Take A Break With Choices

Take a Break with Choices is a respite service for up to seven people. On the day of inspection five people were using the service. Take a Break with Choices supports people with varying needs, including dementia, autism, drug and alcohol use and learning disabilities, across a two-storey building, with minor adaptations. The service is situated close to Bolton Town Centre.

Take a Break with Choice’s also provide personal care to one person living in their own home. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service

Systems were in place to keep people safe from abuse. People’s risks were identified, monitored and managed appropriately. The premises of the care home were undergoing redecoration in areas, but were well maintained, clean and tidy.

Staff were recruited safely. Staffing levels were sufficient to meet people’s needs and there was flexibility within the rota to adjust staffing levels should people’s needs change. The service had robust supervision and appraisal systems in place for staff. Staff training was thorough and in-date.

Medicines were managed safely. The provider had systems in place for infection control and staff knowledge of this was good. Extra systems and precautions were in place to manage the risk of the Coronavirus.

People’s health and emotional needs were fully assessed when they started using the service. People’s nutritional needs were met.

People were supported to maintain relationships with family and friends. There was a wide range of ad-hoc and arranged activities for people to participate in. Complaints were dealt with promptly and were used for analysis to support the service improve. Compliments were fed back to staff during team meetings, encouraging best practice.

The deputy manager had implemented more structure and improved paperwork, such as care plans, support plans, governance, systems and policies. The service welcomed and worked alongside other agencies.

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. The service provided support that promoted people’s independence and people’s privacy and dignity was respected.

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 requires improvement (published 13 March 2019.)

Why we inspected

This was a planned inspection based on the previous rating.

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.

Since that inspection the provider had completed an improvement action plan and we found improvements had been made in a number of areas. For example, all the requirements referred to within the fire risk assessment had been completed and water temperatures were taken regularly. Since the last inspection staff had received training in food hygiene. There was now a medicines policy in place and risk assessments had been completed as required. All staff employed now had an up to date Disclosure and Barring Service (DBS) check in place. Service user forums were being undertaken on a monthly basis and activities books implemented to help ensure all people who used the service had access to interests and activities.

Although improvements had been made in many areas, we did find some issues at this inspection. For example, some of the water temperatures recorded were above the recommended levels and no action had been taken about this. Some audits had been recorded as having been done into the future, i.e., although the inspection was undertaken on 31 January 2019 there were completed documents for the first two weeks of February.

The service is a two-storey property that has been suitably adapted. The service is situated in The Haulgh area of Bolton and is close to Bolton Town Centre and local amenities, public transport and motorway networks. Take A Break With Choices is a respite service that can provide care and support for seven people. At the time of the inspection there were five people using the service.

There was a registered manager in post. The registered manager is also the owner and the nominated individual. 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 and associated Regulations about how the service is run.

People said they felt safe at the service. The service had CCTV in place in communal areas to help ensure people’s safety. There was a CCTV policy in place and notices to alert people to its installation. There was an appropriate safeguarding policy and staff had undertaken safeguarding training.

Recruitment procedures were robust, staffing levels were sufficient during the day to meet people’s needs and there was one staff member on a sleepover at night.

Fire safety and health and safety measures were in place and there were up to date certificates for gas and electrical safety and legionella testing.

The water temperature in one of the sinks was too hot and there were used toiletries and razors in an unlocked cupboard in the bathroom. These could pose a risk to people who used the service.

Medicines were managed safely. Accidents and incidents were logged and followed up appropriately. Infection control measures were in place, but there were some minor infection control issues that needed to be addressed.

Care files included relevant health and personal information. There were some inconsistencies, but in the main care files were well ordered and clear.

Staff completed a full induction and training was on-going. Staff supervisions were undertaken regularly.

The food offered was nutritious, choices were given and there were plenty of supplies of fresh food on the premises. The building was well adapted for people whose mobility was restricted.

The service sought consent as required and worked within the legal requirements of The Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People told us they were happy at the service. We observed people being cared for with kindness and compassion and people’s privacy and dignity were respected. People were treated equally and without discrimination.

There was a service user guide available for people who used the service. The service ensured they worked within the requirements of confidentiality and data protection legislation.

People who used the serviced were involved in planning their own support and were encouraged to be as independent as possible.

Support plans were person-centred and people’s likes, dislikes, and backgrounds were recorded and their interests supported and encouraged. People’s life choices were respected.

Information was available in different formats as required by the Accessible Information Standard.

Residents’ meetings were held regularly. There was an appropriate complaints policy in place and complaints were responded to in a timely way.

We saw audits and quality assurance checks in place at the service. However, a number of audits had been completed for dates in the future and therefore could not have been verified as correct.

Staff told us they felt well supported by the management at the home. The service worked well in partnership with other agencies and professionals.

The service is a two storey property that has been suitably adapted. The service is situated in The Haulgh area of Bolton and is close to Bolton Town Centre and local amenities, public transport and motorway networks. Take A Break With Choices is a respite service that can provide care for seven people.

There was a registered manager in post. The registered manager is also the owner and the nominated individual. 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 and associated Regulations about how the service is run. The service has a service manager who facilitated the inspection. The registered manager was on site but chose not assist with the inspection.

There were two people staying at the service at the time of the inspection. Take A Break With Choices 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.

This service is also a domiciliary care agency providing personal care to four people living in their own houses and flats in the community. Not everyone using Take A Break With Choices receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We last inspected Take A Break With Choices on 24 August 2017 and the service was rated as ‘Inadequate’. This meant the service was placed in ‘Special Measures’. When a service is placed in ‘Special Measure’ we inspect the service again within six months of the last report being published to see if the service has improved. Placements by the local authority to the service and the domiciliary service were suspended. This imposed suspension, by the local authority remains in place.

At the inspection on 24 August 2017 we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to failing to ensure that robust procedures and process were in place to make sure people were protected, there was a lack of risk assessments, staff had not received appropriate training, a lack of suitable activities and communal involvement and a lack of systems in place to assess and monitor the quality of the service. An action plan was received from the provider on 17 November 2017 with actions and timescales provided.

At the inspection on 28 February 2018 we worked through the action plan with the service manager and found that the breaches had mainly been addressed and the service had improved.

We received information from the Greater Manchester Fire Safety Enforcement Officer that following a visit to the service on the 6 February 2018 they would be sending a ‘notification of deficiencies letter’ which provided recommendations for improvement. The findings included: The need for a more suitable fire risk assessment. There was no smoke detection in the garage and the fire officer asked the provider to confirm that fire resistance from there to the accommodation above is adequate. Some of the bedroom doors did not close fully unaided, due to maintenance required (door sticks on carpet). That the provider considered the suitability of the keypads on the doors, especially if access needs to be gained to assist in an emergency and suggested they consider availability of evacuation chair to assist from disabled rooms if main office area becomes compromised due to fire. We will liaise with the fire safety officer to check that the recommendations for improvements have been addressed.

Systems were now in place to ensure staff were safely recruited. All staff had relevant checks in place.

Staff demonstrated a commitment to providing high quality personalised care for the individuals who accessed the service.

Systems were in place to ensure the safe handling and recording of medicines. However the auditing of medicines was inadequate.

Regular checks took place to ensure the safety and cleanliness of the environment. The service manager had introduced a cleaning schedule and a domestic had been employed.

Health and safety checks were in place and equipment had been serviced in line with the manufacturer’s instructions.

Systems were in place to reduce the risk of cross infection in the service. Paper towels and liquid soap were now in all areas as required.

The service manager had implemented supervision and appraisal records and staff confirmed they had received supervisions.

The service manager had sourced in-house and external training for staff and a training plan was now in place. However it was apparent that several staff had not completed essential training.

The statement of purpose which provides information about the service required updating and did not contain the CQC address to enable people to contact the regulator.

Take A Break With Choices provides respite care for up to seven people. Whilst the provision is meant to be for respite and therefore time limited the people accommodated had been there for several months with no indication as when they would be moving on to alternative permanent care. At the time of the inspection there were five people staying at the home.

The service also provides care and support to people in their own homes. Four people were receiving care in their own homes and support was provided to people with tasks such as shopping and cleaning.

There was a registered manager at the service. The registered manager is also the provider. 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 and associated Regulations about how the service is run.

At the previous inspection on 10 and 15 of February 2016 the Care Quality Commission (CQC) Inspectors found breaches in Regulation 9 – person centred care, Regulation 11 – need for consent, Regulation 12 safe care and treatment, Regulation 17 good governance and Regulation 18 staffing.

On 06 June 2016 a focused inspection was carried out with regard to information suggesting the Provider was operating above the number of beds specified on the registration certificate. The inspection found the Provider was in breach of a condition of registration and was accommodating more people than she was registered to care for. This breach of condition is currently being considered by the Commission as to what action to consider.

At this inspection on 24 August 2017 we found that some policies and procedures needed updating for example the medication policy.

Risk assessments were tick box sheets and did not clearly identify risks to individuals. For example where a risk had been identified, in an area such as falls or medicines, there was no individual risk assessment outlining the specific risks, actions taken, equipment or techniques used to minimise the risks and review of the risk.

There was no evidence of a fire risk assessment, testing of emergency equipment or fire drills taking place. We noted that some fire doors were propped open. The registered manager was unaware that personal emergency evacuation plans (PEEPs) should be in place.

We asked for the recording of water temperatures to ensure that water was discharged at the appropriate temperature. These could not be provided by the registered manager. There was no legionella certificate the registered manager was unaware of what this was and why it was required.

We noted that infection control procedures were not adhered to. There were cloths towels in communal bathrooms and toilets which allow for the transfer of bacteria. Paper towel dispensers were empty which meant that good hand washing and drying techniques were not supported.

There was no food hygiene standard awarded for the service. The registered manager did not know this was required. It is the responsibility of the registered person to register the service with the Environmental Health agency.

The registered manager was unaware of what a dependency tool was despite the PIR stating, ’We use a dependency tool to ensure that there are always enough competent staff on duty with the right mix of skills’.

Staff rotas for August and September 2017 were requested. The rotas supplied were insufficient and did not detail the names of staff or dates worked.

The provider was unable to provide us with information to assure us that all staff had been properly vetted through checks with the Disclosure and Barring Service (DBS). There was no evidence of audits carried out by the registered manager to check medication, the environment, accidents/incidents or complaints. There was some evidence of satisfaction questionnaires but these had not been collated to track any themes or trends identified.

One person told there was a lack of activities and there were no residents meetings for people to discuss their views and opinions on the service.

We checked our records before the inspection and saw that, although some incidents that CQC needed to be informed about had been notified to us by the registered manager there were some significant events CQC had not been informed of. This meant we were unable to see if appropriate action had been taken by management to ensure people were kept safe.

We saw that medicines were administered safely. We saw that medicines were stored in a wall mounted lock cupboard in the kitchen. Other items such as communication books were stored in the cupboard. It is recommended that other items are not stored in the cupboard with medicines.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider's registration to remove this location or cancel the provider's registration at Take A Break With Choices, 9 Chadwick Street, The Haulgh, Bolton , Lancashire BL2 1JN.

Take a Break with Choices provides respite care for a maximum of five people and also provides domiciliary care and support to people in their own home. The home and office are situated close to Bolton town centre. The service is a day centre for social and recreational purposes and also provides other social and recreational services such as cleaning, shopping and befriending to people living in the community.

There was a registered manager at the home. 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.

During our inspection visit, we identified that there were seven persons living at the home. Together with one of the home managers, we looked at each bedroom that was occupied. Each room was clean and well furnished, there were adequate toilets and bathrooms available throughout the home for the people who used the service.

We also looked at staffing rotas and spoke to visitors and people who used the staff about staffing arrangements at the home. People told us that they believed there was sufficient staff during the day and night to meet their needs.

We looked at seven care files, and established that up until the 25 May 2016, five people had been living at the home. On this date a further person was accommodated at the home. On the 31 May 2016, another person was admitted to the home. This demonstrated that since the 25 May 2015, the service had been in breach of their requirements of registration with the Care Quality Commission, which stated the provider must only accommodate a maximum of five service users.

We suspect an offence under Section 33 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 may have been committed by the service. We are currently considering our enforcement option in respect of this offence.

Take a Break with Choices provides respite care for a maximum of five people and also provides domiciliary care and support to people in their own home. The home and office are situated close to Bolton town centre. The service is a day centre for social and recreational purposes and also provides other social and recreational services such as cleaning, shopping and befriending to people living in the community.

People we spoke with told us they felt safe using the service. Staff demonstrated a good understanding of how to safeguard vulnerable people. The service had a safeguarding adult’s policy in place but this was in need of updating. The service had a whistleblowing policy in place and staff told us they were aware of the policy and how to use it.

We looked at how the service managed people’s medicines. We looked at the medicines administration record (MAR) charts for one person who used the domiciliary service and saw MAR charts were available and properly completed. We looked at the medicines records held for one person who used the respite service and found the service was unable to produce any documentary evidence of a best interest decision regarding the service taking control of administering the person’s medicines.

There were risk assessments in people’s files but these had not always been signed and dated and had not all been recently updated. There was no evidence to identify that the service had completed their own risk assessments for every person who used the service either on, or prior to admission.

This was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment because the service had failed to assess the risks to the health and safety of people receiving the care or treatment and had failed to do all that is reasonably practicable to mitigate such risks. You can see what action we told the provider to take at the back of the full version of the report.

We found people were receiving care from care staff that were deployed consistently in a way that met people’s needs. People who used the service told us they felt that staff had the right skills and training to do their job. We found there were suitable recruitment procedures in place and required checks were undertaken before staff began to work for the service. There was a staff induction programme in place, which staff were expected to complete when they first began working for the service. There were gaps of several months between staff supervisions in some of the staff personnel files we looked at.

Some people who used the domiciliary service lived alone and staff required the use of a key to access their property which were appropriately stored in a ‘key safe’ outside the house.

We found that the premises were generally clean throughout but the service was unable to locate any records of cleaning schedules.

The service liaised with health and social care professionals involved in people’s care and worked alongside other professionals and agencies in order to meet people’s care requirements where required such as social workers.

People’s care files had consent forms in them but these were not signed and dated which meant it was not clear if the person or their representative had consented to receiving care and treatment.

This was in breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, need for consent, because care and treatment of people must only be provided with the consent of the relevant person. You can see what action we told the provider to take at the back of the full version of the report.

We saw one example of the service participating in a multi-agency best interest meeting involving a number of health and social care professionals.

The service did not have a staff training matrix that would enable them to identify what training staff had completed and what training was needed. Care staff told us they had not completed any training in MCA/DoLS and were unable to describe what this meant. The service was unable to locate the MCA/DoLS policy and told us a staff member may have taken a copy for personal training purposes

This is a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, staffing, because persons employed by the service had not received the appropriate training to enable them to carry out the duties they are employed to perform. You can see what action we told the provider to take at the back of the full version of the report.

People who used the service and their relatives told us that staff were kind and treated them with dignity and respect. Staff were caring and affectionate to the people they supported. We heard laughter and saw people smiling as part of the interaction that took place. Staff were able to describe how they aimed to treat people with dignity and respect. There were appropriate supporting policies in place that would assist staff in carrying out their duties such as equality and diversity, autonomy and independence, confidentiality and equal opportunities.

People told us that should there be a need to complain they felt confident in talking to the manager directly. However the written complaints procedure was out of date and referenced a non-departmental public body of the Department of Health that is now closed.

The service sought the views of people regarding the quality of services provided through an annual questionnaire. There was a wide range of different activities available to people who used the respite service.

We found the organisation of the care plans was difficult to follow and there was no standard format that would assist staff to easily access information. Daily records that staff used to record information about care and support provided at each care and support visit were not always completed.

This is a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, person-centred care, because the service had failed to carry out an assessment of the needs and preferences for care and treatment of the people who used the service. You can see what action we told the provider to take at the back of the full version of the report.

Although some audits had been carried out there was no process for the regular systematic auditing of people’s care plans in place. There was evidence of care worker spot checks having taken place in 2015 but the ‘action taken’ section of the spot check reports were not always signed and dated.

There was a buildings checklist file in use which covered areas such as a weekly fire alarm test and weekly fridge/freezer temperature monitoring charts.

There were a range of policies and procedures that would support staff in carrying out their duties but some were several years old and in need of review to ensure they were fit for purpose.

The service had a statement of purpose in place but this was out of date, contained information that was no longer valid and was in need of updating. The service had a business continuity plan in place but it was limited in the range of scenarios it considered and needed updating.

Although some audits had been carried out there was no process for the regular systematic auditing of people’s care plans in place. This meant that the process of audit had failed to identify the issues regarding care plan information that we found during the inspection.

This is a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance, because the service had failed to maintain accurate contemporaneous records for each person using the service, had not established and operated effectively systems and processes to ensure compliance with the requirements of this Part and had failed to assess, monitor and improve the quality of the services provided.You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager at the home. 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. An up to date registered manager’s registration certificate was on display.