We carried out an unannounced inspection of Sahara Parkside on 30 and 31 July 2018. Sahara Parkside is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Sahara Parkside is a care home for up to 30 adults with learning disabilities, acquired brain injuries and autistic spectrum conditions. It is arranged as ten three-bedroom flats. At the time of our inspection, 9 people were living there.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The home was last inspected on 6 and 7 November 2017 when it was found to be in breach of five health and social care regulations. These breaches related to risk assessments, medicines, staffing, training, access to healthcare, good governance and record keeping. The home was rated Inadequate overall and therefore this service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the provider demonstrated to us that improvements have been made in the service and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However, we found some areas that required further improvement and therefore the home has been rated ‘Requires Improvement’.

The home did not have a registered manager. The previous manager had left the home after our last inspection and a new manager was in the process of being recruited. The home was managed by external care consultants and two deputy managers with the support of the Chief Executive Officer. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Concerns we found at the last inspection with one particular person’s risk assessments had been addressed. Risk assessments for most people who lived in the home included information on how to mitigate identified risks. However, we found risk assessments for people that may demonstrate behaviours that challenged were inconsistent and did not include robust de-escalation techniques.

People received their prescribed medicines and Medicine Administration Records (MAR) evidenced that medicines were given on time. However, where people refused medicines that were to be taken as needed, known as PRN medicine, this was not recorded on their MAR. Medicines were not being administered as instructed by the pharmacist. Immediate action was taken to remedy this.

Care plans were inconsistent. We found care plans were personalised and included information on how to support people. However, assessments carried out on falls and skin integrity using a scoring methodology was incorrect.

Quality assurance systems were in place. Although the audits which the home carried out had identified and addressed most shortfalls, further work was required to ensure all issues were captured within people’s care plans and risk assessments. We made a recommendation in this area.

Staff we spoke with were aware of how to identify abuse and knew who to report abuse to, both within the organisation and externally. Pre-employment checks had been carried out for new staff to ensure they were suitable to provide care and support to people safely.

There were sufficient

We carried out an unannounced inspection of Sahara Parkside on 6 and 7 November 2017. Sahara Parkside is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Sahara Parkside is a care home for up to 30 adults with learning disabilities and autistic spectrum conditions. It is arranged as ten three-bedroom flats. At the time of our inspection, 14 people were living there.

The home was last inspected on 12 and 13 April 2017 when it was found to be in breach of three regulations relating to training, need for consent and good governance. An action plan was submitted by the provider after the inspection that included how the breaches would be addressed. During this inspection we found the home continued to be in breach of these three regulations. In addition to the aforementioned breaches, the home was in breach of two more regulations. These breaches related to risk assessments, medicines, staffing, access to healthcare and record keeping.

We carried out this inspection due to the high number of safeguarding concerns we had received about the home.

The home did not have a registered manager. The previous registered manager had left the home in August 2017 and a new manager had been appointed and intended to apply to become registered with us. We were informed that the change of managers had an impact on the running of the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Risk assessments for most people who lived in the home included information on how to mitigate identified risks. However, risks were not always robustly managed for one person to ensure they were safe at all times.

Medicines were not being managed safely. We found that people’s Medicine Administration Records (MAR) were not always completed in full or accurately. Medicines were not being administered as instructed on people’s MAR, or in accordance with the provider’s policy.

Staff we spoke to were aware of how to identify abuse and knew who to report abuse to, both within the organisation and externally. However, we were informed that some staff had not received refresher safeguarding training therefore may not be up to date with safeguarding procedures. We also found incidents with medicines that had not been recorded as an incident and relevant authorities had not been notified of this.

Incident records were reviewed and these showed the provider took appropriate action following incidents that had been recorded. However, systems were not in place to analyse incidents for patterns and trends to ensure lessons were learnt and incidents were minimised.

At our last inspection, we made a recommendation that the home seek and follow best practice guidance from a reputable source about staff deployment. During this inspection, people, relatives and staff continued to raise concerns with staffing levels. Records showed there were enough staff on duty to meet people’s needs. However, the way staff were deployed across the building meant there were sometimes delays for people who required support.

Not all staff had received core and specialist training they needed to do their jobs effectively. Supervisions had not been carried out regularly and there were no records of appraisals that had been carried out since 2016. Staff told us that they were supported by the manager.

People did not have access to all the healthcare services. Systems were not in place to ensure people received annual health checks.

People and staff told us that people had choices during meal times. We found the kitchen in

The inspection took place on 12 and 13 April 2017 and was unannounced.

The service was last inspected in February 2016 when it was found to be in breach of two regulations. The service had taken action to address the breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and risk assessments and behaviour care plans were now more robust. However, the actions taken to address the breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had not been effective as the number of staff who had received the specialist training required to meet people’s needs remained low.

Sahara Parkside is a service for up to 30 adults with learning disabilities and autistic spectrum conditions. It is arranged as ten three-bedroom flats. At the time of our inspection 15 people were living there permanently and an additional six people used the service occasionally as a respite service.

The service did not have a registered manager. The previous registered manager had left the service in February 2017 and a new manager had been appointed and intended to apply to become registered with us. 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.

Care plans and risk assessments for people who lived in the home permanently contained a high level of detail and personalisation. This included details of peoples dietary preferences, health needs and care preferences. Care plans and goals were reviewed and updated on a monthly basis, although some people did not feel they were involved in this process. The quality of documentation and risk management for people who used the service on a respite basis varied. The provider produced a plan to address these variations during the inspections.

The service supported people to take their medicines. This was not always managed in a safe way and errors in the records were identified during the inspection which the provider took immediate action to address.

People and staff told us they did not think the service had enough staff. Records showed there were enough staff on duty to meet people’s needs, but the way staff were deployed across the building meant there were sometimes delays for people who wanted to receive support. We have made a recommendation about staff deployment.

The service had had a high turnover of staff and had completed recruitment of new support workers. The service completed checks on people’s identity and criminal records to ensure they were suitable to work in care. However, records showed the service did not consistently follow its recruitment policy regarding interview recording and references. We have made a recommendation about recruitment.

Staff were knowledgeable about safeguarding adults from avoidable harm and abuse. Records showed that concerns were appropriately escalated and investigated.

At the last inspection we found that records of care were not completed fully and made a recommendation about record keeping. The service had followed this recommendation and records of care were now clear and contained the information required.

People who lived at the home were deprived of their liberty under the Mental Capacity Act 2005. Records showed the service was not complying with the conditions imposed on people’s deprivation of liberty safeguard authorisations.

Feedback from people and their relatives about the quality of the relationships with the staff varied. Some people told us staff were kind and caring but others told us they did not find staff friendly or caring. Some people did not feel they were treated with respect. Records showed some staff did not understand the importance of respecting people’s pre

The inspection took place on 16, 17 and 19 February 2016 and was unannounced.

The service is a registered care home for people with learning disabilities. The building is divided into 10 three bedroom flats. At the time of our inspection 13 people were living in the home.

The service was last inspected in June 2014 when it met the outcomes that were inspected.

The service 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The manager of the service had been in post for two weeks and had submitted an application to register with CQC.

Risk assessments and support plans relating to behaviour that challenged the service and health conditions lacked detail and did not provide staff with the information they needed to provide good support. We have made a recommendation about supporting people with complex health conditions.

Permanent staff received a thorough induction, but this was not the case for agency workers who were not always provided with all the information they needed to provide people with good support. Staff had not received the specialist training they required to meet people's needs.

The management of the service had changed and there were concerns that information had been lost in the transition. Although the new management team had plans in place to assess and improve the quality of the service, these were not in place. We have made a recommendation about quality assurance systems.

The service was meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. However, records of consent and capacity assessments were not always clear. The management team were taking action to address this.

People and relatives told us they thought the service was safe. There were safeguarding policies and procedures and staff had received training regarding abuse and knew how to report any concerns.

The service had robust recruitment procedures in place which ensured staff in post were suitable to work in a care environment. There were sufficient staff on duty to meet people's needs.

People had support plans in place in relation to their nutritional needs. Where people followed specialist diets for religious reasons this was supported. People were supported to maintain a balanced diet.

People, their relatives and staff told us they had time to build up positive caring relationships.

People were involved in making day to day decisions about their care. People told us they could speak up easily in the home. Relatives told us it was easy to talk to staff at the home.

People's privacy and dignity was respected and promoted. People were supported to practice their religious beliefs.

The service had a robust complaints policy which was available in an accessible format for people who lived in the home. The service responded to complaints in line with the policy. People and relatives told us it was easy to raise concerns.

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

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

During the inspection we spoke with five of the eleven people that used the service, two relatives of people that used the service and eight members of staff. This included the area manager, the manager of the home and six senior support workers or support workers.

This is a summary of what we found-

Is the service safe?

We found that the home had a safeguarding vulnerable adult’s procedure in place and that staff had a good understanding of their roles and responsibility for reporting any allegations of abuse. Risk assessments were in place which included information about how to manage and reduce risks people faced. Clear guidelines were in place about supporting people who exhibited challenging behaviours. Arrangements were in place for the safe storage, administration and recording of medication. The service had robust staff recruitment procedures in place. These included seeking references and carrying out criminal records checks on prospective staff. People and relatives we spoke with told us they felt the home was safe. One relative told us “I feel my sister is safe and happy with the place.”

Is the service effective?

We found that care plans and risk assessments were in place which set out how to meet people's assessed needs, for example in relation to communication and personal hygiene. Some people we spoke with were aware of their care plan, one told us "my folder is in my flat, I can look at it when I like." We found that there was enough staff on duty to meet people's assessed needs. Staff we spoke with said staffing levels were sufficient to enable them to carry out all their duties. Records showed people had access to health care professionals and people we spoke with confirmed this. One person said "they (opticians) come here to test my eyes" and they also told us the service arranged for them to see a doctor if they felt unwell.

Is the service caring?

People we spoke with told us that staff treated them with respect. We observed staff interacting with people in a polite and caring manner. We saw that when people wished to be on their own staff respected this which promoted people's privacy. Staff we spoke with told us how they promoted peoples dignity for example by encouraging people to be as independent as possible.

Is the service responsive?

We found that care plans had been signed by people or their relatives where appropriate to show people were happy with the content of their care plans. The service supported people to make choices for themselves. Where people lacked capacity to make choices we saw that mental capacity assessments had been carried out. If a person lacked capacity to make a decision we saw that a 'best interest' decision had been made on their behalf. This involved relevant persons including staff from the home, relatives and health and social care professionals.

Is the service well-led?

At the time of our inspection the service did not have a registered manager in place. A manager had been appointed to manage the home approximately one month prior to our inspection. They told us that they were in the process of applying for registration with the Care Quality Commission at the time of our inspection. The service had various quality assurance and monitoring systems in place including health and safety audits, surveys of relevant people and quality monitoring visits carried out by senior managers. We found that confidential records were stored securely and records we looked at were accurate and up to date. The service notified the Care Quality Commission of significant events as appropriate.

People told us that they were treated with respect by the staff. They said that the care they received was "good". One person said, "yes I like living here. I like the staff they take me out."

People who use the service and their relatives were satisfied with the care and support provided at the service. One family member said "staff know how to support him and he has settled down there." Another person told us staff were friendly and knew what they were doing. We found staff to be caring and supportive to people.

People who use the service and their families told us they were involved in making decisions around their care and support planning. We found that where people did not have the capacity to consent, the provider had not acted in accordance with appropriate guidance on consent.

We found that procedures were in place to protect people who use the service from abuse. People told us that they felt safe with the staff and they would raise any concerns with the staff or their relative or friend. The staff were aware of the signs and symptoms of abuse.

Staff told us that they received appropriate training and support from the management team.

We found that the recording of essential information was inconsistent and incomplete making it difficult to assess whether people were receiving the level of care that they required.

People said they felt supported by the staff team and that they were included in decisions about their care as far as possible.

They told us that staff were kind and respected their privacy.

They told us that staff listened to them and involved them in aspects of their care and the general activities in the home.

People gave us examples of how they were given choices about their care and what they like to do. They confirmed that the management and staff included them in some decisions about the running of the home. They also told us that they had good contact with the local community.

People told us that staff talk to them about their care needs and let them know how and why they are supporting them. One person commented, “the staff are kind, good, help me when I need it.” Another person said, “the staff are brilliant.”

A relative said “the staff liaise with us all the time.” “Absolutely brilliant couldn’t fault them at all, my sister is very well looked after there.”

People told us they were happy with the food at the home and that they were given a choice of menu. One person said “the staff help me do the shopping and prepare the food with me.”

People who use the service told us they felt safe at the home and that they would talk to the manager or staff if they were concerned about anything. People told us they were happy with the general environment of the home and their rooms. One person told us, “I like my bedroom”. Another said, “it is a clean place. ”A relative said “the home is like a five star hotel.”

People told us that they had confidence in the staff team and that staff responded to their needs appropriately.

Everyone we spoke with said they knew how to make a complaint and who they would talk to if they needed to. One person said that when she made a complaint they acted on it straight away and kept her informed about what was happening.

We carried out this inspection after being contacted about the service by two whistleblowers. The whistleblowers raised concerns about the way incidents were managed, the management of medicines, staffing levels and the recruitment process. We also wanted to check that the home had made improvements following our last inspection.

We spoke with four people using the service. They were all positive about the home. One person said they “enjoyed” living there. Another person said, “it’s OK, yes it’s alright. They are good.” People told us they had support from staff when they needed it and could choose what they wanted to do.

The provider assessed people's needs on admission. However, people's progress was not regularly reviewed and people's needs were not always being met. For example, some people had not received one-to-one support from a member of staff although they had been assessed as needing this. We also found that the home's procedures for recording and administering medicines were not being followed by staff. We could not be sure that people were taking their medicines as prescribed.

Some people using the service experienced profound learning disabilities affecting their capacity to consent to care. The provider had not documented people's consent and could not demonstrate that people's mental capacity had been formally assessed when appropriate.

We found that the staff were not always clear about safeguarding arrangements and when to raise an alert. Some of the home's procedures and checks, for example around managing people's money, did not adequately safeguard people from the risk of abuse.

The managers had identified a number of key risks and were taking action to address these. However the provider's systems to recruit staff and monitor the quality of care in the home were not robust and placed people using the service and staff at risk.