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 the recruitment of staff.
Medicines were being managed safely and the service learned from incidents or events. We have recommended that where staff make hand written entries on the medicines administration record (MAR) that these are signed by two staff to help reduce the risks of an error. When people had emergency medicine to manage epilepsy this was taken with them whenever they left the home. Staff had received training in how to use this and there were clear protocols in place so staff had guidance of when this should be used. Staff received the training they needed for their job role. People received the healthcare they needed, and good working relationships had been established with local GPs. Staff at the home had worked with people to reduce their anxieties in relation to their health and using community medical services to good effect.
The registered manager ensured there were effective systems for governance, quality assurance and ensuring safe care for people. There were development plans in place to make improvements based on best practice guidance, and these were on target to be met. The premises provided a homely and comfortable setting for people to live in. Adaptations and improvements were continually planned to the environment to meet people’s needs and wishes. For example the front garden area was being developed with decking and seating areas and the activities room was also due for refurbishment. The service took account of good practice guidance and people and their relatives had opportunities to influence the way the home was run.
Records were well maintained, and notifications had been sent to CQC or other agencies as required by law.