1 July 2020
During an inspection looking at part of the service
Sapphire House is a residential care home for up to seven people who may be living with a learning disability, autistic spectrum disorder and a mental health condition or complex needs. The property is a detached house on a residential street which has been converted to self-contained flats and bedrooms with communal areas. There were five people living in the home when we visited. People using the service received support with their personal care. This is help with tasks related to personal hygiene and eating.
The service had 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 could live as ordinary a life as any citizen. These values were seen in practice at the home. For example, the building was like any other on the road with no signs to show it was a care home. Staff did not wear uniforms and people lived their lives in the ways they wanted.
People’s experience of using this service and what we found
Some people were diagnosed with new mental health conditions just before the restrictions put in place due to the Covid-19 pandemic. They did not receive the required support from outside specialist services, due to the restrictions. This led to a decline in the quality of support they received from specialist health professionals; this was reflected in adverse behaviours and a decline in mental health.
People had positive behaviour support plans (PBS) which enabled staff to support people consistently and were regularly reviewed. However, staff had to develop these for some people without the usual support from specialist healthcare professionals.
Staff felt supported by the registered manager and provider, although staff supervision had not always taken place in line with the provider’s policy. An action plan was in place to address this.
Where people presented specific risks to themselves or others, risk assessments were in place to minimise the risk and occurrence. People were involved in review meetings about their support and aspirations. They were involved in setting goals and targets and were supported by staff to achieve these.
Support plans detailed people’s preferred routines, wishes and preferences. They detailed what people were able to do for themselves and what support was required from staff to aid their independence wherever possible.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Staff recognised that most people had the capacity to make day to day choices and supported them to do so. People were encouraged and supported to be independent. People were engaging in the community, for example utilising their local community to use ordinary community resources, shops, access day services and activities. However, some restrictions had been in place to meet with national Corona Virus guidance.
The registered manager and staff demonstrated a detailed knowledge of the people they supported. Over time they had developed trusting relationships, so that people felt safe receiving support. People were able to have privacy and independence with staff accessible nearby if support was needed.
Staff had a detailed understanding of people's support needs and training was in place to help staff to meet them. Staff were encouraged to continuously learn and develop by completing qualifications and additional learning.
People had positive relationships with staff who knew them well. There were enough staff available to meet people's needs and give individual care and support. There was a strong emphasis on person-centred care. People were supported to plan their support where possible and they received a service that was based on their individual needs and wishes. The service was flexible and responded to changes in people's needs.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 18 February 2019).
Why we inspected
The inspection was prompted due to concerns received about ligature risks, safeguarding and support for people experiencing mental health crisis. A decision was made for us to inspect using our targeted methodology developed during the Covid19 pandemic to examine those specific risks and ensure people were safe.
We undertook this targeted inspection to check on specific concerns we had. The overall rating for the service has not changed following this targeted inspection and remains Good.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.