concerns were raised, these were addressed. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes. One person told us, "I'm happy here, I like my room and I like going to the library."

Is the service responsive?

People were regularly involved in a range of activities inside and outside the service. The home supported people to take part in activities within the local community which included visiting local places of interest, attending places of work which provided specific supported activities and shopping. People knew how to make a complaint if they were unhappy and three people we spoke with told us that they felt that they could talk with any of the staff if they had a concern or were worried about anything.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. The deputy manager told us that the service did experience occasional delays in responses from care managers from some local authorities and staff at Sunningdale House were concerned about the potential impact of this on some people who used the service. The service had a quality assurance system which included planned audits. People who lived in the service, staff and relatives were asked for their views. Any identified shortfalls were addressed promptly and as a result the service was constantly improving. New staff had recently been appointed. A programme of refurbishment was underway and much of the planned work had been completed. The manager had introduced a more person centred care planning process which staff had started to implement. Staff told us that they felt well supported by the manager.

People told us they were happy living at the home, and understood and were involved in their care and support. People told us “The staff are pretty good, you can come and go and do your own thing” and “I like it here, it’s generally pretty settled”. People told us their consent was sought in relation to their care and support, and we were able to observe this. Staff acted in a respectful and helpful manner towards people living at the home.

People’s support plans contained detail on their likes and dislikes, and support needs. They contained sufficient information to enable appropriate care and support to be given, and staff were able to describe people’s needs. Where people could not make their own decisions, the service worked in the person’s best interest and involved other professionals as needed.

We found some issues with the maintenance and upkeep of the building, and have asked the provider to take action in relation to these.

The home operated recruitment procedures which included appropriate police checks and references for staff, although the home was not able to produce all the information we asked for.

There was a complaints procedure in place which was available in a format to meet people’s needs.

We engaged in conversation with six people who were in at the time when we visited the home. Everyone said they were well looked after and that they were happy with the care they received at Sunningdale House. One person said "We are well looked after here." Other comments included; "I get my own space" and "The staff are pretty good they do their best - they work hard." People we spoke with said they were involved in their care, with their preferences being sought and taken into consideration. This included being enabled and supported to live their lives as independently as they wished.

We spoke with six people about meals at the home. They told us that they enjoyed the food at the home. People made comments about the food such as 'nice' and 'very good'

We spoke with health and social care professionals who told us that the staff at Sunningdale House worked well with them, to ensure people are well cared for. One said "Fantastic service - they communicate really well. They treat people as individuals. Staff are approachable and all of them are on the ball."

We spoke with the Local Authority Contracts Officer who informed us that they did not have any concerns about this service.