Sesame

The provider and staff gave us assurance that people were being admitted to the service safely and in accordance with national guidance. It was not evident from one person’s admission records what factors had been considered to mitigate the risks of catching or spreading infection to either this person or other people living at the service. Following the inspection, the provider informed us they had introduced a specific risk assessment as part of their new Covid 19 protocol to ensure that risks associated with the transmission of Covid 19 is a primary consideration to all future placements.

We found the following examples of good practice.

There was a clear system in place for visitors to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing.

Instructions were easily accessible upon arrival at the service to ensure visitors understood the services infection prevention and control protocols and what they needed to do to keep people and themselves safe.

Staff had received additional training in infection prevention and control and the use of PPE including masks, gloves, aprons and hand sanitiser.

There were enough stocks of PPE available and staff were seen to be wearing PPE appropriately.

Staff took part in regular COVID-19 'whole home' testing and staff who tested positive, followed national guidance and self-isolated for the required amount of time. Due to people’s complex care needs they were not taking part in a regular COVID-19 testing programme at the time of the inspection.

Cleaning schedules and procedures had been enhanced to include more frequent cleaning of touch points such as handrails and light switches.

The registered manager had developed specific COVID-19 policies, procedures and risk assessments which had been reviewed and updated where necessary in line with the latest guidance.

People’s experience of using this service:

Sesame had been developed and designed prior to Building the Right Support and Registering the Right Support guidance being published. We found the service supported people in a way which incorporate this guidance, and which promoted choice, independence and inclusion to enable people with learning disabilities and autism to live their life as any citizen.

People received safe and personalised care from staff who understood their needs well. We saw people enjoying staff’s company and smiling and making physical contact with staff.

There was a strong emphasis on person-centred support to ensure people could developing their skills and confidence and look to achieve their aspirations. Support plans and risk assessments provided staff with the guidance they required to support people’s independence and to protect their safely. Our observations showed staff were patient, calm, clear and consistent with people which supported their communication and understanding of what was occurring during the inspection.

People were supported to take part in activities that involved them in the local community and enabled them to develop friendships outside of the home.

The registered manager promoted an open and positive culture across the service which ensured people's diverse needs were understood and respected. Relatives and professionals were positive about the way in which the service supported people. The registered manager and staff worked collaboratively with other professionals to ensure people received effective care. Staff were well trained and motivated to provide good care.

Quality assurance processes and management systems used to assess and monitor the safety and quality of the service were robust.

The service recorded and acted on complaints and sought the views of people, relatives, professionals and staff on how things could be improved at the service.

Rating at last inspection: Sesame was previously inspected in April 2018 and rated ‘Requires Improvement’. (The report was published in May 2018)

At this inspection we found the service met the characteristics of ‘Good’ for all key questions: The service’s overall rating has improved to ‘Good’.

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

Follow up: We will continue to monitor information and intelligence we receive about the service to ensure good quality care is provided to people. We will return to visit in line our re-inspection programme.

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

Sesame is registered to provide personal care and support for up to four people living with a learning disability and/or autistic spectrum disorder. Some people also had long-term health conditions, complex communication needs, or behaviours that may be seen as challenging.

Sesame had a registered manager, however at the time the inspection they were on a period of planned leave. An interim manager had been appointed by the provider to oversee the home in the registered managers’ absence. 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 home is run.

Sesame had been developed and designed prior to Building the Right Support and Registering the Right Support guidance being published, we found it followed some of these values and principles. These values relate to people with learning disabilities being able to live an ordinary life.

We looked at the home’s quality assurance and governance systems to ensure procedures were in place to assess, monitor, and improve the quality and safety of the services provided. Although some systems were working well, others had not been effective, as they had not identified the concerns we found during this inspection.

The provider did not have a systematic approach to determine the number of suitably qualified and competent staff required to meet people’s needs at all times. We raised our concerns about people’s safety at night with the nominated individual who took immediate action and increased the staffing levels at night from one to two waking night staff.

People were not always protected from the risk of harm because the systems in place to manage/ mitigate risks were not always effective. We looked at how the home managed people medicines; we found the system in place to manage people medicines, when they left the home placed people at risk. Following the inspection the interim manager confirmed that they had changed the system and reduced any associated risks. Other risks were managed well. People's care plans contained detailed risk assessments and clear guidance for staff on how to ensure people's safety was maintained, while encouraging people to be as independent as possible.

We checked whether the home was working within the principles of The Mental Capacity Act 2005 (MCA). Whilst we saw staff obtaining people’s consent, we found where a person’s capacity to make complex choices or decisions was in doubt. Records did not show staff had assessed the person’s capacity or where decisions had been made in a person’s best interests, these were not always being recorded properly. We have recommended the home reviews all documentation relating to MCA and best interests decisions

We looked at the induction and supervision records for three staff. None of the staff files contained a completed induction. Staff we spoke with told us they did not feel supported and records confirmed that staff were not receiving regular supervision in line with the home’s policy.

Staff told us people were involved in identifying their needs and developing their support. We found people’s records contained out of date information; lacked detail and were not provided in a way that supported people to be involved in their care for example in a pictorial format. We have made a recommendation in relation to care planning.

People told us they were happy living at the home and liked the staff that supported them. Relatives told us they did not have any concerns about people’s safety. People were protected from the risk of abuse. Staff treated people with kindness and supported people to lead full and active lifestyles, and follow their interests.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on the 24 February 2016 and was unannounced. The last inspection of Sesame was carried out in January 2014 where no concerns were identified.

Sesame is a care home without nursing, providing support for up to four people living with an autistic spectrum disorder or learning disability. Some people also had long term health conditions, complex communication needs, or behaviours that were challenging.

There was a registered manager in post. A registered manager is a person who has registered with the 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.

Best interests decisions made under the Mental Capacity Act 2005 (MCA) had not always been recorded in accordance with the MCA, although we did not find that the decisions made had been inappropriate or unduly restrictive We found that staff had taken appropriate actions in people’s best interests, such as providing an epilepsy monitoring system for one person’s room, but that these had not been recorded in accordance with the framework for decision making under the Mental Capacity Act 2005. Applications for the Deprivation of Liberty Safeguards had been made appropriately, and outcomes of the decisions were awaited. We recommend the provider takes advice from a suitably qualified person on the Mental Capacity Act 2005 and code of practice in relation to best interests assessments.

Care plans were personalised to each individual. They were up to date, detailed and contained sufficient detailed information to assist staff to provide care in a manner that was safe and respected people’s wishes. People had individual activity programmes which were followed unless the person chose otherwise. Opportunities were explored to maximise people’s involvement in the local community, and people were encouraged to be active and follow healthy lifestyles. They were supported to attend clubs and groups that interested them, including drama and crafts.

We saw examples of positive and supportive care and relationships. Staff were creative and reflective about how to help people develop new skills, positive about people’s progress, and were actively involved in raising funds for the charity and the home. People were valued as individuals and there was a focus on maximising people’s abilities for self-care and independence. For example, people were supported to have increased independence with their meal choices and be involved more in meal preparation. Healthy eating was encouraged and some people were supported to lose weight and others gain weight in accordance with their needs. People were involved in making choices about their meals and were involved in food shopping and meal preparation. Information was presented wherever possible in ways people could understand, and plans helped ensure staff understand how people communicated.

People were supported to develop new skills and have new experiences through the taking of appropriate risks. Risks to people were assessed and actions taken to minimise them where possible. We saw evidence that staff were involving people in strategies to manage some risks through positive intervention plans. Staff understood what they needed to do to keep people safe or report concerns about potential abuse. Systems were in place to manage complaints and ensure people with communication difficulties were able to raise any unhappiness or distress to staff and be understood.

There were enough staff on duty to support people, as staffing levels were adjusted each day to meet people’s needs and the activities they wanted to undertake. This meant that staff shift times varied for example where people wanted to take part in activities in the evenings. A full recruitment procedure was followed aimed at identifying and minimising risks from the recruitment of staff.

Medicines were being managed safely and the service learned from incidents or events. We have recommended that where staff make hand written entries on the medicines administration record (MAR) that these are signed by two staff to help reduce the risks of an error. When people had emergency medicine to manage epilepsy this was taken with them whenever they left the home. Staff had received training in how to use this and there were clear protocols in place so staff had guidance of when this should be used. Staff received the training they needed for their job role. People received the healthcare they needed, and good working relationships had been established with local GPs. Staff at the home had worked with people to reduce their anxieties in relation to their health and using community medical services to good effect.

The registered manager ensured there were effective systems for governance, quality assurance and ensuring safe care for people. There were development plans in place to make improvements based on best practice guidance, and these were on target to be met. The premises provided a homely and comfortable setting for people to live in. Adaptations and improvements were continually planned to the environment to meet people’s needs and wishes. For example the front garden area was being developed with decking and seating areas and the activities room was also due for refurbishment. The service took account of good practice guidance and people and their relatives had opportunities to influence the way the home was run.

Records were well maintained, and notifications had been sent to CQC or other agencies as required by law.

We observed daily life within the home and spoke with two staff members and two agency workers. We also spoke with one staff member from the organisation who supports a person living at Sesame to go to college and access other community facilities.

We noted that one person's daily pictorial chart and care plan both reflected the persons daily schedule. We were able to ascertain by communicating with a person, that they were looking forward to a trip to Cockington village to walk and see the horses. Another person told us that they were visiting the 'Mare and Foal Sanctuary' before going shopping to buy ingredients for some soup they had chosen to make the following day.

One person was unwell on the day of our visit and was being cared for in their room. Throughout the time we were in the service we noted that staff stayed with the person. Staff recorded every visit and observation.

We noted that people were offered choices and were given time to process the information before being prompted to provide an answer.

Everyone we spoke to was complimentary about the home. One relative told us "they are very warm, welcoming. It's somewhere (person) feels comfortable. We were concerned that (person) would become settled and content and this has happened".

We observed staff offering people choices consistently through the day. Staff adjusted the way they offered choices according to the person's communication needs to ensure they acted in accordance with their wishes.

We found people's care plans to be an accurate reflection of their support and people told us "we (staff and people) do go through the file together".

People told us they got on well with staff and staff had time to support them with activities they enjoyed. One person told us "we do shopping, go to market. Drama last night".

There was a safeguarding procedure in place. People told us they could raise concerns with staff. One person told us "if I worry about something I talk to staff".

The quality of the service was monitored and incidents in particular were recorded in a detailed, reflective manner in order to implement changes to people's support where needed.