About the service: Sandon Road is a respite service offering accommodation and support for people with mental health support needs. Two people were supported at the time of the inspection of a maximum of five people.

People’s experience of using this service:

People benefitted from the support of the service and were treated with respect. People’s independence and wellbeing was promoted. People went out as they wished and carried on with their own routines. Staff told us they were able to provide more practical support following the recent increase in staffing. Improvements had been made to the safety of the service. Two of three breaches identified at the last inspection had been met. However, we identified a continued breach of the regulations related to governance because systems and processes were still not robust. More information is in the full report.

Rating at last inspection: Requires Improvement (July 2018). This service has been rated Requires Improvement at the last two inspections.

Why we inspected: This inspection was scheduled based on the previous inspection rating and other concerns known to CQC about the provider.

Enforcement / Follow up: This inspection identified a continued breach of the regulations related to governance. We did not take enforcement action on this occasion because shortly after our inspection, the provider submitted an application to de-register. We will continue to monitor this provider and service until the de-registration process is complete.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 01 March 2018 and was unannounced. We last inspected this service in September 2016 and it was rated Requires Improvement overall and two breaches of regulation were found. At this inspection we found improvements were still required and the service was rated Requires Improvement overall for the second time. We identified three breaches of the regulations that relate to safe care and treatment, safeguarding processes and governance. We also identified a breach of Regulation 18 of the Health and Social Care 2008 (Registration) Regulations 2009. We are deciding our regulatory response to this and will issue a supplementary report once this decision is made.

Sandon Road 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. Sandon Road is a respite service for a maximum of four people with mental health needs. At the time of our inspection, three people were using the service.

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.

People told us they felt safe and that staff were available to talk to about any of their concerns. However, the providers systems had not protected people using the service where an incident had occurred as they had not been investigated and referred to relevant partner agencies as required. Risks and incidents were not appropriately recorded or responded to in order to protect people and ensure their safety.

People told us they were happy with their medicines being monitored and maintained within the home. However, the provider had not ensured that records accurately recorded the medicines people had taken. Improvements were need in record keeping and competency assessments for staff to ensure they always provided safe support.

At the inspection on 20 October 2105 we found the service required improvement in leadership and governance. At this inspection we found that further improvements were needed to demonstrate continual improvements. Quality assurance processes did not always effectively monitor and improve the safety of the service. The provider had not demonstrated how these would make positive changes to how people were supported to live their lives now and in the future.

People told us their needs were monitored and referrals were made to community health teams by staff as needed. People were satisfied with the support of staff and described their improved health and wellbeing. People told us they knew staff who were available to assist and guide them where needed.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice People were involved in making decisions about their care and their consent was appropriately obtained by staff when caring for them.

People told us they liked the staff and told us their care needs were supported well. People were encouraged to be in control of their decisions and choices. Staff respected people’s dignity and privacy. People spoke with us about the registered manager being accessible and provided examples of when the registered manager had listened to them. Care plans had not always detailed people’s needs and wishes or included guidance for staff on how to support people.

You can see what action we told the provider to take at the back of this report.

The inspection took place on 26 September 2016 and was unannounced. This is the first time we have inspected this service since it was registered in May 2016.

Sandon Road is a respite service offering accommodation, care and support for a maximum of four adults with mental health needs. At the time of our inspection, there were two people using the service. There was a registered manager in place. 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 were not always protected by effective risk management or processes at the service. Although people using the service felt safe and staff demonstrated an awareness of how to report safeguarding concerns, people were not always supported by staff who were aware of their needs.

People were not always supported to take their medicines safely or as prescribed. Records showed that one person had missed medicines on several occasions and this has not been identified by staff or the registered manager.

People were often supported by staff who worked alone at the service. Recruitment processes at the service had been improved to ensure people were supported by staff that were suitable.

People were not always supported by staff who had received sufficient guidance and training for their roles. Staff had some understanding of the MCA and people felt that they had freedom at the service and were supported to make their own decisions about their care.

People were not always encouraged to eat sufficient or healthy foods to stay well. People were supported to access healthcare support, however their day to day needs and symptoms were not always effectively monitored by staff.

People appeared at ease and enjoyed positive interactions with staff. Care had not been taken to ensure that people resided in a safe and comfortable environment and staff failed to demonstrate that they consistently promoted people’s dignity in practice. People had the privacy they needed and were encouraged to maintain their independence.

People had the opportunity to discuss some of their support needs with staff when they first joined the service. We saw that staff supported people with aspects of their needs and people told us that they were satisfied with the service they received.

People and staff spoke positively about the management at the service, however processes to monitor and maintain the quality and safety of the service were not effective. People could not be confident that their feedback and concerns would always be acted upon and resolved. The registered manager had not established systems or processes to ensure that regulations were met and that people received safe care that met their needs.

You can see what action we told the provider to take at the back of the full version of the report.