Short Break Service

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance the Care Quality Commission (CQC) follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. We saw the model of care and setting maximised people’s choice, control and independence. Care was person-centred and promoted people’s dignity, privacy and human rights. The ethos, values, attitudes and behaviours of leaders and care staff ensured people who used the service lead confident, inclusive and empowered lives.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

A more joined-up, cohesive and responsive approach to safety and risk management had been embedded into everyday practice.

Practices for the prevention and control of infection were operated effectively.

Medicines were managed safely. This included systems for receipt, storage, administration and disposal of medicines. Medicines systems were organised, and people received their medicines when they should.

Systems which sought to protect people from the risk of abuse were operated effectively. Relatives told us they were confident their loved ones were as safe as possible when using the service.

Environmental improvements had been made to better reflect national best practice guidance. Rooms were individualised to people who used the service on a visit by visit basis to ensure an appropriate environment. The communal garden had been transformed into a space that was safe, accessible and welcoming.

Improvements had been made, and sustained, to strengthen management oversight and quality assurance. Roles, responsibilities and staffing structures were better defined. A new registered manager was in post, along with a new deputy manager and a new service-wide Matron for learning disabilities.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an announced comprehensive inspection of this service in May 2019. Breaches of legal requirements were found in respect of safe care and treatment and premises and equipment. Consequently, the service was rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Short Break Service on our website at www.cqc.org.uk.

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.

The short break service is a care home providing respite care for up to three adults who live with complex needs associated with autism and/or a learning disability. During the course of the inspection, two people were using the service.

People’s experience of using this service:

Accommodation used by the service had undergone a recent refurbishment.

However, some aspects of the environment and surroundings had not been developed and designed in line with the principles and values that underpin CQC's policy for Registering the Right Support, the fundamental standards, and other best practice guidance. This meant the refurbishment had not been completed in a way that best supports people who live with autism and/or a learning disability.

A number of safety issues were identified associated with a refurbishment. The building had reopened before an updated fire risk assessment had been completed; grab rails had not been fitted in the newly refurbished communal bathrooms; no environmental risk assessments had been completed; and the outside garden area was found to be poorly maintained and not a safe space for people to access within a care setting.

There was an organisation structure in place, but the lines of accountability were not always clear. Nurse managers were required to navigate multiple departments and a variety of different officers when escalating concerns or seeking to find solutions.

Medicines systems were organised and people were receiving their medicines when they should. The provider was following safe protocols for the receipt, storage, administration and disposal of medicines.

The provider had effective safeguarding systems and policies and procedures which sought to protect people from abuse.

People had personal risk assessments in place and Positive Behaviour Support (PBS) plans. This was complimented by the fact staff knew people well.

Before a person started using the service, an initial assessment was completed with people and their relatives to ensure care was planned proactively and in partnership with them. Care plans were then reviewed and before each short break stay.

Staff had the required knowledge, experience and skills to meet people’s needs. Staff received a range of appropriate training applicable to their role.

The ethos of the service supported people's rights to make choice. This was well reflected in the good care and support people received from a committed and caring group of staff.

We observed staff demonstrating kindness, patience and respect and people were given time to express themselves fully. Staff knew people well and interactions were relaxed.

Rating at last inspection:

The service was newly registered on 01 October 2017. This was the first comprehensive inspection since new registration.

Why we inspected:

This was a routine planned inspection.

Enforcement:

At this inspection we identified breaches of legal requirements in relation to safe care and treatment and buildings and premises. You can see what action we have taken at the back of the full report.

Follow up:

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and other relevant stakeholders to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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