Sahara House

Sahara House is a residential care home registered to provide accommodation, personal care and support for up to 19 people, with a learning disability and/or autism and physical disabilities.

At the time of our inspection, 13 people were living in the home.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support

We found that people were not always protected from the risk of harm as risks were not always identified in people’s risk assessments. Some people’s records contained inconsistent information in care plans in regard to the support they needed. However, at the time of our inspection, the registered manager was in the process of changing over people’s care records to an electronic care plan and reviewing people care needs.

The risks related to people’s medicines were not thoroughly assessed and identified. We observed that staff did not always support people in a person-centred way when supporting them with their medicines.

People were not always supported to have maximum choice and control of their lives. For example, some people’s Mental Capacity Assessment (MCA) and best interest forms were not fully completed to help support people to make decisions in relation to the use of surveillance system [CCTV] in the service. However, the registered manager was in the process of holding MCA and best interest meeting with people and their family’s. People were supported by staff to pursue their interests.

Right Care:

The providers systems and processes were not always effective. The service was in need of redecorating and in some of the communal area’s maintenance was also required such as the kitchen was in need of refurbishing. The laundry room and bath rooms were not clean, which is a potential infection control risk.

People told us they received care that met their support needs and preferences and that they were treated with kindness and respect. We received mixed feedback from relatives about the care and support to people. Staffing levels were sufficient to meet people's needs.

The provider had systems in place to carry out recruitment checks to ensure that staff were recruited safely. Staff received up to date training to meet people’s support needs.

Right Culture:

The provider did not always identify areas of improvement in their audits that were carried out and issues with safety concerns were not picked up. The registered manager had an action plan to help improve the service. There were systems in place to receive feedback, however we were informed that not everyone was asked to give feedback.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, managing the risk of preventing and controlling of infections, need for consent, care and treatment must be appropriate and assessed, monitor and mitigate risks to the health of people who used the service. We have made 2 recommendations in relation to preventing and controlling infection and for the provider to review their current communication plans for people.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sahara House is a residential care home for people with learning disabilities and/or autism, physical disabilities and mental health needs. The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was two large homes, bigger than most domestic style properties. It was registered for the support of up to 19 people. One house accommodates ten people and the other nine people. One of the houses accommodates men only. At the time of the inspection 17 people were using the service.

This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that identified they were care staff when coming and going with people.

People’s experience of using this service and what we found

People told us they felt safe. Systems were in place to protect people from abuse and the service had notified local safeguarding teams of safeguarding concerns in a timely manner. People told us they felt there were enough staff to meet their needs. Risk assessments were completed to identify and manage risks to keep people safe. Staff were trained to support people to take their medicines and measures were in place to protect people from the spread of infection. Pre-employment checks were carried out to ensure staff were suitable to support people. There were procedures for responding to and learning from accidents and incidents.

The service carried out assessments of people’s needs prior to admission to the service to ensure they could meet their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to eat and drink enough to meet their needs. Staff had completed required training to perform their roles effectively and felt supported in their role. The service worked with other agencies to promote people’s health, safety and well-being.

People and their relatives told us they were happy with the care and support provided. People and their relatives were included in decisions about their care. People received care and support from staff who were caring and compassionate. Staff treated people in a respectful manner maintaining their dignity and encouraging independence. Systems were in place to protect people’s right to confidentiality. The service was inclusive and people were respected for their differences.

Support plans were person centred and included the individual needs of people. Support plans were reviewed monthly to reflect people’s changing needs. People had access to activities. However, staff did not always feel there were enough of them available to support people with additional activities.

People did not always feel the service supported them to make complaints about other agencies in a timely manner. We have made a recommendation about supporting people to make complaints.

Support plans did not always include detailed information about people’s wishes at the end of their life. We have made a recommendation about staff training in end of life care.

People and staff told us they found the management team approachable and supportive. Staff were positive about the culture of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 27 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Sahara House provides care, accommodation and support with personal care for up to 19 people with a learning disability. 15 people were using the service when we visited.

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 and associated Regulations about how the service is run.

At the last inspection in January 2016, we found one breach of regulations. The registered provider had not appropriately managed people’s medicines. At this inspection we found action had been taken and people received their medicines safely. Medicines were administered by staff who were trained and assessed as being competent to do this.

Systems were in place to minimise risk and to ensure that people were supported as safely as possible. Staff were aware of their responsibilities to ensure people were safe and what to do if they had any concerns. They were confident that the registered manager would address any concerns.

People were supported and encouraged to make choices about all aspects of their care and support.

People were protected by the provider’s recruitment process which ensured staff were suitable to work with people who need support.

Staff were knowledgeable about people’s needs and how best to meet these. The training and support they received helped them to provide an effective and responsive service.

People received a person centred service. Their cultural and religious needs were respected and celebrated and their nutritional needs were met. They were encouraged to be as active as possible. There were enough staff to support them to do things that they liked and provide the care and support they needed.

People’s healthcare needs were identified and monitored. Action was taken to ensure they received the healthcare they needed to enable them to remain as well as possible.

The quality of the service was monitored by the provider and the registered manager to ensure people received a quality service that met their needs and wishes

Staff were clear about their roles and responsibilities. The registered manager and staff team were committed to continuous improvement of the service and to improving people’s quality of life.

People and their relative’s views were sought and valued. Their feedback was used to inform developments in the service.

People were supported by kind, caring staff who treated them with respect. They were supported to do as much as possible for themselves and to gain new skills. Care records contained detailed information about people’s needs, wishes, likes, dislikes and preferences.

People lived in an environment that was suitable for their needs. Specialised equipment was available and used for those who needed this.

During an inspection on 19/06/14 we found care records contained inconsistent information about people's needs, did not adequately assess people's risks and lacked sufficient detail in some areas. They had not been reviewed or updated when people's needs had changed.

We also found that people who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff training in safeguarding was not up to date.

We noted staff were not receiving appropriate professional development. The regional manager told us that some of the staff training was not up to date. We looked at the staff training matrix and noted that some mandatory training had not been updated since 2011 for example fire awareness.

People's personal records including medical records were not always accurate and fit for purpose. We found care records were disorganised with both current and historical information mixed together. This meant that a clear audit trail of people's current needs was difficult to follow with the need to search in several places for information.

During this visit we found that the provider had taken appropriate action and had made improvement in the areas where there were shortfalls.

Below is a summary of what we found. The summary describes what the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

People who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. During our visit we found that staff training in safeguarding was not up to date.

Is the service effective?

We looked at the records and care plans of five people using the service. We found that their care records contained inconsistent information about their needs, did not adequately assess their risks and lacked sufficient detail in some areas.

Is the service caring?

Staff understood the need to respect people's privacy and dignity and staff interactions with people using the service were sensitive and respectful. People we met were dressed in well maintained clothes that were appropriate for the season.

Is the service responsive?

Information about the involvement of healthcare professionals in people's care was available in their care plans so that staff had the necessary information to support people to meet their healthcare needs. However, we saw that people's care plans had not been reviewed or updated when people's needs had changed.

Is the service well-led?

Care records were disorganised with both current and historical information mixed together. This meant that a clear audit trail of people's current needs was difficult to follow with the need to search in several places for information. This posed a risk that staff may be referring to information which did not reflect people's current needs to ensure their care, welfare and safety.

People’s consent was sought and their views and experiences were taken into account in the way the service was delivered in relation to their care. Care was planned and delivered in line with their individual care plan because peoples’ needs were fully assessed. Staff were caring and supportive to people. Staff were adequately supported and supervised by the manager. Medicines were safely administered by staff who were trained and competent to carry out this task. A relative told us "the staff are pleasant and friendly. They keep me informed and answer any questions I ask. So far so good."

A relative said,"I think X is being looked after very well, especially her medical needs. Her keyworker is brilliant."

People we spoke with told us that they felt safe with the staff. They said they would raise any concerns with the manager or their relative or friend.

People who use the service were positive about the staff who supported them. They told us that the staff were "friendly".

A visiting professional told us "the staff are very receptive and followed instructions given. Things have improved greatly here since the new manager started."