Sanderling House provides residential care for up to seven adults with an acquired brain injury. The service has particular experience in support for people whose brain injury is related to alcohol or substance misuse. The service is located in a detached house near the centre of Formby.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of good for the safe, effective and well led domains. There has however been a change of rating for the service to Outstanding based on our findings for the caring domain and responsive domain.

People told us that the staff provided very good care and support in respect of their health and wellbeing. We saw excellent evidence of the positive impact this had on people’s lives, with emphasis on the promotion of people’s rights and independence. Staff and people using the service had developed very caring, strong, meaningful relationships.

Supporting people to live in the community was very well managed with on-going staff support for all stages of the transition. Staff went out of their way to build up close working relationships that were based on trust, understanding and the promotion of people’s independence and self-worth to aid people’s personal development. Staff told us this was a key element of people’s recovery and integration back into independent living. We saw how this had been achieved with the service’s dedicated staff and their promotion of enriched innovative care, rehabilitation and social programmes.

The culture of the service ensured people felt they mattered in all aspects of their lives. People and relatives we spoke with were very complimentary regarding the supportive and very caring nature of the manager and staff.

Care was recorded in a very person centred way with excellent emphasis on how people wished and needed to be supported. Staff fully involved people and/or relatives with support plans and care reviews. People were encouraged to make decisions about how their support was provided and staff were very respectful and understanding of people’s rights and choices.

The service placed a strong emphasis on a ‘person centred approach’ to enrich people’s lives. This meant care and support was centred on people’s individual needs and wishes. People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. Relatives told us staff had an exceptional understanding of people’s beliefs, values and how they wished their family member to be supported. Feedback from relatives was excellent regarding all aspects of the service.

People's individual communication needs were understood and information provided in a format appropriate for them, which meant they could participate fully.

Staff supported people to access a wide range of community based healthcare services in accordance with individual need. External health professionals spoke highly about the service and the committed values of the highly trained staff team.

People had access to an excellent range of social activities which they enjoyed and people were encouraged to take part in new areas of interest.

People living at the home and relatives we spoke with told us the staff were very caring, polite and exceptionally supportive in achieving daily life goals, developing personal interests and overseeing their health needs.

People told us they enjoyed the menu options and took part in choosing recipes and food shopping.

Staff had been recruited safely so they could work with vulnerable people.

People were supported by a good consistent skilled staff who received appropriate training and support.

Medicines were managed safely and people were encouraged to be responsible for their own medicines according to assessed risk.

Staff were aware of safeguarding procedures and the concept of whistle blowing.

The service had a robust complaints procedure which was accessible

This unannounced inspection of Sanderling House took place on 22 October 2015.

Sanderling House provides residential care for up to seven adults with an acquired brain injury. The service has particular experience in support for people whose brain injury is related to alcohol or substance misuse. The service is located in a detached house near the centre of Formby.

A registered manager was 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 2008 and associated Regulations about how the service is run.

People living at Sanderling House told us they felt the home was a safe place to live and staff we spoke with had a good understanding of safeguarding and how to report concerns. Safeguarding policies and procedures were available and appropriate referrals had been made.

Arrangements were in place for checking the environment to ensure it was safe, including risk assessments and regular equipment checks. There was a system in place to report and address any maintenance issues. Care files we viewed showed that risks had been assessed in areas such as nutrition, mobility and accessing the community, however they were not always reviewed regularly.

We found there was adequate numbers of staff on duty to meet people’s care needs and safe recruitment processes were usually followed when new staff were employed.

A medicine policy was in place to ensure staff followed principles of safe administration of medicines. Regular audits were completed to ensure risks regarding the management of medicines were minimised and action plans developed to address areas that required improvement.

We found the home to be clean and well maintained.

People living at Sanderling House were supported by the staff and external health care professionals to maintain their health and wellbeing.

Staff felt well supported in their role and had completed an induction on commencement of their post. Staff felt this induction was sufficient to ensure they could meet people’s needs. Regular supervisions, training and an annual appraisal were also completed in order to support staff in their roles.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), and appropriate DoLS applications had been made. We found that people’s consent was sought in line with the principles of the MCA.

Menu’s evidenced that people had choice regarding meals and some people were supported to shop and prepare their own meals. Menu’s were based on the preferences of people living in the home. People’s nutritional risks were assessed and appropriate support measures put in place.

Staff knew people and their individual needs well and provided support to promote their independence through person centred support planning and adaptations around the home. People we spoke with told us staff were kind and caring and treated them with respect. Our observations showed us staff protected people’s privacy and dignity.

People told us their needs were being met and support plans we viewed were detailed, individual to the person and reflected people’s needs and preferences. People were involved in the creation of their support plans and they were reviewed regularly. Processes were in place to seek feedback from people living in the home, for instance through regular meetings and quality assurance surveys. A complaints procedure was also available within the home.

Staff received up to date information regarding people’s care needs through effective handover processes and updated support plans.

People had individual activity schedules which were based on their preferences and people told us they could choose how to spend their day.

Feedback regarding the management of the home was positive from staff and people living in the home. People felt they were listened to and could raise any concerns with the manager.

Systems were in place to monitor the quality and safety of the service, such as regular audits and the manager had notified CQC of required incidents and events within the home.