Archived: Sapling

The house has one floor, with easy wheelchair access to the private garden with a patio at the rear of the property. People’s bedrooms are single occupancy. Communal space consists of a lounge area and a conservatory.

The home was well decorated and adapted to meet people’s needs. Flooring was smooth and uncluttered to aid people’s mobility needs. The home had a homely feel and reflected the interests and lives of the people who lived there. There was positive feedback about the home and caring nature of staff from people who live here, and their relatives.

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.

The inspection took place on 13 September 2016 and was unannounced.

People were safe at Sapling. There were sufficient staff deployed to meet the needs and preferences of the people that lived there. Staffing levels changed to reflect the support needs of people, such as when they had to receive one to one support to attend appointments.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people’s freedom. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received an induction and ongoing training, tailored to the needs of the people they supported.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building. Staff understood the support that each person would need to get safely out of the building in an emergency. An alternative location for people to stay was also identified in case the home could not be used for a time.

People’s rights under the Mental Capacity Act (2005) (MCA) were met. Where people could not make decisions for themselves best interest decisions were made on their behalf. Assessments of people’s ability to make specific decisions had been completed before these decisions had been made. Staff asked people for their permission before they provided care.

The staff had an understanding of the requirements of the Deprivation of Liberty Safeguards (DoLS). The registered manager had submitted applications in accordance with the MCA, due to the fact that some people were under constant supervision, and could not leave the home if they wanted to.

People had enough to eat and drink, and received support from staff where a need had been identified. Staff had a good understanding of specialist diets that people were on to ensure people could eat and drink safely, and still enjoy their meals.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. When people’s health deteriorated staff responded quickly to help people and made sure they received appropriate treatment. People’s health had improved due to the care and support staff gave, such as a decrease in epileptic seizures.

The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection. Staff took time to talk with people and encourage them to take part in activities. People looked relaxed and happy with the staff. People could have visitors from family and friends whenever they wanted.

Care plans were based around the individual preferences of people as well as their medical needs. They gave a good level of detail for staff to reference if they needed to know what support was required. Care plans had clear pictures and text to enable to staff to understand and know the people they cared for. People received the care and support as detailed in their care plans. Details such as favourite foods in the care plans matched with what we saw on the day of our inspection, and with what people told us.

People had access to activities that met their needs. Activities were based on people’s interests, but also their medical needs or abilities. People who lived with dementia had activities to meet their needs, such as gentle exercise to maintain mobility, while other people took part in games or went for trips out shopping or to day centres. The staff knew the people they cared for as individuals, and had supported them for many years.

People knew how to make a complaint. The policy was in an easy to read format to help people and relatives know how to make a complaint if they wished. No complaints had been received since our last inspection. Staff knew how to respond to a complaint should one be received.

Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. Records for checks on health and safety, infection control, and internal medicines audits were all up to date. This was a small family owned business so the provider (who was also the registered manager) was regularly working at the home to give people and staff an opportunity to talk to them, and to ensure a good standard of care was being provided to people.

People had the opportunity to be involved in how the home was managed. Surveys were completed and the feedback was reviewed, and used to improve the home.

People lived in a caring and well-managed and happy home. A relative said, “I think this is the best place for meeting my family member’s needs. I don’t think he could get any better care than he receives here.”

We looked at whether people and their relatives were able to give consent to care and treatment, and found that within the severe limitations of their conditions people were able to give some consent, and that their relatives were also able to do so. People told us they were happy with the activities they did in the home.

We looked at the care of people in the home and found that people were generally happy with their care, that there was an effective care planning process in place.

We looked at the management of medicines in the home and found an effective process in place to enable the safe provision of medicines.

We looked at the suitability of the workers; we found the provider ensured the staff were trained effectively to carry out their roles. We found that the provider ensured the staff were of good character through obtaining references and the use of the disclosure barring service (DBS).

We looked in to the complaints system. We found this to be an effective procedure to manage and respond to any concerns, the manager advised that they had not received any complaints.

We looked at whether people and their relatives were able to give consent to care and treatment, and found that within the severe limitations of their conditions people were able to give some consent, and that their relatives were also able to do so. However, we noted that there were no written consent forms to document this.

We looked at the care of people in the home and found that people and their relatives were generally happy with their care, and that there was an effective care planning process in operation.

We looked at safeguarding and found that the provider was taking steps to ensure that people were protected from abuse, although there was some uncertainty over whether staff had undertaken safeguarding training.

We looked at support for staff and found they had received proper training and induction, and were offered regular supervision and appraisal. Finally we looked at the assessment and monitoring of service quality, and whilst we found that the provider was taking steps to do this, we were unclear how often some of these processes were being undertaken.