CQC report explained · a residential care home
What the CQC found at Sapphire House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Risks to people, including possible ligature risks and safeguarding concerns, had been assessed and managed. Staff understood how to respond to abuse and there were suitable staffing levels, including extra staff during crises.
- Effective?
- Good
- People were assessed and supported to make choices and remain independent. However, some people did not receive timely specialist mental health support, and staff supervision had not always taken place within the provider's policy.
- Caring?
- Good
- Caring was not assessed in this targeted inspection. Inspectors did report positive relationships between people and staff who knew them well.
- Responsive?
- Good
- Responsive care was not assessed as a separate question. Inspectors found that support plans described people's routines, wishes and preferences, and that the service responded to changes in people's needs.
- Well-led?
- Good
- The provider investigated incidents and identified lessons, including the need to improve some training and escalation with outside agencies. Audits and action plans were in place, but the inspectors said they would check some improvements at the next inspection.
What inspectors found, September 2020
Inspected but not rated; inspectors found caring, person-centred support, but delays in specialist mental health help had affected some people.
This was a targeted inspection on 1 July 2020. Inspectors looked specifically at ligature risks, safeguarding and support for people experiencing a mental health crisis. They spoke with people and staff, observed care, and checked care records, risk assessments, staffing, training and management records.
The inspection did not give new ratings. The previous overall rating was Good, published in February 2019, and remained unchanged. The inspectors found that people were supported by staff who knew them well, with enough staff available and a strong focus on choice, independence and individual needs.
There were important difficulties during the COVID-19 pandemic. Some people did not receive timely support from specialist mental health services after new conditions were diagnosed. This contributed to increased incidents and a decline in some people's mental health and behaviour. Staff supervision had also not always happened as required, although an action plan was put in place.
Staff knew people well
People had trusting relationships with staff and could have privacy and independence while staff remained nearby when needed.
“The registered manager and staff demonstrated a detailed knowledge of the people they supported.” from the report
Choice and independence
People were supported to make day-to-day choices, use ordinary community resources and develop daily living skills.
“People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.” from the report
Risk management
The home had risk assessments and positive behaviour support plans. Staff understood people's triggers and acted to reduce immediate risks.
“Risks to people's safety, individual health and wellbeing had been assessed and plans were developed to help people and staff manage these risks.” from the report
Staffing levels
Inspectors found enough staff to meet people's needs, with additional staff used when someone needed more intensive support.
“There were suitable numbers of staff to provide the care and support people were assessed as needing.” from the report
Quality monitoring
The manager and quality team carried out audits. Shortfalls were recorded in action plans with named responsibility and timescales.
“Shortfalls were highlighted and formed the basis of an action plan.” from the report
Delayed specialist mental health support
seriousSome people did not receive the outside specialist support they needed during the pandemic. Inspectors linked this to increased incidents and worsening mental health and behaviour.
“The lack of timely external specialist support contributed to increased incidents with some people, a decline in their mental health and behaviours associated with crisis.” from the report
No alternative support plan
needs fixingThe home tried to work with outside services but did not have a contingency plan for providing alternative support when those services were unavailable.
“There was no contingency plan about how to provide alternative support when established resources could not be accessed.” from the report
Staff supervision and training
needs fixingSupervision had not always happened within the provider's eight-week policy. The home also identified a need for further training linked to a newly diagnosed condition.
“Staff felt supported, however, supervision for them to carry out their roles had not always been completed within the service's eight week policy.” from the report
- 01What specialist mental health support is currently available when a person's needs change or they experience a crisis?
- 02What is the home's contingency plan if community mental health teams, hospitals or psychiatry services cannot respond promptly?
- 03Have all outstanding staff supervisions and the additional crisis and condition-specific training now been completed?
- 04How are positive behaviour support plans reviewed when specialist healthcare professionals are not available?
- 05How are remaining ligature risks checked and managed for each person?
This was a targeted inspection of specific concerns about ligature risks, safeguarding and mental health crisis support; it did not assess the full key questions, so the previous Good ratings were not changed. This explanation was written from the published report of 19 September 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2019
Sapphire House is rated Good; inspectors found safe, caring and personalised support, with some people experiencing prolonged discomfort while waiting for secondary dental care.
Inspectors visited on 12 and 13 December 2018. They spoke with people, relatives, staff, managers and other professionals. They observed care and checked care records, medicines, recruitment, training, incidents and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough trained staff, safe medicines systems, detailed risk plans and personalised support. People were helped to make choices, stay independent, access healthcare and take part in community activities.
The rating stayed Good overall, as it had been at the previous inspection in January 2016. Well-led improved from Requires Improvement because a registered manager was now in post and inspectors found stronger oversight and record keeping. The report also noted that access to secondary dental care was difficult and had caused prolonged discomfort for some people.
Detailed safety planning
Risks were assessed for each person, with clear guidance for staff on reducing harm.
“Risks to people were assessed on an individual basis and there was detailed guidance for staff in people's care records.” from the report
Positive behaviour support
Inspectors found that the provider's approach had reduced challenging behaviour for four people and reduced the use of restrictive measures.
“The providers approach had resulted in a reduction of people's behaviour that challenges for four people.” from the report
Kind and respectful staff
Staff knew people well, supported their communication and promoted their privacy, dignity and independence.
“We observed positive, personal and caring interactions throughout the day” from the report
Personalised lives and activities
People were supported to follow their interests, achieve goals and take part in ordinary community activities.
“People were encouraged and supported to take part in activities they liked in the home and within their community.” from the report
Improved management oversight
The home had a registered manager and inspectors found stronger monitoring, learning from incidents and action plans.
“The registered manager promoted a positive, person centred and professional culture, had good oversight of the quality and safety of the home” from the report
Difficult access to secondary dental care
needs fixingInspectors found that access to secondary dental care was difficult and this led to prolonged discomfort. The report said this was outside the provider's control, but families should ask how delays are managed.
“However, access to secondary dental care for people was difficult although out of the providers control and this resulted in prolonged discomfort.” from the report
Mixed feedback
minorRecent surveys from people, relatives and health professionals had mixed feedback. The provider had planned actions in response.
“Surveys had been done or sent recently to people, relatives and health professionals which showed mixed feedback and actions planned in response.” from the report
- 01How do you arrange secondary dental care, and what do you do if someone is waiting and experiencing discomfort?
- 02What recent actions have you taken in response to the mixed feedback from people, relatives and health professionals?
- 03How will you involve my relative in their support plans, risk assessments and choices about daily activities?
- 04What training and competency checks do staff complete for medicines and positive behaviour support?
- 05How do you review accidents, incidents and audits, and explain any resulting changes to families?
This was a comprehensive inspection covering all five key questions, and it also included a detailed review of oral health support; the home was not supporting anyone receiving end-of-life care at the time. This explanation was written from the published report of 20 February 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Sapphire House
2 rated inspections over 3 years: the service has held its Good rating throughout.
- September 2020Inspected but not ratedcurrent ratingSafe: Inspected but not ratedEffective: Inspected but not ratedWell-led: Inspected but not rated
- February 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2014
Report published without a new overall rating.
- May 2014
Registered with the Care Quality Commission on 14 May 2014.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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