About the service: Reach Sistine Manor is a residential care home that was providing accommodation and personal care to 14 people. At the time of the inspection 12 people were living in the main building and two people were living in the adjacent building known as the coach house. The service is one of eight registered locations on the providers portfolio.

People’s experience of using this service:

¿The service did not have a registered manager. However, the providers monitoring and auditing of the service was comprehensive which enabled them to provide a safe, effective, caring and responsive service.

¿Relatives were happy with the care provided but some feedback from them indicated communication could be better around care planning, key working and choice of meals provided.

¿People received safe care. Risks to them were identified and managed.

¿ Safe medicines practices were promoted.

¿Staff were suitably recruited, inducted, trained and supported.

¿Staffing levels were flexible to meet people’s needs.

¿People’s health needs were identified and met.

¿Staff were kind and caring and promoted person centred care.

¿People were consented with about their care and safeguards were in place for people who were unable to make decisions on their care.

¿People were supported to communicate their needs and they were encouraged to be involved in activities.

¿The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence

¿People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this.

Rating at last inspection: The previous inspection was carried out on 24 May 2016 (Published on 5 July 2016). The service was rated Good at the time.

Why we inspected: The inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Inspections will be carried out to enable us to have an overview of the service, we will use information we receive to inform future inspections.

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

Reach Sistine Manor provides residential care for up to 19 adults living at the service. The home is split into two, with a coach house to the side which accommodates three service users. The home provides care to people with severe learning disabilities and complex needs. At the time of our inspection, 14 people were living at the service.

Reach Sistine Manor did not have a registered manager however an application had been made by the current operations manager. A manager was in place and managing the service with the support of the operations manager. 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.

This inspection was undertaken over two days and was unannounced.

We undertook an inspection at Reach Sistine Manor in October 2015 which was unannounced and completed over two days. At our last inspection, we found a number of breaches under requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was in breach of Regulation 10; Dignity and respect, Regulation 11; Need for consent, Regulation 12; Safe care and treatment, Regulation 17; Good governance and Regulation 18; Staffing. Sistine Manor was placed into special measures. After our inspection in October 2015, we began to look at taking further enforcement action against the provider. We decided to revisit the service after six months to assess their progress.

At this inspection, we found major improvements had been made to the service. Since our last inspection, the number of people living at Sistine manor had reduced and improvements had been made to the training and development of staff working at Sistine manor. We found these changes had a positive impact on the way people were cared for, and the way staff interacted and supported people living at Sistine Manor.

New processes and procedures had been implemented to ensure the quality of the service provision and to assess where and how improvements could be made. We saw staff had been actively involved in providing input into how Sistine Manor could improve and in turn, this had a positive impact on how they engaged and supported people living at Sistine Manor to have their voices and choices promoted.

Staff we spoke with told us they felt the service had improved, and that further training and supervision had been beneficial to their roles. Staff told us learning disability training they had received since the last inspection had helped them to understand how people with learning disabilities see the world and their environment, and gave them an understanding of how best to support people. We received positive feedback from staff on the training they had received and saw the positive impact this had on people living at Sistine Manor.

We found there was now effective governance in place to ensure the smooth running of the service. Where feedback was obtained from staff, visitors or relatives, we saw this was fed back into the service to make further improvements. For example, where complaints were made, these were acted on in line with the provider’s policy and discussed at team meetings to promote further learning and to encourage improvement. We previously had concerns about management and leadership within the service. We now found the manager was being supported to develop their understanding and skills by the operations managers. This again, appeared to have a positive impact on both staff and people living at Sistine.

At previous inspections, we raised concerns about poor culture within the service. This included poor staff practice and lack of dignity and respect shown towards people living at Sistine Manor. Since our last inspection, changes had

The people we met were happy and relaxed and told us they liked living at the home and that they felt they were looked after well. These people also told us they regularly went out on shopping trips, to the cinema and attended a variety of local social clubs. We looked at a range of people’s weekly activity plans and we noted that these plans promoted a broad range of weekday, evenings and weekend activities. We spoke with one person who told us, “I am going to go to bingo tonight; I like it, and I go every week.”

We spoke with two staff who told us they supported people be as independent as possible and to work towards and achieve personal activity or social goals. We looked at four care files that demonstrated the personalised approach in place to plan to support the staff’s comments. In one care pan we looked at a person who used the service could be seen pictured at the home, out and about on excursions and holidays and with friends and relatives.

The staff we spoke with demonstrated a good understanding of the different types of abuse and were able to provide good insight into the organisations safeguarding policies and that of the Local Authorities reporting processes.

We observed that the managers operated a model of good practice by offering staff regular supervision and access to a framework of training and support that enabled them to provide a high quality of care.

The staff we spoke with told us that the ‘key worker’ system was an effective model of practice. These people told us that it enabled them to provide the appropriate levels of support needed by people who used the service so that they were able to make independent choices and decisions around the way they received their care.

The people we met at Sistine Manor all seemed to be quite relaxed. People living there had a range of things to do each day. People talked to us about going to College. People also told us they went to the shops, cinema, for walks, played bingo, played tennis on occasions, went horse riding, bowling, and to social clubs. People had a plan showing the things they did each week. One person showed us the outcomes they were working on. For example a person was being supported to brush their hair on their own as part of being more independent.

We saw a lot of staff around over the course of the day. That was good as it meant people were safe. The staff were friendly and generally talked to people in a nice way. On one occasion, however, we did note a member of staff inappropriately refer to items used in some activities as ‘toys’.The care plans we saw included photographs of the person at home, on day trips and when they went to see their family. There were also other pictures and photographs to help people understand what some of the papers in their care plan meant.

We found people’s needs were assessed and their care was provided in line with their care plan. People were protected against the risk of abuse. Staff were supported in providing care and support to people. There was an effective system in place to assess and monitor the quality of the care people were receiving. The service looked into people's complaints.

The people we spoke to during our visit to the home, both in the main house and in the Coach house, told us that they were happy living at Sistine Manor.

Two people said the home was convenient for visiting their families.

One person told us that he enjoyed going out with staff and other people to clubs in Cippenham and Langley, and to the cinema and bowling in Slough.

Reach Sistine Manor is registered to provide residential care for up to 19 adults. The home is split into two, with a coach house to the side which accommodates three service users. The home provides care to people with severe learning disabilities and complex needs. At the time of our inspection, 18 people were living at the service.

Reach Sistine Manor did not have a registered manager. 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. A manager was in post and had sent an application to the Commission which was being processed.

This inspection was undertaken over two days and was unannounced.

We undertook an inspection at Reach Sistine Manor in June 2014 which was unannounced and completed over two days. At our last inspection, we found a number of breaches under requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The service was in breach of Regulation 9: Care and welfare of people who use services, Regulation 23: Supporting workers, Regulation 10: Assessing and monitoring the quality of service provision and Regulation 20: Records. After the inspection, we were provided with a comprehensive action plan submitted by the provider on how they intended to address the concerns raised.

We undertook a comprehensive inspection in April 2015 to follow up on non-compliance at our June 2014 inspection. We continued to find concerns with the service and minimal improvement had been made. The service was rated inadequate in four domains (Safe, Effective, Responsive and Well Led) and was placed into special measures and was required to be inspected after six months. After our April inspection, we took enforcement action against the provider in the form of a notice of decision to impose ‘positive conditions’ on the service, predominantly around their training requirements. The notice was due to come into effect on the 12 November 2015.

At this inspection in October 2015 we found some minor improvements had been made, but not enough to ensure the service was placed out of special measures. Due to the lack of required improvement, the service continues to be rated as ‘inadequate’.

Risk assessments were not always reflective of people’s needs and did not provide staff with the guidance they needed to ensure people were kept safe. We raised concerns with the local authority around the process of recording and reporting incidents and the lack of improvement to the service. We continued to raise concerns about fire safety and the layout of the building.

Staff were still not receiving adequate training to undertake their roles effectively. Particularly around required training and skills to work with people with severe learning disabilities. Staff were still not receiving training in line with the provider’s training plan. Staff input was not always sought into how the service could improve until the second day of our inspection.

The service did not respond to concerns raised by the Commission and local authority commissioners in respect of the Mental Capacity Act 2005. The provider did not ensure staff were working in line with Deprivation of Liberty Safeguards (DoLS).

The service had improved through re-decoration however; this had not improved the quality of care that people received. People were not always treated with dignity, and respect of their privacy protected. Staff appeared unaware how to de-escalate unwanted behaviours. Most staff appeared unaware of how to treat people in a person- centred way. Engagement between people and the majority of staff members did not appear to be meaningful or purposeful.

There were poor quality assurances in place considering the ongoing breaches since June 2014. Although the manager and operations manager had tried to improve the service, there was poor leadership and management within the service. This meant the service had not improved and remained in breach of the required regulations under registration of the Health and Social Care Act 2008. We found the manager and operations manager were not appropriately supported by the provider to ensure the service was safe, effective, caring, responsive and well-led.

We found the home was still not tailored to meet the needs of people with complex needs and learning disabilities.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We are taking further action in relation to this provider and will report on this when it is completed.