The inspection took place on 24 May 2017 and wasunannounced. We carried out a comprehensive inspection of this service on 24 and 28 October 2014 at which a breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 9 July 2015 to check that they had followed their plan and to confirm that they met legal requirements.

Royal Mencap - 25 The Sandfield is a care home providing accommodation and personal care for up to four adults with a learning disability, an autistic spectrum condition and/or a physical disability. There were four people living at Royal Mencap – 25 The Sandfield during our inspection.

There was a registered manager in post at Royal Mencap – 25 The Sandfield. 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 service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment to support people. Staff had a good awareness of safeguarding policies and procedures and felt confident to raise any issues or concerns with the management team. The registered manager had carried out the relevant checks to ensure they employed suitable people at Royal Mencap – 25 The Sandfield.

People were receiving effective care and support. Staff received appropriate training which was relevant to their role. Where required, the service was adhering to the principles of the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS). The environment had been adapted to meet the needs of people living at the home. People were supported to personalise their living spaces.

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which maintained peoples dignity.

The service was responsive to people’s needs. Support plans were person centred and contained sufficient detail to provide consistent, high quality care and support. People were supported to engage in a range of activities based on their preferences and interests. There was a complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

The service was well-led. There was an experienced registered manager working at the service. Staff, people and their relatives spoke positively about the registered manager. Quality assurance checks and audits were occurring regularly and where issues had been identified, action had been taken to address them. The registered manager and staff were aware of the vision and values of the service and worked hard to provide a service which was person centred for each individual.

We carried out an unannounced comprehensive inspection of this service on 24 and 28 October 2014 at which a breach of legal requirements was found. This was because the registered person had not notified the Commission without delay of abuse or an allegation of abuse in relation to a service user.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 9 July 2015 to check that they had followed their plan and to confirm that they 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 ‘Royal Mencap Society - 25 The Sandfield’ on our website at www.cqc.org.uk.

25 The Sandfield is a care home for up to four people with a learning disability or an autism spectrum disorder. There were three people living at the home when we visited. The people living at 25 The Sandfield have a range of support needs. Some people cannot communicate verbally and need help with personal care and moving about. Other people are physically able but need support if they become confused or anxious. Staff support was provided at the home at all times and most people required staff support when outside the home.

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 our focused inspection on 9 July 2015 we found the provider had followed the action plan which they had told us would be completed by 23 January 2015 and legal requirements had been met. Notifications of significant events were being shared with us in line with the requirements of the law.

During this inspection we looked at how medicines were managed to check that issues identified at the last inspection had been addressed in line with the action plan submitted by the provider. We spoke with people living at the home but not specifically about their medicines as they were unable to give us feedback on this topic.

We looked at medicines records and protocols, we spoke with staff and we checked the medicines stored at the home. We found that the systems in place supported and protected people to safely take their medicines. A regular audit was in place to ensure that staff were following the local protocols. The registered manager had ensured that all of the changes identified in the action plan had been completed. Staff told us the systems were working well.

We spent time with two people living at the home and two staff during our inspection. We also observed care in the communal areas. People communicated to us that they were happy to live at the home. We saw staff interacting appropriately with people. We spoke with one relative who was happy with the level of support provided by the home.

We saw staff consulting with people to gain their consent and encourage independence. Staff followed the guidelines in people’s communication profile to maximise their ability to make decisions. The support provided was in line with people’s support plans. We saw that some progress was being made towards meeting people's goals. The level of activity in the home, particularly in the evening and at weekends was limited and had caused other professionals concern.

The majority of the home was clean and tidy. One room required remedial work and this was being addressed by the registered manager.

Medication administration was generally being done safely but we found a few processes, such as dating prescribed sprays and creams on opening, were not being followed. The registered manager did not have systems in place to monitor medication administration for poor practice.

The procedures in place to recruit new staff appeared robust and were being followed by the registered manager.

The care plans were comprehensive and user friendly. Daily notes had been simplified and staff were completing them consistently.

We spoke with two people living at the home and two staff during our inspection. We also observed care in the communal areas. People communicated to us that they were happy to live in the home. People had access to an appropriate range of activities and we saw positive interactions with staff.

We saw staff consulting with people to gain their consent and encourage independence. One member of staff told us that their primary function was “giving [the people living in the home] a good quality of life”.

People living at the home felt safe and staff felt able to report any safeguarding concerns as required. Concerns from a previous inspection about infection control had been resolved.

Staff told us that they felt well supported and had access to high quality training. Concerns were raised by staff about the workload of the manager. Staff records showed that the majority of staff had up-to-date training in all mandatory training topics.

The provider had good quality management systems in place that seemed comprehensive and user friendly. Complaints and incidents were seen as a learning opportunity and were acted on appropriately.

The care plans were comprehensive and user friendly. Daily notes, however, were inconsistent and did not allow behavioural and health changes to be monitored.

Residents confirmed that they are able to be involved in everyday household activities such as washing up, cleaning and doing laundry if they want to. One person said ' I help out with filling up the dishwasher' and 'I can do things I like to do. I can do what I want to.'

The residents confirmed that they felt safe living at the home and that they felt that the staff looked after them. They confirmed that they knew who to speak to if they had concerns. One resident said, 'I would speak to my mum or I could speak to staff. They would listen'.

Staff demonstrated that they have come to know the residents as individuals. One said "You get to know the guys, they become like family".

This inspection took place on 24 and 28 October 2014 and was unannounced.

25 The Sandfield is a care home, without nursing, for up to four people with learning disabilities and autistic spectrum conditions. There were three people living at the home but one person was in hospital when we visited. The people living at 25 The Sandfield had a range of support needs. Some people could not communicate verbally and needed help with personal care and moving about. Other people were physically able but needed support when they became confused or anxious. Staff support was provided at the home at all times and most people required staff support when outside the home.

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.

We had not received a relevant notification from the service. Services tell us about important events relating to the service they provide using a notification. This was a breach of our regulations. You can see what action we told the provider to take at the back of the full version of this report.

People using the service, relatives, a learning disability liaison nurse and a speech and language therapist told us they were happy with the care provided by 25 The Sandfield. Staff were kind and were able to empathise with people. The registered manager ensured staff provided a service which was tailored to each person’s individual needs and preferences. As part of this, a balance was achieved between keeping people safe and supporting them to make choices and develop their independence.

Work was ongoing to help people become as involved as possible in the local community and to achieve their personal goals. People were proud of what they had achieved and one person was very pleased to have a voluntary job in a local barbershop. We did, however, find there was scope for staff to investigate whether some people could take on more responsibility for their own care.

People were supported by staff who monitored their physical and psychological health and sought guidance from health and social care professionals as needed. This included getting and following guidance on eating and drinking when people had particular difficulties. Staff felt well supported and had the training they needed to provide personalised support to each person. Staff met regularly with their line manager to discuss progress and concerns and met as a team to review the care people received. When things did not go well, staff reviewed the situation and learned for the future.