Sandalwood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Sandalwood accommodates five people in one adapted building.

This inspection was carried out on 26 January 2018 and was unannounced.

The home had a registered manager, who was also responsible for another of the provider’s registered care homes. 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.

Rating at last inspection

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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Why the service is rated Good

People were safe because staff understood any risks involved in their care and took action to minimise these risks. There were sufficient staff on each shift to keep people safe and meet their needs. Staff understood their roles in keeping people safe and protecting them from abuse. The provider carried out appropriate pre-employment checks before staff started work.

Medicines were managed safely. Accidents and incidents were recorded and reviewed to ensure any measures that could prevent a recurrence had been implemented. Staff maintained a safe environment, including appropriate standards of fire safety. The provider had developed plans to ensure people would continue to receive care in the event of an emergency. People were protected from the risk of infection. The environment was adapted and designed to meet people’s needs.

People’s needs had been assessed before they moved into the home to ensure staff could provide the care they needed. Staff knew people’s needs well and provided support in a consistent way. Staff had access to the induction, training and support they needed to do their jobs. They met regularly with their line managers for one-to-one supervision and had an annual appraisal, which gave them opportunities to discuss their development and training needs.

Although people’s care was provided in line with the Mental Capacity Act 2005 (MCA), documentation relating to capacity assessments and best interests decisions had not been completed in line with best practice guidance. We have made a recommendation that the home review its processes and documentation when assessing capacity and recording best interests decisions.

People were involved in choosing the food they ate and were encouraged to maintain a healthy diet. Any dietary restrictions were recorded in people’s support plans and referrals had been made to appropriate professionals if people developed needs in relation to eating and drinking. People’s healthcare needs were monitored and they were supported to obtain treatment if they needed it. People who had ongoing healthcare conditions were supported to see healthcare professionals regularly.

People were supported by caring staff. Staff treated people with respect and maintained their privacy and dignity. There was a friendly, relaxed atmosphere in the home in which people felt comfortable and at ease. Staff understood people’s individual communication needs and supported people to give their views about their care. People were encouraged to be independent.

The support people received was personalised to their individual needs. People’s needs were kept under review and their support plans updated if their needs changed

People who used the service had individual and complex communication needs. In some

cases, this meant that we were not able to gain their views directly. To understand

people's experiences, we gathered evidence through observation, checking records and

speaking to staff about how they supported people.

We saw that staff used a variety of methods to obtain consent from people and their relatives, which ensured the care they received was understood and agreed to.

We found that people's needs were assessed and that care was delivered in line with their

individual care plan. Guidance about how to support people was available to staff, which

meant that staff provided support in a consistent way. There was evidence that people were supported to make medical appointments if they

needed them and visits to other health and

social care professionals.

We found that systems were in place to maintain good standards of hygiene and regular checks were made which ensured that people lived in a clean and tidy home.

We found that the provider maintained accurate and up to date records within the service and that these were kept safely and securely.

People using the service had individual and complex communication needs. In some cases, this meant that we were not able to hear their views directly. To understand people’s experiences, we gathered evidence through observation, checking records and speaking to staff about how they supported people.

We found that people's needs were assessed and that care was delivered in line with their individual care plan. Guidance about how to support people was available to staff, which meant that staff provided support in a consistent way.

There was evidence that people were supported to make medical appointments if they needed them and that the home made referrals where necessary to other health and social care professionals.

We found people had opportunities to take part in social and leisure activities and to access their local community. People were provided with a choice of suitable food and drink and had opportunities to contribute to the home’s menu.

The home provided spacious accommodation that was accessible to the people who lived there. We found that regular checks were made to ensure that people lived in a safe environment and that the home was kept clean and hygienic at the time of our visit.

We found that the provider carried out appropriate checks on staff before they began work and had developed a procedure for the handling and management of complaints.

People who use services at Sandalwood have multiple or complex needs. It was therefore difficult to ask them about their levels of satisfaction with the outcome areas reviewed.

We observed however that people using services, appeared relaxed and at ease in their surroundings. We saw good interactions between staff and people who use the service. We observed that staff were attentive to those at home and they demonstrated a good understanding of their communication styles or body language.

Some of the people using services were out of the home on the day of our visit. Records showed them to be taking part in planned day care activities.

Staff were seen to offer support and guidance in a sensitive, knowledgeable and caring manner.

Sandalwood provides accommodation, care and support for a maximum of five adults with learning disabilities. There were five people using the service at the time of our inspection.

The inspection took place on 23 and 26 October 2015. The first day of the inspection was unannounced.

There was a registered manager in post at the time of our inspection. 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.

People were kept safe because staff understood their responsibilities should they suspect abuse was taking place and knew how to report any concerns they had. Risks to people’s safety had been assessed and measures had been put in place to mitigate these risks. There were plans in place to ensure that people’s care would not be interrupted in the event of an emergency.

There were enough staff on duty to keep people safe and meet their needs. The provider’s recruitment procedures helped ensure that only suitable staff were employed. People’s medicines were managed safely.

People received their care from a consistent staff team who knew their needs well. Staff were well supported through supervision and appraisal and had opportunities to discuss their professional development. All staff had attended a comprehensive induction and had access to relevant, ongoing training. Staff were motivated and had a commitment to providing high quality care and support. They said morale was good and they worked well together as a team.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s best interests had been considered when they needed support to make decisions and applications for DoLS authorisations had been submitted where restrictions were imposed to keep people safe.

People’s nutritional needs were assessed and any dietary needs were managed effectively. Staff enabled people to make informed choices about what they ate and supported them to maintain a balanced diet. People were supported to maintain good health and to obtain treatment when they needed it. The service had effective relationships with healthcare professionals which ensured that people received the care and treatment they needed.

Staff were kind and caring. They treated people with respect and supported them in a way that maintained their privacy and dignity. Staff made sure people had the information they needed to make informed choices and to understand information that was important to them. A relative told us their family member received high quality care from caring staff. Staff promoted people’s involvement in their local community. People had opportunities to take part in social events and activities and were supported to maintain relationships with their friends and families.

People received personalised care and support based on their individual needs. Staff shared information about people’s needs effectively to ensure that care was being provided in a consistent way. People’s needs and wishes were reviewed regularly and relatives’ contributions to reviews were encouraged and valued.

The registered manager provided good leadership for the service and led by example in their approach to supporting people. The registered manager encouraged the input of people, their relatives, staff and other stakeholders in developing and improving the service. Staff told us the registered manager encouraged staff to think creatively about how support could be provided in a way that best met people’s needs. The provider had effective systems of quality monitoring, which helped ensure that all areas of the service were working well and records were up to date.

The last inspection of the service took place on 11 October 2013 and there were no concerns identified.