Sudbury House is registered to provide accommodation and personal care to a maximum of five people with learning disabilities. At the time of our inspection, there were four people using the service.

At the last inspection on 4 January 2016 the service was overall rated Good.

At this inspection we found the home remained Good.

People in the home had complex needs and were therefore unable to provide us with verbal feedback. On the day of our inspection, all four people were out at day centres during the day. Following the inspection we spoke with two relatives and one social care professional to obtain their feedback about the service. Relatives of people who used the service spoke positively about the care provided by the home. They told us they were confident people were safe in the presence of care workers and in the home.

There were systems and processes in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Risks associated with people’s care had been identified and appropriate plans were in place to minimise potential risks to people.

Medicines management arrangements were in place in relation to the recording, storage and administration of medicines. There were enough staff to meet people's individual care needs and this was confirmed by staff we spoke with.

Care workers told us that they felt supported by management. They spoke positively about the new manager and said they had confidence in her abilities. Staff had received training in areas that helped them to carry out their roles effectively. Staff received regular supervision sessions and a yearly appraisal.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were clearly documented. Care plans were reviewed regularly and were updated when people's needs changed.

The home was working within the principles of The Mental Capacity Act 2005 (MCA). The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. We found that necessary DoLS authorisations were in place.

Arrangements were in place to ensure the nutritional needs of people were met. The home provided vegetarian food at the request of people and their relatives for cultural reasons. The menu included a variety of foods which were freshly prepared daily.

The home ensured they respected people’s individual cultural and spiritual needs. People in the home were Hindu and the home had a Hindu calendar available which highlighted special cultural and religious events. The home had organised a religious prayer for people to participate in. People were also supported to visit the temple and supported to attend religious festivals.

We found the home had a management structure in place with a team of care workers, the cook, the new manager and interim supporting manager. Staff told us that the morale within the home was good and that staff worked well with one another. They spoke positively about working at the home. They told us management was approachable and there was an open and transparent culture within the home and they did not hesitate about bringing any concerns to management.

Staff were informed of changes occurring within the home through staff meetings and we saw that these meetings occurred regularly and were documented. Staff told us that they received up to date information and said communication in the home was effective.

The home carried out checks and audits which looked at various aspects of the care provided at the home which included health and safety, infection control, staffing, medication, fire safety and docume

This inspection took place on 4 January 2016 and was unannounced. Sudbury House is registered to provide care and accommodation for up to five people with learning disabilities. At the time of our inspection, there were five people using the service.

At our last inspection on 11 September 2014 the service met the regulations inspected.

There was a registered manager in post at the time of our inspection. 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.

People in the home had complex needs and were therefore unable to provide us with verbal feedback. On the day of our inspection four people were out at day centres during the day. We did meet one person who used the service. We spoke with four relatives, two care professionals and care staff to obtain their feedback about the service. Relatives of people who used the service spoke positively about the home and they were confident that people were safe in the home and around staff.

There were systems and processes to help protect people from the risk of harm and staff demonstrated that they were aware of these. However, the safeguarding policy did not include details of the Care Quality Commission. The registered manager confirmed that the policy would be updated to reflect this. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

Risk assessments had been carried out for people and staff were aware of potential risks to people and how to protect people from harm. Staff were knowledgeable regarding care issues and the needs of people with learning disabilities. They knew the triggers and warning signs which indicated that people were upset and how to support people appropriately.

The home had plans in place for a foreseeable emergency. This provided staff with details of the action to take if the delivery of care was affected or people were put at risk. On the day of the inspection we noted that there were some maintenance issues that needed to be addressed and raised this with the registered manager. The fire authorities (London Fire & Emergency Planning Authority) had visited the home and their report dated 4 September 2015 identified four areas of concern. These included issues with the fire doors as well as the fire risk assessment was not sufficiently comprehensive. The registered manager explained to us that these issues had been addressed and provided documented evidence to confirm.

On the day of the inspection we observed that there were sufficient numbers of staff to meet people’s individual care needs. Staff did not appear to be rushed and were able to complete their tasks. Staff we spoke with confirmed that there were sufficient numbers of staff to safely care for people. We noted that there were times when there was one member of staff on duty. However at the time of the inspection the home did not have an up to date lone working policy setting out the procedures for staff to follow in the event of an emergency. After the inspection, the home provided us with a copy of their policy. However it was evident that at the time of this inspection this policy was not available to staff in the home for them to refer to in an emergency. We told the home to ensure that this policy was clearly available in the home for staff to refer to.

Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

We found the premises were clean and tidy. The service had an Infection control policy and measures were in place for infection control.

Staff confirmed that they received regular supervision sessions and appraisals to discuss their individual progress and development. Staff spoke positively about the training they had received and we saw evidence that staff had completed training which included safeguarding, medicine administration, health and safety, first aid and moving and handling. Staff were confident that they had the knowledge and skills they needed to perform their roles.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people’s likes and dislikes. Identified risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to people. Relates told us that people received care, support and treatment when they required it. Care plans were updated when people’s needs changed.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people’s care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The home had made the necessary applications for DoLS and we saw evidence that authorisations had been granted.

Relatives spoke positively about the cook and food provided in the home. People in the home were vegetarian and the food menu offered a choice of two vegetarian meals daily. Food was freshly prepared. Details of special diets people required either as a result of a clinical need or a cultural preference were clearly documented and staff were aware of such preferences.

Relatives told us that there were sufficient activities available. Activities available included attending the local day centre and park. During the inspection we saw some people go out to the day centre.

The home had carried out a satisfaction survey in 2015 and the feedback was positive. Relatives spoke positively about the registered manager and staff. They said that the registered manager was approachable and willing to listen and said that they did not hesitate to raise concerns or queries directly with management. .

There was a management structure in place with a team of care staff, domestic staff and the registered manager. Staff told us that the morale within the home was good and that staff worked well with one another. Staff spoke positively about working at the home. They told us that the registered manager was approachable and the service had an open and transparent culture.

Staff were informed of changes occurring within the home through staff meetings and we saw that these meetings occurred monthly and were documented. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

There was a quality assurance policy which provided detailed information on the systems in place for the provider to obtain feedback about the care provided at the home. The service undertook a range of checks and audits of the quality of the service and took action to improve the service as a result.

A single inspector carried out this inspection. The purpose of the inspection was to monitor compliance with areas of non-compliance from our last inspection on 1 March 2014.

We spoke with two members of staff, including the Registered Manager. We looked at care records for the five people who used the service, and we checked the areas of the premises that had caused concern.

Four people who used the service were away from the premises when we visited. We met the fifth person, but they were not able to understand and discuss with us the areas that we were looking at on this occasion.

The provider had carried out assessments for each person of their capacity for making decisions. The assessments followed the principles of the Mental Capacity Act 2005 and specified family members for each person who should be involved in any decisions made in the person’s best interest.

We found that all cleaning materials that may be hazardous to health were stored securely in an outbuilding in the garden and replaced there after use. This meant that the risk to people using the service of contact with harmful substances was minimised.

At the time of the inspection all the people using the service were male and of Indian origin. We observed that staff interacted with each person to make sure that they addressed their needs and wishes. We saw daily logs completed by staff that recorded what each person did each day and how staff supported them to meet their assessed needs.

The care plans that we saw were written taking the person's views and preferences into consideration. However the care plans and reviews of care that we saw were not signed by the people concerned to show their agreement.

We found no evidence of any assessment of people's capacity to take individual decisions in line with the Mental Capacity Act 2005. There was no record of decisions taken in a person’s best interest if they did not have the mental capacity to understand and make the decision for themselves.

We observed that the home was clean and that an appropriate standard of hygiene was maintained in the kitchen and bathrooms. However we observed that items that could be a risk to people’s health were accessible to people in the home.

Records were kept securely and could be located promptly when needed. We saw evidence that the provider carried out regular checks to ensure that people’s personal records were up to date. Training records were maintained and showed that all the training for 2013 had been completed.

When we visited Sudbury House we met four people who lived there and saw them engage with care workers. We met the manager and two of the care workers. People using the service were from Asian background and the home provided culturally appropriate Vegetarian food. People had limited communication skills, we obtained peoples’ views from relatives and staff surveys carried out in 2012.

We found that people were supported in promoting their independence and community involvement. Their diversity, values and human rights were respected. People seemed to like the staff and they were provided with good care and support. They felt safe and were listened to when they communicated any concern or anxieties.

We looked at staff training records and spoke to staff.. The staff felt the staffing levels allowed them to spend quality time with people. Staff felt well supported and trained. The provider had systems in place to check the quality of the service.

Although people's comments were limited, due to their learning disability and English not being their first language, they did make positive comments about the service provided. They told us that they enjoyed living at Sudbury House and that they "liked the food" provided. They said that they were comfortable there and that staff working at the home were "looking after us well". Members of staff would "help if needed" and staff "is very nice". They told us that they felt safe living in Sudbury House and that there was nothing worrying them. If there was a problem they said they would talk to staff or the manager. People using the service took part in a range of activities, "I go to the day centre and like going out for meals".