Sainthill House Care Home

Sainthill House is registered to provide accommodation for 19 people who require accommodation and personal care. The service provides care and support for up to 14 older people who may have physical and/or mental health needs. The service includes Sainthill Cottage, attached to Sainthill House, which provides care and accommodation for up to five younger people who have a learning disability. On the day of our visit eighteen people lived in the service.

We found the following examples of good practice.

The service ensured people could continue to receive visitors in line with government guidance. There was a clear process and testing regime in place for visitors, with personal protective equipment (PPE) provided. A ‘visiting hub’ had been created where visitors did their tests, with up to date information and guidance provided.

People had been supported to maintain contact with the important people in their lives during lockdown, using information technology. A safe visiting space had also been constructed with a glass partition and intercom.

Staff received ongoing training in infection control. The registered manager was proactive in ensuring staff put what they had learnt into practice. They carried out hand washing audits and spot checks. A hand hygiene teaching aid used ultraviolet light to highlight any areas missed. They told us, “It’s a fun exercise and staff engage well.”

Staff were seen to wear PPE throughout the inspection. They frequently used hand sanitiser, available

throughout the home. People told us the measures in place helped them feel safe, and they had got used to staff wearing masks.

Masks were a real barrier of communication for one person who was profoundly deaf. Staff had worked with a sensory worker to find ways to support communication. They used white boards and objects of reference, as well as body language. Staff had also learnt some sign language.

People living with a learning disability needed additional support to understand covid. The service sought specialist guidance. They used easy read information to help people understand how to tell staff if they felt unwell; why people wear masks and not to be frightened of them.

There were robust cleaning schedules in place. Their effectiveness was closely monitored by the team leaders and registered manager who carried out daily spot checks.

The provider ensured staff were well supported. They delivered welfare bags and did the shopping for staff who were isolating. One member of staff with long covid had been redeployed to a different, less physically demanding role to support their recovery.

People’s experience of using this service:

People were not all able to fully verbalise their views therefore they were not able to tell us verbally about their experience of living there. Therefore, we observed the interactions between people and the staff supporting them.

The management team and staff knew people well and understood their likes and preferences and health needs. Staff were caring and spent time chatting with people as they moved around the service. Relatives told us they were welcome at any time and any concerns were listened and responded to.

People and staff told us the service was well managed. People said they were treated with kindness and compassion and felt respected. Staff showed a true fondness for the people they cared for and there was a warm, friendly and welcoming atmosphere. People’s wellbeing was promoted.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for social interaction and activity with staff.

The environment was safe and people had access to equipment where needed. Staff had received appropriate training and support to enable them to carry out their role safely, including the management of medicines.

There were positive working relationships with external professionals and a passion for continuous learning and improvement.

People were kept safe and protected from avoidable harm and abuse, and people had their medicines safely managed. New processes had been put into place to ensure a more robust oversight. People lived in an environment which was fully assessed for safety.

People received personalised care and support, and had their human rights protected. Staff were competent in their roles and were well supported. Quality monitoring systems had been further developed.

Rating at last inspection: Good (Report published 13 October 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection, the service remained rated Good overall.

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

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

We carried out this inspection in September 2016 to check whether these improvements had been made. Sainthill House is registered to provide accommodation for 19 people who require accommodation and personal care. The service provides care and support for up to 14 older people who may have physical and/or mental health needs. The service includes Sainthill Cottage, attached to Sainthill House, which provides care and accommodation for up to five younger people who have a learning disability. At the time of the inspection there were five people in the cottage and 14 people in the main house, with three people coming in for day care.

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 registered manager had kept us informed about progress towards achieving the provider’s action plan, and we found significant improvements in all aspects of the service since the last inspection. There had been input from the local authority Quality Assurance and Improvement Team (known as QAIT). QAIT had evaluated the quality of the support provided, highlighting what was going well and making recommendations where improvements were needed. The provider had further developed the quality assurance system, and used the findings to create a comprehensive service improvement plan. At the time of this inspection the majority of the improvements had been made. People were very positive about the service. One person told us, “It’s extraordinary…There is a family mentality. The staff have a good relationship with each other and I’ve got to know them all very well. It’s an ideal placement”. A member of staff said, “I’m very proud of what we have done at Sainthill”.

At the last inspection in October 2015 we found staff did not understand their role in relation to infection control and hygiene, which placed people at risk. At this inspection we found improvements had been made. Staff had received training, PPE (Personal Protective Equipment) were readily available and accessible for staff, cleaning hours had been increased and weekly and monthly housekeeping and infection control audits were carried out.

At the last inspection we saw medicines administration records (MAR) for the application of creams and topical medication were not always being signed by staff. At this inspection we found systems were now in place to ensure people received all of their medicines safely. MAR charts had been completed correctly, care plans contained clear guidance for staff and mandatory training was in place about topical medication administration. Regular medication audits ensured this improvement was maintained.

At the last inspection in October 2015 we found people’s rights were not always protected under the Mental Capacity Act 2005 (MCA). Staff did not have an understanding of the MCA or how the principles applied to their practice. People’s capacity to make particular decisions had not always been assessed and documented, or a best interest process followed. In addition, people had not been referred for assessment under the Deprivation of Liberty Safeguards (DoLS). This meant they were potentially being deprived of their liberty to receive care and treatment without being assessed to determine if this was in their best interests and legally authorised under the MCA. At this inspection we found staff understanding of the MCA had improved significantly following training. The service was now working within the principles of the MCA, and applications had been made for people to be cared for under DoLS where appropriate. This meant people’s human and legal rights were now protected.

At the last inspection we found people and their relatives were unsure of whether they had been involved in the planning and review of their care. At this inspection people and their relatives confirmed they had been involved in developing and reviewing their care plans with the support of their keyworker.

At the last inspection we found the service had not notified the Care Quality Commission of all significant events which had occurred, in line with their legal responsibilities. Since this inspection improvements have been made. As far as we are aware, the provider now met their statutory requirements to inform the relevant authorities of notifiable incidents.

People told us they felt safe. There were sufficient numbers of staff deployed to meet their needs. They were protected from the risk of abuse through the provision of policies, procedures and staff training, and an effective recruitment process. Risk assessments and care plans were effective in enabling staff to minimise risks and support people according to their needs and preferences.

People were supported to maintain good health and had access to healthcare services. People were referred appropriately and guidance followed. One health professional commented, “They flag anything up with us they need. I have no reason to have any concerns. Everybody is happy and the carers are fantastic”.

People had sufficient to eat and drink and received a balanced diet, and care plans guided staff to provide the support they needed. People were extremely positive about the quality of the food. Comments included, “The food is very good” and, “The meals are very nice…You can ask for something different that’s not on the menu”.

Staff promoted people’s independence and treated them with dignity and respect. People were supported to make choices about their day to day lives, for example how they wanted their care to be provided and how they wanted to spend their time.

People’s relatives said they were made welcome and encouraged to visit the home as often as they wished. They said the service was good at keeping them informed and involving them in decisions about their relatives care.

There was a committed staff team at the home which was well supported by managers and the providers. An induction and training programme was in place to support them to do their jobs effectively. Ongoing professional development was encouraged for all staff members. One member of staff told us, “I’ve been doing care for 10 years. They are the first manager that’s ever listened to me and allowed me to progress [with qualifications]. They empower you to be the best you can be”. In addition the manager had given staff additional responsibilities to further develop their knowledge and skills and build confidence.

There were 11 people living in Sainthill House and five people living at Sainthill Cottage at the time of this inspection. We met with everyone living at the home. We spoke with eight people in some depth to hear about their experience of living there. We also looked at the care records of five people and spoke with two relatives, six health and social care professionals and five members of staff including the registered manager.

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

Is the service safe?

All of the people we spoke with told us they felt safe living at Sainthill. Comments included, 'Staff are kind and considerate. I am never rushed. They treat me very well here'; 'Staff are never rough with me'; and 'If I had any concerns I would be able to speak with the manager'.

Relatives and health professionals spoke positively about the care and support provided. One professional told us, 'I have been particularly impressed by the manager. She has good strategies in place to manage care safely'. A relative said, 'I have a great deal of confidence in the manager and staff. My relative's care is second to none'.

We found that risks had been assessed to identify any potential risk and the actions required to manage the risk. This meant people were not put at unnecessary risk but had access to choice and remained in control of decisions about their care and daily lives. For example one person enjoyed horse riding. The risk assessment and care plan supported this activity.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, relevant policies and procedures were in place. Appropriate staff had been trained to understand when an application should be made, and how to submit one. This meant that people would be safeguarded as required.

People were cared for in a clean, hygienic environment. Both Sainthill House and the Cottage were clean and odour free throughout and people told us it was always like this.

People were protected against risks associated with medicine management because the provider had appropriate arrangements in place to manage medicines.

Systems were in place to make sure the manager and provider learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

Equipment was maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

The service was effective because people's health and well-being was promoted. Care plans provided instructions to staff about the care each person wanted and needed. We saw evidence of multi-professional visits and appointments, for example GP, speech and language therapist, and community nurses.

External professionals told us the home worked well with them to ensure people's health was promoted and their needs were met. Specialist dietary, mobility and equipment needs had been identified in care plans where required. We saw that specialist equipment such as chairs and mattresses were provided where needed. People told us their current needs were being well met by the service.

People's preferences and interests had been recorded and care and support was provided in accordance with people's wishes. We found improvement in the frequency and the variety of activities offered since the last inspection, which meant people had increased opportunities for meaningful occupation.

There were effective recruitment and selection processes in place. We checked staff files and found the provider had maintained a satisfactory recruitment process, which protected people using the service from unsuitable staff.

Is the service caring?

We saw that people were supported by kind, caring and attentive staff. The staff were patient and gave encouragement when supporting people. One person commented, 'Some of the staff are excellent. All are polite and friendly'. Another person told us, 'All of the staff are lovely. They understand me'

Relatives spoke very positively about the care and support given to their family members. One told us, 'The home has a lovely homely feel to it. 'they have been wonderful with X and the family'. Another relative told us, 'The staff are very caring. Sainthill has very high standards in my opinion'.

During our visit, we observed people were provided with the care and support they needed in a timely way. Staff were responsive to people's requests and we saw staff had a friendly and respectful approach and treated people in a kind manner. We found from speaking with staff they knew people well and were aware of their different care needs and individual preferences.

Is the service responsive?

Visiting health and social care professionals told us the service was responsive to people's changing needs. Comments from external professionals included, 'We are alerted to any changes in people's health needs appropriately'; 'Communication is excellent. They fully embrace our recommendations and suggestions'; and 'The manager bends over backwards to meet people's needs. She is creative and inclusive in her approach'.

People knew how to make a complaint if they were unhappy. No complaints had been received since our last inspection. However, people said they would be happy to speak to staff or the manager and that they were confident any concerns would be listen to and acted on. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

Since the last inspection the manager has registered with CQC. People using the service, relatives, and health and social care professionals spoke highly of the registered manager and the positive impact she had had on the service.

The service worked well with other agencies and services to make sure people received their care in a joined up way. Professionals spoken with expressed their confidence in the manager and staff.

The service had an established quality assurance process in place to promote the continual improvement of the service. People said they had taken part in 'residents meetings' where issues relating to the running of the home were discussed, these included food and activity choices. Annual satisfaction surveys were used to gain people's views and suggestions. There was evidence that people's opinions had been acted upon as improvements had been made in respect of the food available, the activities provided and the laundry service.

During this inspection we met with or saw the majority of people using the service. We spoke with six people using the service in some depth to hear their experiences of living at the home. We also spoke with seven members of staff including care staff, the unregistered manager and the company representative. During the visit we met and spoke with three relatives and two health professionals (GP and community nurse specialist). As part of this inspection we contacted a number of health and social care professionals, including a community psychiatric nurse, professional advisor, occupational therapist, four care managers and an environmental health officer.

Overall people living at the home were satisfied with the care and support they received. Their comments included, 'I am very happy here. I have no worries', 'I love the staff. They are all very good to me', 'The staff treat me well' and 'The care is wonderful here. Five stars all around!' People living in the home and their relatives told us the home was a safe place to be.

We spoke with three relatives and they confirmed that they were satisfied with the care provided. One told us, 'X always looks comfortable and well kept'. Another relative said 'We have no concerns. X seems well cared for. Staff are friendly and kind'.

The feedback from visiting professionals was positive overall. They told us they were contacted appropriately and that the service implemented their recommendations. Comments included, 'Patients appear happy', 'There is good monitoring of people's mental health', 'The manager and staff are doing a great job' and 'They have gone out of their way to settle X'. All of the professionals we spoke with spoke highly of the unregistered manager.

During the inspection we spent time with people in the communal areas of the home and with people individually in their rooms. We found that care and support was offered appropriately to people. People told us and records showed that before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

The focus of this inspection was to review the action taken by the provider to meet the warning notices. We found improvements had been made. Work was on-going to ensure records were accurate to protect people against the risks of unsafe or inappropriate care and treatment. A review had been undertaken in relation to staff recruitment processes and records. We found the provider was compliant with these outcomes.

During this inspection we met with or saw a number of people. People living at the home told us that they were happy with the care provided to them.

There were 14 people living at Sainthill House and Cottage and we met or spoke with 10 of them. People told us about the management and staff changes over the past months, which some had found disruptive. One person told us, 'It has been chaotic', and another person said 'There have been lots of changes'.

We received mixed comments about the quality of the food. People told us the home was always clean and free from offensive odours. We found that the home had suitable equipment. The fire service had visited the home and found it to be broadly compliant. They had made recommendations were failures were found.

We found that the provider was not meeting all of the essential standards and action was needed. Care and treatment was not always planned and delivered in a way that ensured people's safety and welfare. An effective recruitment process was not in place. People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.