This inspection took place on 12 and 13 December 2017 and was unannounced on the first day. This was the first inspection of this location since a change in provider. Sarsen House is a residential home for adults with learning disabilities; providing accommodation for up to six people. There were six people living at the service during the inspection. Sarsen House is arranged over two floors, with bedrooms upstairs and downstairs, a communal lounge/dining room, a separate dining room, shared bathrooms and accessible kitchen. The bedrooms were spacious and one person had their own small lounge connected to their bedroom. The service has a minibus to support people to access the local community.
A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (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. During the inspection we met with the registered manager, deputy manager and care staff. Staff told us that they felt supported by the registered manager and deputy manager. The registered manager and deputy manager told us that they felt there had been improvements in communication within the staff team.
We received feedback from three relatives. One person told us, “There are no negatives at all” and that “There is a good balance between doing ordinary things, like the chores such as recycling or washing up, and the fun things.” Another person said that their relative living at Sarsen House “is really well looked after, really happy, it feels like it is their home”. The feedback received was positive and praised the staff team for the support they provide.
Six health and social care professionals were contacted for their feedback of the service; three professionals provided information. One professional said, “The team [at Sarsen House] have always been prompt in contacting us when an individual’s needs change; as well as if they have concerns, or require advice-” and “The service has been given much advice and recommendations over the years, which has been received and acted upon promptly.” All feedback from health and social care professionals expressed that the service provides person centred support.
Support staff sought consent from people before providing support. However, the principles of Mental Capacity Act (MCA) were not always followed when making decisions about people’s care and support. Best interest decisions were not reviewed annually for one person. For another person, they had lived at the service for six months, without their capacity being assessed, but with decisions being made for them. When asked, staff were not consistently able to recall the principles of MCA, or relate them to their role.
Audit systems were in place for medicines management. However, the format of the audit was not understood by the person completing them. While areas requiring action were identified, it was not recorded what the response had been, or when this had been completed. During the inspection, the registered manager liaised with the regional manager to gain support in developing their understanding of this audit process.
Where appropriate, risks had been identified and recorded in people’s care plans, with guidance for staff to manage these risks safely. Accidents and incidents were recorded and analysed at the service, as well as at a head office level to check for patterns and trends.
Staff said they felt confident they could ask for more training; and the manager identified that training in MCA was required for all staff. However, there was no overview of the training needs of individuals, meaning that gaps in training could not immediately be identified. During the inspection the registered manager liaised with the regional training manager to plan how this could be improved in 2018.
Each person had a care plan which contained person centred information about the person’s life and preferences. The care plans contained paperwork from the current provider and the previous provider, the transfer of information was a work in progress at the time of the inspection. The plans contained one page profiles.
During the inspection there were sufficient staff on duty to ensure three people could attend an art club, one person attended a health appointment and another person was driven to meet with a relative for lunch.
Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action has been taken. The management team had submitted notifications where required.
Care plans showed that people had been referred to healthcare professionals promptly when needed. Input received from healthcare professionals was recorded and used in care planning.
There were gaps in recording for one person who required their fluid intake to be monitored, the total fluid intake was not recorded and the fluid intake goal was not written down in the recording system. During the inspection the regional manager implemented a new recording process to incorporate the recommendations made.
Staff understood their roles and responsibilities; they acknowledged there had been challenges in changing providers, but felt that the team was continually strengthening. Staff received individual supervision meetings with the registered manager or deputy manager.
Providers are required, by law, to display their CQC rating to inform the public on how they are performing. The latest CQC rating was displayed in the service and these details were also on the provider’s website.