About the service: Sarsen House is a residential home for adults with learning disabilities. It provides accommodation for up to six people. There were five people living there at the time of our inspection. Sarsen House is arranged over two floors with bedrooms upstairs and downstairs, shared bathrooms and a communal kitchen, lounge and dining area. The home had their own minibus for people to access the local community.

People’s experience of using this service: The service was rated as requires improvement at the last inspection in December 2017. Protocols for ‘as required’ medicines were not detailed or person-centred and information on where to specifically apply creams was missing. Medicines audits identified these areas but did not detail the actions taken to rectify the errors. The principles of the Mental Capacity Act 2005 had not been consistently followed. At this inspection we found the necessary improvements had been made.

People were protected from the risk of abuse by staff who had been trained and knew how to report any concerns they had.

People had a variety of risk assessments which identified areas of risk and gave guidance to staff to minimise those risks.

People’s medicines were managed and stored correctly.

People were supported by staff who had regular one-to-one supervision from their manager and up-to-date training.

People’s needs were assessed by a multi-disciplinary team of professionals to ensure the home could meet their complex needs. Care plans were updated and reviewed at regular intervals or when people’s needs changed.

The staff were caring and Sarsen House had a family home atmosphere. Staff told us they enjoyed working there and found it rewarding to make a positive difference to the people they supported.

The management team had robust processes in place to monitor the quality of the service being provided which meant the service was well run.

Rating at last inspection: Requires Improvement, published January 2018.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will monitor all intelligence received about the service to inform when the next inspection should take place.

This inspection took place on 12 and 13 December 2017 and was unannounced on the first day. This was the first inspection of this location since a change in provider.

Sarsen House is a residential home for adults with learning disabilities; providing accommodation for up to six people. There were six people living at the service during the inspection. Sarsen House is arranged over two floors, with bedrooms upstairs and downstairs, a communal lounge/dining room, a separate dining room, shared bathrooms and accessible kitchen. The bedrooms were spacious and one person had their own small lounge connected to their bedroom. The service has a minibus to support people to access the local community.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. During the inspection we met with the registered manager, deputy manager and care staff. Staff told us that they felt supported by the registered manager and deputy manager. The registered manager and deputy manager told us that they felt there had been improvements in communication within the staff team.

We received feedback from three relatives. One person told us, “There are no negatives at all” and that “There is a good balance between doing ordinary things, like the chores such as recycling or washing up, and the fun things.” Another person said that their relative living at Sarsen House “is really well looked after, really happy, it feels like it is their home”. The feedback received was positive and praised the staff team for the support they provide.

Six health and social care professionals were contacted for their feedback of the service; three professionals provided information. One professional said, “The team [at Sarsen House] have always been prompt in contacting us when an individual’s needs change; as well as if they have concerns, or require advice-” and “The service has been given much advice and recommendations over the years, which has been received and acted upon promptly.” All feedback from health and social care professionals expressed that the service provides person centred support.

Support staff sought consent from people before providing support. However, the principles of Mental Capacity Act (MCA) were not always followed when making decisions about people’s care and support. Best interest decisions were not reviewed annually for one person. For another person, they had lived at the service for six months, without their capacity being assessed, but with decisions being made for them. When asked, staff were not consistently able to recall the principles of MCA, or relate them to their role.

Audit systems were in place for medicines management. However, the format of the audit was not understood by the person completing them. While areas requiring action were identified, it was not recorded what the response had been, or when this had been completed. During the inspection, the registered manager liaised with the regional manager to gain support in developing their understanding of this audit process.

Where appropriate, risks had been identified and recorded in people’s care plans, with guidance for staff to manage these risks safely. Accidents and incidents were recorded and analysed at the service, as well as at a head office level to check for patterns and trends.

Staff said they felt confident they could ask for more training; and the manager identified that training in MCA was required for all staff. However, there was no overview of the training needs of individuals, meaning that gaps in training could not immediately be identified. During the inspection the registered manager liaised with the regional training manager to plan