This unannounced inspection took place on 22 and 24 March 2017.

Sahara House provides care, accommodation and support with personal care for up to 19 people with a learning disability. 15 people were using the service when we visited.

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 the last inspection in January 2016, we found one breach of regulations. The registered provider had not appropriately managed people’s medicines. At this inspection we found action had been taken and people received their medicines safely. Medicines were administered by staff who were trained and assessed as being competent to do this.

Systems were in place to minimise risk and to ensure that people were supported as safely as possible. Staff were aware of their responsibilities to ensure people were safe and what to do if they had any concerns. They were confident that the registered manager would address any concerns.

People were supported and encouraged to make choices about all aspects of their care and support.

People were protected by the provider’s recruitment process which ensured staff were suitable to work with people who need support.

Staff were knowledgeable about people’s needs and how best to meet these. The training and support they received helped them to provide an effective and responsive service.

People received a person centred service. Their cultural and religious needs were respected and celebrated and their nutritional needs were met. They were encouraged to be as active as possible. There were enough staff to support them to do things that they liked and provide the care and support they needed.

People’s healthcare needs were identified and monitored. Action was taken to ensure they received the healthcare they needed to enable them to remain as well as possible.

The quality of the service was monitored by the provider and the registered manager to ensure people received a quality service that met their needs and wishes

Staff were clear about their roles and responsibilities. The registered manager and staff team were committed to continuous improvement of the service and to improving people’s quality of life.

People and their relative’s views were sought and valued. Their feedback was used to inform developments in the service.

People were supported by kind, caring staff who treated them with respect. They were supported to do as much as possible for themselves and to gain new skills. Care records contained detailed information about people’s needs, wishes, likes, dislikes and preferences.

People lived in an environment that was suitable for their needs. Specialised equipment was available and used for those who needed this.

This unannounced inspection took place on 6 January 2016. The service was last inspected on 2 September 2014 and met all regulations inspected.

Sahara House provides accommodation for up to 19 people who require nursing or personal care. The service is provided in two separate houses (house 1 and house 2) next to each other. At the time of the inspection there were 13 people using the service and one person was admitted to a hospital.

The service did not have a registered manager. A registered manager is a person who has registered with the (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.

People and relatives told us that people were safe in the home. They told us there were always staff around to ensure their needs were met and they were safe. Care files showed that each person had a risk assessment which identified possible risks to them and gave guidance to staff on how to manage the risks. Staff told us they had read the risks assessments and knew how to support people to ensure their needs were met and they were safe.

We found medicines were not always managed well. We found gaps in medicine administration records and it was not always clear if people had received their medicines as prescribed by their doctors. This put people's wellbeing at risk.

People and relative talked positively about the staff. They told us staff knew what they needed to do to meet people's needs. Staff told us they had attended various training courses related to their roles. We noted that staff had good knowledge about people’s care needs and how to support them. Records showed staff had attended different training programmes including Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff told us the acting manager was supportive and they could seek advice when and if they needed it. Records showed that staff had supervision which enabled them to discuss their day to day practice and training needs. This showed that there was a good support system in place for staff.

People and their relatives told us staff supported them to attend a range of activities. We noted people had access to local amenities and staff had arranged holidays for them. Records showed each new person was assessed before their admission and care plans were formulated for them. We noted key workers organised care plan reviews to ensure that changes in people's needs were identified and appropriate support was available to them.

The service had a complaints procedure and people and their relatives told us they knew how to make a complaint if they were unhappy about the service. The acting manager said staff informally asked people about their experience of the service. We noted the provider had various quality auditing systems in place but the response of people and their relatives to the survey questionnaires was not great. The acting manager told us they would consult with stakeholders with the objective of improving their response to the survey questionnaires.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

A single inspector carried out this inspection. The focus of the inspection was to check if the service had made improvement with regards to care planning, staff training and record keeping.

During an inspection on 19/06/14 we found care records contained inconsistent information about people's needs, did not adequately assess people's risks and lacked sufficient detail in some areas. They had not been reviewed or updated when people's needs had changed.

We also found that people who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff training in safeguarding was not up to date.

We noted staff were not receiving appropriate professional development. The regional manager told us that some of the staff training was not up to date. We looked at the staff training matrix and noted that some mandatory training had not been updated since 2011 for example fire awareness.

People’s personal records including medical records were not always accurate and fit for purpose. We found care records were disorganised with both current and historical information mixed together. This meant that a clear audit trail of people's current needs was difficult to follow with the need to search in several places for information.

During this visit we found that the provider had taken appropriate action and had made improvement in the areas where there were shortfalls.

People told us that they liked living at Sahara House. One person told us “I like it here." Another smiled and nodded his head indicating he liked the home. A relative told us “he has settled well. He gets on with the staff and is quite happy.” Another relative said "we have been very satisfied with his care."

People’s consent was sought and their views and experiences were taken into account in the way the service was delivered in relation to their care. Care was planned and delivered in line with their individual care plan because peoples’ needs were fully assessed. Staff were caring and supportive to people. Staff were adequately supported and supervised by the manager. Medicines were safely administered by staff who were trained and competent to carry out this task. A relative told us "the staff are pleasant and friendly. They keep me informed and answer any questions I ask. So far so good."

People told us that the care they received was "good". Another person said, "yes I like living here."

A relative said,"I think X is being looked after very well, especially her medical needs. Her keyworker is brilliant."

People we spoke with told us that they felt safe with the staff. They said they would raise any concerns with the manager or their relative or friend.

People who use the service were positive about the staff who supported them. They told us that the staff were "friendly".

A visiting professional told us "the staff are very receptive and followed instructions given. Things have improved greatly here since the new manager started."

The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

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

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. During our visit we found that staff training in safeguarding was not up to date.

Is the service effective?

We looked at the records and care plans of five people using the service. We found that their care records contained inconsistent information about their needs, did not adequately assess their risks and lacked sufficient detail in some areas.

Is the service caring?

Staff understood the need to respect people's privacy and dignity and staff interactions with people using the service were sensitive and respectful. People we met were dressed in well maintained clothes that were appropriate for the season.

Is the service responsive?

Information about the involvement of healthcare professionals in people’s care was available in their care plans so that staff had the necessary information to support people to meet their healthcare needs. However, we saw that people's care plans had not been reviewed or updated when people's needs had changed.

Is the service well-led?

Care records were disorganised with both current and historical information mixed together. This meant that a clear audit trail of people's current needs was difficult to follow with the need to search in several places for information. This posed a risk that staff may be referring to information which did not reflect people's current needs to ensure their care, welfare and safety.