The inspection took place on 10 January 2018. The inspection was announced.

36a Birling Avenue is a residential care home providing respite care for up to seven people with a learning disability or autistic spectrum disorder. A respite care service provides care and support for people who do not require a permanent stay in a care home. For example, people stayed at 36a Birling Avenue where they could receive the care and support they required when their families or carers (carers) planned time to go on holiday or a weekend away. Many people saw their stay in respite care as their holiday too. Bedrooms were available on the ground and the first floor. People who were able to use the stairs independently could use the upstairs bedrooms. One double bedroom was available if two people chose to share, such as siblings or friends, but was also used for emergency accommodation at times. The service was in a residential location with easy access to shops and public transport so that people who were able to go out into the community independently could continue to do so while staying at the service. Due to the nature of the support needs of people, two members of staff slept at the premises each night and a bedroom was set aside for this purpose. Three people were staying for respite care at the time of our inspection.

At the last inspection on 18 November 2015 the service was rated Good. However, we did find one breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not have systems and processes in place to ensure they could identify, assess and monitor quality and safety within the service.

At this inspection we found the service remained Good and improvements had been made to the quality auditing systems.

A registered manager was employed at the service and had been in the position since before the last inspection. 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.

Staff continued to be aware of their responsibilities in keeping people safe and reporting any suspicions of abuse. Staff knew what the reporting procedures were and were confident their concerns would be listened to.

Individual risks were identified and steps continued to be taken to reduce and control risk, making sure people and staff had the guidance they needed to prevent harm while at the same time supporting independence. Accidents and incidents were recorded by staff, action was taken and followed up by the registered manager.

The processes for the administration of people’s prescribed medicines was still managed and recorded well so people received their medicines as intended. Regular audits of medicines were now undertaken to ensure safe procedures were followed and action was taken when errors were made.

The registered manager continued to undertake a comprehensive initial assessment with people when they applied for a respite care service which fully included the involvement of the person and their carer’s. Care plans were developed and regularly updated and reviewed to take into account people’s changing needs between visits to the service. People’s specific needs were taken account of and addressed in care planning and in planning people’s respite care visits to ensure equality of access to services.

People were supported to make their own choices and decisions. The registered manager and staff continued to have a good understanding of the basic principles of the Mental Capacity Act 2005 (MCA) and promoted people’s rights.

People were given plenty of choice at mealtimes and staff were flexible, often planning meals around the food they knew people liked. Staff were aware of people’s specific dietar

The inspection was carried out on Wednesday 18 November 2015 and was unannounced. The service provided accommodation and personal care within a respite service for up to seven people with a moderate to severe learning disability.

The accommodation was spread over two floors with bedrooms on the ground floor as well as the first floor. There was one double room, mainly used by siblings or friends who chose to share but were also used for emergency accommodation at times. The accommodation was well presented with a large communal area. A garden of good size at the back of the property was well maintained and provided a good space for people to use. There were four people staying for respite care at the time of our inspection

There was a registered manager employed at the service. 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.

The provider did not have systems and processes in place to monitor the quality and safety of the service. We found discrepancies in two people’s medicines records.

People and their relatives said they felt safe at the service and knew who they would speak to if they had concerns. A safeguarding procedure was in place and staff knew what their responsibilities were in reporting any suspicion of abuse. Staff could also describe how to recognise the signs of abuse.

People were kept safe by the management of risks without impacting on their independence. Plans were in place with safety measures to control potential risks. Risk assessments were reviewed regularly so had up to date information for staff to follow.

Fire prevention and safety was well thought out and managed. The premises and gardens were well maintained, clean and well presented. All maintenance and servicing checks were carried out, keeping people safe when staying at the property.

There were enough staff on duty to support people with their assessed needs. The provider followed safe recruitment procedures to ensure that staff working with people were suitable for their roles. Robust recruitment procedures were followed to make sure that only suitable staff were employed.

Accidents and incidents were reported and recorded following the provider’s policy and procedure. There was evidence of the registered manager and the team learning from these experiences. This kept people safe from similar incidents occurring in the future.

The staff had the skills and knowledge to support the people who came to the service for respite care. Training plans were in place and all staff had the required training to meet the needs of the individuals attending the service. Additional training was also provided as necessary so the development of staff was taken seriously. Staff received regular support and supervision from the management team.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager and staff showed that they understood the Mental Capacity Act 2005 and DoLS. The registered manager understood their responsibilities as Mental Capacity assessments and decisions made in people’s best interest were recorded.

People’s needs were assessed before moving into the service with involvement from people and their family members/carers. Care plans contained detailed person centred information and guidance. All aspects of a person’s health, social and personal care needs were included to enable staff to meet their individual requirements. People were encouraged and supported to engage in activities within the service and in the community.

People said the food was very good and there was plenty of it. People were able to choose from a menu but also choose something different if they didn’t like what was on offer.

People and their relatives confirmed the service was a caring environment. The staff knew people very well. We observed a relaxed atmosphere with everyone chatting together.

People’s privacy and dignity were respected by staff who could describe what this meant. There was an emphasis on maintaining and increasing independence. People described helping to make meals and making their own drinks.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

- Is the service safe?

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that a proper policy relating to DoLS was in place and we spoke with the registered manager who demonstrated their knowledge of the procedures to follow. We saw evidence that all staff had been trained in DoLS, in the Mental Capacity Act 2005 and in the safeguarding of vulnerable adults. We found that best interest meetings were held when necessary following people's mental capacity assessments. Risk assessments with clear action plans were in place to ensure people remained safe. There were effective systems in place to reduce the risk and spread of infection.

- Is the service effective?

People and their relatives stated they were satisfied with the quality of care that had been delivered. We saw that the delivery of care was in line with people's care plans and assessed needs. We found that the staff had received training to meet the needs of people living at the home. Staff received additional training when needed and when they requested it. We found that people who used the service were supported by suitably qualified, skilled and experienced staff. Relatives commented, "We are very pleased with the service that is provided", and, "My son is always happy when he knows he is going there for respite".

- Is the service caring?

We found that people who lived in 36a Birling Avenue were supported by kind and attentive staff. We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. We saw staff helped people with their care and support, at mealtimes and during activities with patience and kindness. People who used the service told us, "It is like a holiday, I like it a lot"; A member of staff said, "This is where people can have a break, feel safe and enjoy themselves ". We found that the service responded promptly and appropriately when people were unwell.

- Is the service responsive?

People's needs had been assessed before they moved into the home and their support plans were reviewed regularly to reflect any change in their needs. We saw that people's records included people's history, wishes and preferences and individual communication needs. Preferences such as choice of rooms were accommodated when practicable. People and/or their representatives were involved with reviews of care plans and were kept informed of any changes. People had access to daily activities that included outings to bingo, bowling, golf driving ranges, cinema, drama and social clubs. People and their relatives' comments and suggestions were listened to and followed through with adjustments made when practicable.

- Is the service well-led?

We found that comprehensive policies and procedures that addressed every aspect of the service were in place. The registered manager operated a system of quality assurance and completed audits to identify how to improve the service. Staff told us the manager and deputy manager operated an open door policy. They described how they were able and encouraged to express their views and concerns they may have and said they were listened to. Complaints, incidents and accidents were appropriately recorded and audited. People and their relatives or representatives were consulted about how the service was run and annual survey questionnaires were sent and analysed. The surveys were audited to identify how the service could improve.

The visit was carried out by one Inspector over four hours. During this time we met four people receiving respite care and we were able to chat with two of these. One person had limited verbal ability, and the other person just greeted us but did not want to talk.

We found that there was a calm and relaxed atmosphere. People said that they liked going to the home for respite care. One person said “I have been here for a few days and I am going home today. I have had a good stay. I did lots of things like bowling, going to a fireworks party and going to the disco.”

We looked at the processes for people coming in for respite care and saw that these were appropriately detailed. The staff obtained updated information so that they were aware of any changes in people's health needs or social situations.

We found that people’s care plans contained clear directions to help staff to care for people, and to give them an enjoyable time during their stays.

We inspected medicines management and found there were suitable procedures in place.

Staff were kept up to date with mandatory training courses, and were able to develop their skills and competencies according to their own preferences. The staff said that they felt supported by the management.

The home had on-going systems in place for obtaining people’s views and making any appropriate changes to improve the quality of the service. A relative had commented on a questionnaire: “I have never found anything other than a relaxed and calm atmosphere. All the staff are very friendly and approachable, and caring and professional.”

The home had two people who were having respite care at the time of the inspection, and we met both of these. One person was reported as being shy, and did not wish to talk with us, and the other person had limited communication abilities. We saw that both people were relaxed with the staff, and responded to their comments and questions. One of the people accompanied the Inspector for most of the visit, and gave positive answers to questions. For example, they said “Yes” to confirm that they liked going into the home for respite care; they liked the staff; and the staff looked after them well.

We saw that the home was clean and well maintained. The manager told us that many rooms had been redecorated and refurbished during the previous year. People were able to bring in small items of personal belongings to keep in their bedrooms.

We found that the manager and staff carried out ongoing liaison with other health and social care professionals to enable the home to run smoothly. The home had an on-call system to provide back-up for staff in the event of any emergency.

The home ensured that there were sufficient numbers of staff to care for people receiving respite care. The staffing numbers were worked out in relation to the number of people receiving care, and their individual dependency levels.

We met three people receiving respite care during our visit. They did not talk easily with someone who was a stranger to them. However, in response to gentle questioning, all three said that they “liked it here”, and “liked coming in here.”