The inspection took place on 15 April 2018 and was unannounced. When the service was last inspected on 5 January 2016, no breaches of the legal requirements were identified.

Sheepwood Road Care Home provides personal care and accommodation for up to three people. At the time of our inspection there were three people living at the home.

Sheepwood Road Residential care home 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager for the service. The registered manager also ran two other locations for the provider. A team leader was in post who took day-to-day charge of the service. 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.

Staff supervision was not being carried out in accordance with the provider’s own supervision policy. This meant staff were not fully supported in their work, which in turn put people at risk of receiving unsafe and unsuitable care. Consideration needs to be given by the registered manager to how to embed into practice the provider's own policy in this area.

Quality audits were not fully effective and had not identified where there were shortfalls in staff supervision. This put people at risk if staff were not properly supported. It also impacted on staff if checks had not identified that they had received suitable development in their work.

Staff understood about abuse and how to protect people at the home. There were safe systems in place for storing, giving and managing people’s medicines. Risks were identified and actions put in place when needed to keep people safe. People were protected by a recruitment procedure that aimed to minimise the risks of unsuitable staff being employed.

People continued to be supported in a way that ensured the Deprivation of Liberty Safeguards (DoLS) were applied for when appropriate. DoLS is a legal framework to lawfully deprive a person of their liberty when they lack the capacity to make certain decisions in regards to their care and treatment. When a person lacked capacity to make a particular decision, a process was followed in line with the Mental Capacity Act 2005 (MCA).

People were well supported so that their nutrition and hydration needs were met. When it was needed people were able to access healthcare professionals to support them with their care and treatment needs. Care records contained detailed information about how to support people with their full range of needs.

People were supported by staff who had a kind and respectful approach towards them. Staff knew about equalities and diversity when they supported people at the home. People were supported by staff who understood their unique needs.

People were supported in ways that were flexible to their needs. Care plans helped staff to understand how to provide care and support that was responsive to their changing needs. People were well supported to take part in social and therapeutic activities in the home and the community.

There continued to be systems in place to monitor the quality of the care provided. There were regular team meetings and staff were encouraged to give feedback. Staff felt involved in making decisions with people about the home.

We undertook an unannounced inspection of Sheepwood Road Care Home on 5 January 2016.  When the service was last inspected in August 2014 no breaches of the legal requirements were identified.

Sheepwood Road Care Home provides personal care and accommodation for up to three people.  At the time of our inspection there were three people living at the home.  

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

The service was safe for people because staff received training in safeguarding vulnerable adults and were aware of the reporting procedures should they have any concerns.  There were sufficient staffing levels at the home and appropriate recruitment procedures were followed.

Systems were in place to review and monitor reported accident and incidents.  Changes were made to reduce and prevent future reoccurrences.  Risk assessments were in place for people with supporting guidance available to staff.  Suitable health and safety audits were completed on equipment and the environment. 

People’s medicines were managed safely.  Staff were trained and assessed as competent.  The home had taken appropriate steps to reduce the risk of medicine errors.

People were provided with effective and high quality care.  New staff completed an induction programme.  Staff received suitable training in order to meet people’s needs and were supported through regular supervision.

The registered manager had ensured the Deprivation of Liberty Safeguards (DoLS) had been applied for when appropriate.  DoLS is a legal framework to lawfully deprive a person of their liberty when they lack the capacity to make certain decisions in regards to their care and treatment.  When a person lacked capacity to make a particular decision a process was followed in line with the Mental Capacity Act 2005 (MCA). 

Staff demonstrated good knowledge and understanding of the Mental Capacity Act 2005 and how this was put into practice by empowering people through choice.  Care plans reflected how best interests decisions were made and how the outcome benefited people.    

People’s nutrition and hydration needs were met.  People had access to healthcare professionals when needed.  Care records contained detailed guidance on supporting people who may not be able to communicate their health needs.

Relatives spoke highly of the caring nature of staff and the positive relationships they had with people.  Relatives told us they were welcome at the home at any time.  Staff knew people very well and were aware of personal preferences.  We observed staff maintain people’s privacy and dignity and treat people with kindness and respect. 

The home was responsive to people’s needs.  Care records were personalised and showed people’s preferences and how people communicated their wishes.  People had access to a variety of activities of their choosing. 

The registered manager had systems in place to monitor the quality of the care provided.  Staff had regular meetings and were encouraged to give feedback and be involved in making improvements to the home.

This inspection was carried out by an Adult Social Care Inspector. We looked at five standards during this inspection and set out to answer these key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. This is based on our visit to the home when we met with the people who used the service and with members of the staff and management team. Not everybody who used the service was able to express their views verbally. Our observations in the home helped us to make judgements about the support that people received.

Please read the full report if you want to see the evidence supporting our summary.

Is the service caring?

We made observations that showed people experienced positive relationships with staff. We saw people laughed and smiled in response to interactions from staff. One person enjoyed having their nails varnished by staff during the inspection and another person was clearly happy that staff were supporting them to see a relative later that day.

From our discussions with staff, it was clear that they were knowledgeable about the people they supported and understood their individual needs. For example, we discussed how some people were supported to make decisions about the food they wanted with the support of pictures.

Is the service responsive?

We viewed health records that detailed how the support of other healthcare professionals was sought when necessary. In one case we noted that a person had been referred to the dietician in response to concerns about their nutrition. In another example, we saw that the support of a team who advise on behaviour that challenged had been sought.

Is the service safe?

We looked at the processes in place for ensuring that the home was kept suitably clean and hygienic. Staff had cleaning tasks to complete on a daily basis and they signed to confirm that these tasks had been completed. The home was cleaned to a suitable standard on the day of our inspection with some areas highlighted that required further attention. Staff told us that they had access to PPE (Personal Protective Equipment) and that there were suitable arrangements in place for the removal of clinical waste.

Risk assessments were in place to ensure that people were cared for in a safe and appropriate way. These demonstrated that all the options had been considered.

Appropriate records were kept which allowed staff to monitor people's health and support needs. We noted that people's weight was monitored so that any risks in relation to nutrition could be identified and acted upon.

Is the service effective?

People had clearly identified goals that staff were supporting them to work towards. These included working towards greater independence and access to the local community. Records detailed how staff were supporting individuals in these aims, for example by supporting people to attend theatre shows and supporting people to access their own finances.

Is the service well led?

There was a registered manager in place at the time of our inspection. We found that there were procedures in place for monitoring the quality of the service provided. This included seeking the views of people in the home and their representatives. A monthly visit from another manager within the service took place to look at various aspects of the service.

Due to the complex needs of the people living in Sheepwood Road, we were unable to discuss their experiences of living in the home and the care and support that was in place. However, we made observations of their care and spoke with three members of staff and the manager. In addition we looked at records relating to their care.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Information in the planning for life file and the health action plan was in an accessible format and included photographs and communication aids.

People were involved in a combination of activities in the home and the local community.

People were provided with a choice of suitable and nutritious food and drink.

Appropriate arrangements were in place in relation to the recording of medicine. Medicines were safely administered.

People were supported by staff that had received regular training.

There was a suitable system in place to check the quality of care and the overall service people received.

We haven’t been able to speak to people using the service due to the nature of their learning disabilities, and therefore we relied on our observations and discussions with staff to understand their experience of care.

We were introduced to the three people living at Sheepwood Road when we carried out our inspection. We also met two support workers.

We saw people were properly cared for and supported by staff with their care needs. People were cared for by staff who had a very good insight about their individual needs.

Care plans and assessment records were informative and helped to guide staff to effectively give people the support they needed to live a fulfilling life in the home and the community.

There were enough competent staff to meet the complex needs of the people at the home

People were unable to fully tell us how they had been involved in decisions relating to their care due to the complexity of their learning disability. However, we were able to observe interactions between members of staff and the people they support we also spoke with staff and looked at care records.

Through observations and discussions with staff it was evident they had a good understanding of the people they were supporting including how people communicate.

We observed staff supporting people in a dignified and respectful manner. Staff were observed interacting with individuals in a positive way. People were encouraged to participate in conversations.

People were involved in the day to day decisions about their care and more complex decisions were made in accordance with current practice to ensure people were protected.

We observed people being supported during the course of our visit in an appropriate and inclusive manner by the staff on duty. Staff were seen offering people choices about what music to listen to, drinks and activities.

Staff were observed knocking on bathroom and bedroom doors before they entered the room.

People were being supported with planned and structured activities. However, this was dependent on the number of staff working in the home, because the people living in Sheepwood Road required one to one support when out in the community to assist with mobility.

People were supported to maintain contact with relatives and friends.

We visited the home on two occasions. On the first day everyone was being supported to go out to lunch so we stayed only for an hour. We then returned unannounced the following week.