Sandhills is a residential care home for ten adults with a learning disability or needs relating to mental health conditions. 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. There were ten people living at Sandhills on the day of the inspection.

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 2008 and associated Regulations about how the service is run.

At the last inspection, the service was rated Good. At this inspection we found the service Required Improvement.

Quality assurance systems were ineffective. There was an interruption to the supply of heating and hot water. The heating and water system had been inoperative since October 2017. People and staff at the Sandhills raised concerns about the lack of heating and hot water to the home. The provider had not taken timely and corrective action to ensure the continuing supply of hot water and heating to the service for a number of months.

Small portable heaters had been used whilst the main heating system was out of action. Risk assessment were in place in regard the portable heaters. The registered manager told us although people had not had access to hot water in bathrooms, people living at Sandhills were supported to have personal care from electric showers which continued to supply hot water.

The registered manager told us they felt supported by the provider, however they told us although there was continual quality monitoring of the service by email and via their on line computer system they had not received a formal monitoring visit from the provider since January 2017. However following the inspection the provider evidence that two full monitoring visits had taken place at the service during May and September 2017, and the home had received monitoring visits by the board of trustee in December 2017 and were planned.

People were protected from abuse because staff understood how to keep them safe, including more senior staff understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised. People received their medicines safely. There were enough suitable staff to meet people’s needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others.

Staff received training to ensure they had the skills and knowledge required to effectively support people. People were supported to eat and drink according to their likes and dislikes. People who lacked capacity had decisions made in line with current legislation. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People and their relatives were continuously involved in the assessment and planning of their care through regular review meetings.

Staff were kind and patient. People were involved in decisions about the care and support they received. People received care and support which ensured they were able to make choices about their day to day lives.

People were supported to engage in activity programmes. People knew how to complain and there were a range of opportunities for them to raise concerns with the registered manager and designated staff.

Further information is in the detailed findings below.

This unannounced inspection took place on 15 July 2015.

Sandhills is registered with the Care Quality Commission to provide accommodation, care and support for up to 10 adults with a learning disability or needs relating to mental health conditions. There were eight people living at Sandhills on the day of our inspection.

The manager was newly promoted from deputy manager to manager on 1 April 2015.Their application to be a registered manager was being processed. 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.

Healthcare professionals and relatives spoke highly about the service. One healthcare professional told us “It’s one of my favourite places to visit.” Relatives told us staff were “marvellous,” “caring and professional.”

People were treated with kindness and compassion. People were supported with their needs based on an individual preferred daily plan (PDP), this was the term used by the service to describe the persons care record. Staff used a range of communication skills to engage with people with varying communication needs. We saw staff engage warmly with people and used appropriate humour. Staff were flexible and adaptable and the routine was based on how people were feeling or what they wanted to do.

People felt safe and were protected from harm and abuse. There were risk assessments in place. People were supported when taking risks. Positive risks aligned with their PDP which included setting goals.

People were involved in menu planning and were provided with choices at meal times. People had their dietary needs assessed and there was detailed guidance to support people with specific

needs around food and drink.

Medicines were stored and administered safely.

The service was well led. Staff were committed to providing high quality care because the manager had signed up to the Social Care Commitment. There was a home development plan, which identified areas for improvement. Staff told us they liked working there and spoke positively about each other and the manager. Staff felt supported to do their job and received supervision and had an annual appraisal. Management carried out appropriate checks on the home to ensure that the service was safe.

The people who lived in the home all had learning disabilities. Some of the people also had communication difficulties. We spoke with two people about the care they received and observed the care and support of six other people living in the home. We spoke with three staff and observed staff discussion.

People were encouraged to express their views and were involved in decisions about both their own care, and the running of the home.

People's care needs were assessed and care and support was delivered in a timely and respectful manner.

Staff were trained in safeguarding and knew how to identify abuse and how to report it.

There were enough staff to meet people's needs although vacant posts had made covering the rotas difficult for a sustained period of time, and on a few occasions the home had been short staffed.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

When we inspected Sandhills on 12 March 2013, we used a number of different methods to help us understand the experiences of people using the service, because some people had complex needs which meant they were not able to tell us their experiences. We observed that people were offered support at a level which encouraged independence and ensured that their individual needs were met. One person told us, "I'm involved with my care plans and I can look at them if I like."

There was a relaxed atmosphere in the home and people were at ease in the company of the staff supporting them. There were robust recruitment systems in place, and we noted staff were friendly and polite and interacted confidently with people. One person said, I'm happy here and wouldn't want to change anything."

We noted that people were encouraged to express their views using various methods of communication. People were involved in planning their care and making decisions about their support and how they spent their time. Each person who used the service had a 'leisure companion'. This was a staff member who spent time doing one to one activities with people. This could involve trips to the local community, or in house activities helping people with personal development skills.

The provider had systems in place to ensure people were involved in the quality monitoring processes for this service. People were encouraged to share their views and opinions to help improve the standard of care provision.

We visited Sandhills on Wednesday 30 November 2011. We met all the people that live at the home. We talked with some of them. Some people that live at Sandhills are not able to join in conversation. We observed how staff worked with people in the home. We looked at how people’s care and support were planned and recorded.

We saw that people were supported to make choices about what they did and where they went through the day. One person told us they chose things they wanted to do in line with their interests in historical buildings. They were supported to plan outings in advance. We saw a member of staff talking with a person about their choice of food for lunch. They made sure they understood what the person wanted, and when they wanted to eat it. People chose if they wanted to have a key to their room and to keep it locked.

Another person we spoke to told us they had been involved in agreeing the contents of their support plans. People’s support plans and health action plans included pictures and photographs to make them easier to use. A nurse who visited the home told us staff there were always up to date with people’s health needs. They were quick to ask advice from the surgery and they acted on advice they were given.

We asked a person if they knew how to say if they were unhappy about anything and they said they had been told how to do so. They were sure they would receive any support they needed. We saw that staff always knew where people were and they kept checking that they were safe.

The home did a survey with people every year, to see if they were happy with how their home was run. One person told us they remembered answering questions for this. We saw that for another person, their close relative had answered the survey for them. Most people needed help to fill in a survey and staff in the home usually gave this help, rather than people outside the service.