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Inspection carried out on 22 November 2018

During a routine inspection

This was an unannounced comprehensive inspection which took place on 22 November 2018.

Sunlight House is a ‘care home’. People living there received personal care and support as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to four people in one adapted building and specialises in supporting younger adults with mental health needs, learning disabilities and autism. There were three people living at the care home at the time of our inspection.

The care home has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism can live as ordinary a life as any citizen.

The service continues to be owned and managed by an individual who is the registered provider. A registered provider is a person who has registered with the Care Quality Commission (CQC). Registered providers 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 our last inspection of the service in September 2017, we rated them ‘Requires Improvement’ overall and for the two key questions, ‘Is the service responsive’ and ‘well-led’? This was because the provider had failed to submit statutory notifications to us about several police incidents involving people using the service. Providers are required by law to notify the CQC without delay about the occurrence of any incidents or events that adversely affect the health, safety and well-being of people using the service.

In addition, we found wholly inappropriate language had been used to describe people in their care plan. We discussed this issue with the registered provider at the time, who agreed to review and amended care plans where appropriate and to remind staff not to use inappropriate language to describe people in future.

At this comprehensive inspection we found the provider had taken appropriate action to address all the issues we identified at their last inspection. This included improving their arrangements for notifying the CQC about significant incidents involving the people living at the home and the language being used by staff in people’s care plans. Consequently, we have improved the service’s overall rating from ‘Requires Improvement’ to ‘Good’ and for the two key questions, ‘Is the service responsive and well-led?’. The ratings for the key questions, ‘Is the service effective and caring?’ remain ‘Good’.

However, the rating for the key question, ‘Is the service safe?’ has deteriorated from ‘Good’ to ‘Requires Improvement’. This is because we found a number of uncovered radiators in bedrooms and communal areas where the possible risk of harm people living in the home might face had not been properly risk assessed. We discussed this health and safety issue with the registered provider at the time of our inspection who agreed to risk assess all the home’s radiators and immediately cover those radiators deemed to pose a potential hazard to people living in the home.

In addition, although we found staff had completed end of life care training, people’s end of life care preferences and choices had not been sought or recorded in their care plan. We also discussed this matter with the registered provider who agreed to sensitively raise this matter with the people who lived at the home and where necessary record their comments in their care plan.

Progress made by the provider to achieve both the aims described above will be assessed at their next inspection.

People continued to be happy with the care and support they received at the Sunlight House. We saw staff continued to look after people in

Inspection carried out on 13 September 2017

During a routine inspection

Sunlight House is a small care home that provides accommodation and personal support for up to four people. The service specialises in supporting younger adults who have mental health needs and/or a learning disability or an autistic spectrum disorder. There were four people using the service at the time of our inspection.

The service is owned and managed by an individual who is the registered provider. A registered provider is a person who has registered with the Care Quality Commission (CQC). Registered providers 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.

We last carried out a comprehensive inspection of this service on 2 June 2016 when we found the provider to be in breach of the regulations. Consequently we rated them ‘Requires Improvement’ overall and for the three key questions ‘Is the care home safe’, ‘effective’ and ‘well-led’. This was because the provider had failed to ensure their fire safety arrangements, staff recruitment, staff training and support, and governance systems were well-managed.

We undertook a follow-up focused inspection on 24 November 2016 to check the provider had implemented the improvement plan they had sent us and addressed all the aforementioned issues. However, whilst we saw improvements had been made by the provider to meet the regulations we did not change their overall rating of ‘Requires Improvement’ because we wanted to see they could consistently sustain these improvements over time.

At this comprehensive inspection we found the provider continued to maintain the improvements they had achieved at their previous inspection in relation to their fire safety, staff recruitment, staff training and support, and governance arrangements. However, the improvements described above notwithstanding we continued to rate the service as 'Requires Improvement’ overall. This was because we identified a new breach of the regulations. Specifically, the provider had failed to submit statutory notifications to us about several police incidents involving people using the service. Providers are required by law to notify the Care Quality Commission (CQC) without delay about the occurrence of any incidents or events that adversely affect the health, safety and well-being of people using the service. This meant we did not know what action the provider had taken to keep people safe and mitigate the risk of similar incidents reoccurring.

This failure represents a breach of Care Quality Commission (Registration) Regulations 18 (Notifications of other incidents) 2009. You can see what action we told the provider to take at the back of the full version of the report.

In addition, we found inappropriate language had been used to describe people in their care plan. We discussed this with the registered provider who agreed to review and amended care plans where appropriate, and to remind staff not to use inappropriate language to describe people in future. Progress made by the service to achieve this stated aim will also be assessed at their next inspection.

The aforementioned issues notwithstanding people told us they remained happy with the standard of care and support they received at Sunlight House. We saw staff looked after people in a way that was compassionate and kind. Staff had clearly built up good working relationships with people using the service and their relatives. Our discussions with people, their relatives and community health and social care professionals supported this.

There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs and wishes. Personal fire safety risk assessments remained in place and people routinely participated in fire evacuation d

Inspection carried out on 24 November 2016

During an inspection to make sure that the improvements required had been made

We last carried out an unannounced comprehensive inspection of this service on 2 June 2016 when we found the provider was in breach of four regulations. These related to the provider’s fire safety arrangements, staff recruitment and use of volunteers, staff training and support, and governance systems. Following our inspection the provider sent us an action plan which stated what they would do to make the necessary improvements. We undertook this unannounced focused inspection on 24 November 2016 to check the provider had implemented their action plan and were now meeting legal requirements.

This report only covers our findings in relation to this inspection. You can read the report from our previous comprehensive and focused inspections, by selecting the 'all reports' link for ‘Sunlight House’ on our website at www.cqc.org.uk.

Sunlight House is a small care home that provides accommodation and personal care and support for up to four younger adults. The service specialises in supporting young people living with a learning disability or mental ill health. There were four people living at the home when we visited.

The home is owned by an individual who is the registered provider. A registered provider is a person who has registered with the Care Quality Commission (CQC). Registered providers 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.

During our focused inspection, we found that the registered provider had followed their action plan and now met legal requirements.

Specifically, we found the provider’s fire safety arrangements had been improved. Since our last inspection a fire safety risk assessment for the premises and personal emergency evacuation plans (PEEP) had been created in respect of all four people who lived at the home.

The provider had improved their staff recruitment practices. Appropriate employment and criminal records checks had been carried out on all new staff to ensure they were suitable and fit to work at the home. In addition, the provider confirmed they no longer employed untrained volunteers to support people living there.

We also saw improvements had been made to the way staff were trained and supported to meet people’s needs. Staff training was in areas and topics relevant to their work which included courses on learning disability and mental health awareness. Staff also received regular supervision meetings with their line manager and had their working practices appraised annually.

The way the provider assessed and monitored the quality and safety of service people received had improved. A range of regular audits had been introduced by the registered provider to help them continually review and monitor staff recruitment, training and support, and their fire safety arrangements. This help ensure staff remained suitably fit and competent to work at Sunlight House and fire safety arrangements were fit for purpose.

Inspection carried out on 2 June 2016

During a routine inspection

This inspection took place on 2 and 8 June 2016 and was unannounced. The last Care Quality Commission (CQC) comprehensive inspection of the home was carried out on 6 June 2015 when we rated the service as ‘Requires Improvement’. We also imposed two requirement notices that we checked during a focused inspection on 26 November 2015. We found the provider was meeting the regulations we looked at, but we did not amend our rating as we wanted to see consistent improvements at the service.

Sunlight House is a care home that provides accommodation and personal support for up to four people. The service specialises in supporting younger adults living with mental ill health or a learning disability. There were four people living at the home when we inspected, one of whom was visually impaired.

The home is owned by an individual who is the registered provider. A registered provider is a person who has registered with the Care Quality Commission (CQC). Registered providers 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 provider did not always operate safe recruitment procedures. While we saw relevant pre-employment checks had been undertaken in respect of all the services’ permanent members of staff, we found no such recruitment checks had been carried out on a volunteer who had supported people using the service during a recent holiday. This meant people were at risk of receiving inappropriate care and support from volunteers who might not be ‘fit’ or ‘proper’ to work in an adult social care setting.

Staff assessed and identified the risks to people’s health and safety. We saw the majority of these risks were managed appropriately. However, sufficient action was not taken to protect people from the risk of fire because no fire safety risk assessments had been undertaken by the provider.

A system was in place to supervise and appraise staffs’ work performance. However, this was not being followed and staff were not receiving the support they required to undertake their duties.

A full training programme was in place to enable staff to update their knowledge and skills. However, we found that staff were not up to date with this programme and had not completed the necessary training for their role. A system was in place to supervise and support staff. However, this was not being followed and staff were not receiving the support they required to undertake their duties.

Systems were in place to monitor and review the quality of service delivery. We saw that these reviewed all aspects of service delivery and had identified some of the concerns we found during this inspection. However, sufficient improvement had not been made to ensure high quality care was consistently provided that kept people safe. This was because the provider had failed to carry out fire safety risk assessments, check the suitability of everyone who worked at the home and ensure staff were appropriately supported to perform their role.

We identified four breaches of the Health and Social Care (Regulated Activities) Regulations 2014 during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

The aforementioned breaches notwithstanding, people told us they were happy living at Sunlight House. We saw staff looked after people in a way which was kind and caring. Staff had built caring and friendly relationships with people. Our discussions with people using the service and visiting community based mental health professionals supported this. People’s rights to privacy and dignity were also respected.

Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. We saw people could move freely around the home. The provider ensured regular maintenance and service checks were carried out at the

Inspection carried out on 26 November 2015

During an inspection to make sure that the improvements required had been made

The last inspection of this home was carried out on 6 June 2015 when we found the provider was in breach of the regulations. This was because the provider did not always ensure medicines were managed properly and governance systems were operated effectively. This related specifically to the way staff recorded medicines they had handled on behalf of the people using the service and the provider’s internal audits, which had failed to identify these medicines recording errors.

After the home’s last unannounced comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. We undertook an unannounced focused inspection on the 26 November 2015 to check the provider had followed their action plan and now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Sunlight House’ on our website at www.cqc.org.uk’

Sunlight House is a care home that provides accommodation and personal support for up to four people. The home specialises in supporting younger adults with a past or present experience of mental ill health or learning disabilities. The care home also caters for people with a visual impairment. There were four people living at the home when we visited.

The home is owned by an individual who is the registered provider. A registered provider is a person who has registered with the Care Quality Commission (CQC). Registered providers 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.

During our focused inspection, we found that the registered provider had followed their action plan, which they had said would be completed by August 2015. We saw legal requirements had been met because the provider now managed medicines safely and operated more effective governance systems. This meant staff kept accurate records of all medicines they had administered and the provider regularly checked the quality of the care and support people who lived at the home received.

Inspection carried out on 6 June 2015

During a routine inspection

This inspection took place on 6 June 2015 and was unannounced.

At the home’s last inspection on 24 July 2014, we found the service was in breach of the regulations in respect of staff training and the lack of guidance in care plans to enable staff to appropriately manage risks people might face. We asked the provider to take action to make improvements. We went back to the service on 6 June 2015 to check that improvements had been made and found these regulations had been met.

Sunlight House is a care home that provides accommodation and personal support for up to four people. The home specialises in supporting people with a past or present experience of mental ill health or learning disabilities. The care home also caters for people with a visual impairment. There were four people using the service when we visited.

The home is owned by an individual who is the registered provider. A registered provider is a person who has registered with the Care Quality Commission (CQC). Registered providers 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.

We found staff regularly failed to sign for medicines they had administered on behalf of people using the service. This failure might have put people at risk of not receiving their prescribed medicines at times they needed them. The provider had established systems and processes to monitor the safety and quality of the service provided at the home. However these were not always effective. This meant errors were not always identified quickly and appropriate action taken in a timely way to rectify and learn lessons from mistakes made. These were breaches of the Health and Social Care (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

People and their relatives told us Sunlight House was a safe place to live in. Staff had refreshed their training in safeguarding adults at risk since our last inspection and knew how and when to report their concerns if they suspected someone at the home was at risk of abuse or neglect.

Where risks to people had been identified because of their circumstances and specific needs, there was guidance for staff on how to minimise these in order to keep people safe from injury or harm in the home and wider community. Regular maintenance and service checks were carried out at the home to ensure the environment was safe.

People said they were happy living at the home. They told us staff looked after them in a way which was kind, caring and respectful. Our observations and discussions with people using the service and their relatives supported this. People’s rights to privacy and dignity were respected.

The home was open and welcoming to visitors and relatives. People were encouraged to maintain relationships that were important to them. People were also supported to undertake activities and outings of their choosing. People said they felt comfortable raising any issues or concerns directly with staff. There were arrangements in place to deal with people's complaints, appropriately.

People were supported to keep healthy and well. Staff ensured people were able to promptly access healthcare services when this was needed. People were encouraged to drink and eat sufficient amounts to reduce the risk to them of malnutrition and dehydration.

Consent to care was sought by staff prior to any support being provided to people. Care plans had been developed for each person using the service which reflected their specific needs and preferences for how they were cared for and supported. People’s beliefs and values were respected. Care plans gave guidance and instructions to staff on how people’s needs should be met. People were appropriately supported by staff to make decisions about their care and support needs. These were discussed and reviewed with them regularly.

There were enough staff deployed in the home to care for and support the people who lived at Sunlight House. Staff were more knowledgeable about the individual needs and preferences of people they cared for. Staff had a good understanding and awareness of people’s needs and how these should be met. Staff also felt supported by the registered provider and had opportunities to share their views and ideas about how people’s experiences of using the service could be improved.

The registered provider understood when a Deprivation of Liberty Safeguards (DoLS) authorisation application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

The service had a clear management structure in place. The registered provider demonstrated a good understanding of their role and responsibilities, and staff told us they were always supportive and fair.

Inspection carried out on 24 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. At our previous visit in November 2013, we judged that the service was meeting all the regulations we checked.

Sunlight House is a care home providing care and support to up to four adults. This included people with various mental health needs, autistic spectrum disorder, physical health needs and mild to moderate learning disabilities. At the time of our visit there were four people using the service. The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of our visit, the registered manager was away and had appointed an acting manager to take responsibility for the running of the service. The manager had notified CQC in advance of their absence as they are required by law to do.

People told us they felt safe at the home. However, people were not safeguarded from the risk of abuse because at the time of our visit, people who used the service and staff were not familiar with policies and procedures about how to report and deal with suspected abuse.

People had risk assessments and risk management plans. Staff knew how to use the information to keep people safe.

Staff were aware of the requirements of the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS), which care homes are required to meet. There were procedures in place that could be used if they were needed. People said staff sought their consent before providing care.

There were enough staff to keep people safe and the service had safe recruitment procedures to protect people from the risks of being cared for by unsuitable staff.

The service provided support and guidance to staff through supervision and team meetings and they were supported to access further relevant qualifications. This helped staff to care for people effectively. Staff received some training but were not trained in evidence-based interventions or awareness of specific needs of people who used the service. This meant that people did not always feel their needs were met. Some information about risks, particularly those relating to people’s specific conditions or disabilities, was absent from care plans and risk assessments meaning that staff may not have the necessary information to keep people safe. The home was not adapted to meet the needs of one person who lived there and their independence was compromised because staff had to give them extra support to move around the home, although the other three people reported no problems.

People were able to access healthcare appointments when required to meet their needs. They were able to discuss their health needs with staff, who supported them to stay healthy.

People had enough to eat and drink and told us they liked the food. They were involved in planning menus to meet their preferences and cultural needs, and meal choices were available. Staff knew about the risks of dehydration in hot weather and made sure people had enough to drink.

Staff had developed positive caring relationships with people who used the service. They knew people well and involved them in decisions about their day-to-day care. Staff understood and met people’s cultural and religious needs.

People were involved in planning their care and their opinions were sought when decisions needed to be made about how they were cared for. The service involved them in discussions about any changes within the service that needed to be made to keep them safe and promote wellbeing.

People felt that the service responded to their needs and individual preferences. Staff supported people according to their personalised care plans, including supporting them to access community-based activities. Staff respected people’s privacy and treated them with respect and dignity. People felt that at times, staff could do more to promote their independence.

The service encouraged people to raise any concerns they had and responded to them in a timely manner. No formal complaints had been recorded, but people were aware of the complaints policy.

People fed back positively about the management of the service. There was an open and positive culture with approachable leaders and a clear sense of direction. The manager had a plan to improve the service. People said they were not kept informed about the plans but felt it was a good service. The provider had systems in place to continually monitor the quality of the service and people were asked for their opinions via surveys.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 5 November 2013

During a routine inspection

We spoke with all of the people using the service and some of their relatives during our inspection. The majority of people spoke positively about staff. Comments ranged from, �they�re nice people�, �staff are good, caring and supportive� and ��the staff are friendly and make you feel very welcome. They are very kind and gentle people.� Most people agreed they received the care and support they needed. However some people felt there should be more activities, particularly in the evenings and weekends that focused specifically on the needs of people using the service. We also spoke with the provider, who was the manager, and two carers, one of whom was a senior carer.

We looked at annual surveys completed by people using the service, their relatives and other healthcare professionals involved in people�s lives. The majority of people that completed these were positive about the care and support provided by the service. People had been given opportunities through the survey to give their feedback and make suggestions about improvements. People we spoke with knew how to make a complaint if they were unhappy about the service. The majority of people said staff were approachable and easy to talk to. However some people said the provider did not always resolve things quickly.

We looked at people�s individual records and saw plans were in place to care for and support them, based on an assessment of their specific needs. People had been able to sign their care plans to agree to the care and support that had been planned. Records showed people�s families and other healthcare professionals had also been involved in making decisions about people�s care and support.

Risks to people�s health, safety and welfare had been identified and plans were in place to manage these. People�s care plans had been reviewed so that staff had up to date information about people�s current care and support needs. There were enough staff, at the time of our inspection, to meet these needs.

People�s individual rooms were clean and tidy and free from malodours. Communal areas in the home were mainly clean and tidy.

Inspection carried out on 28 February 2013

During a routine inspection

We spoke with two people who use the service, two members of staff and the manager who is also the provider during our visit on the 28th February 2013.

People made positive comments about the home, saying "I have all I need in my room", "staff are there when you need them", "I go out and do the things I want to do", "I'm still here so I must like it", "they know me and what I like" and "the food is good".

Staff were happy to be working at the home saying they had the training and support needed to do their job and had seen improvements in the people who used the service so knew what they were doing was having a positive impact.

Inspection carried out on 3 March 2011

During a routine inspection

People who use the service said that they are happy living at the home. They have all they need in their rooms. They feel staff listen and respond to their needs. They have meetings and opportunities to comment about the care and support they receive. People feel there are enough staff to meet their needs. They are aware how to make a complaint although have not had anything to complain about. People made positive comments about the food, saying �the food is good�. People told us that they have enough to do during the day.