This inspection was carried out over three days on the 30 August and 04 and 05 September 2017. We visited the service unannounced on the first day and held telephone discussions with family members on the second and third days.

Atkinson Grove Chance for a Break Service is based in a residential area of Huyton and run by Knowsley Metropolitan Borough Council. The service provides short term respite care for adults with a learning disability.

At the last inspection in March 2015 the service was rated Good. At this inspection we found the service remained Good.

Hazards which posed a risk to people’s safety were identified and mitigated. Staff knew what abuse was and how to recognise and report it. There were enough staff available to provide safe care and support to people. Processes in place ensured the safe recruitment of staff. Medicines were managed safely and people received their prescribed medicines at the right times.

People received care and support from staff who received training and supervision for their role. People's rights and best interests were promoted in line with the Mental Capacity Act 2005. People's consent was obtained prior to the delivery of any care and support. People's dietary needs were understood and met and they were given a choice of food and drink.

Staff approached people and spoke with them in a kind and respectful way and they promoted people’s privacy and dignity. Staff had a good understanding of people’s emotional needs and how to support them.

People’s needs were assessed prior to each stay at the service and where required care plans were updated to ensure they reflected people’s current needs. Information was made available to people in an accessible format. A complaints policy and procedure was made available to people and relevant others. People knew how to complain and were confident that their complaint would be listened to and acted upon.

The registered manager promoted a positive and open culture. Checks were carried out at the service and improvements were made to ensure people received safe and effective care and support. People and relevant others were given the opportunity to provide feedback about the service and ways in which it could be improved.

Further information is in the detailed findings below.

This was an announced inspection, carried out on 13 March 2015.

Atkinson Grove, Chance for a Break Service is based in a residential area of Huyton and run by Knowsley Metropolitan Borough Council. The service provides short term respite care for a maximum of 4 adults.

The service has had a registered manager since December 2014. 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 last inspection of Atkinson Grove was carried out in August 2014 and we found that the service was not meeting all the regulations that were assessed. During this inspection we found that the required improvements had been made.

People told us they liked staying at the service and that they felt safe during the time they were there. Family members had no concerns about their relative’s safety and the way their relative was treated. Staff knew what their responsibilities were for responding to any concerns they had about a person’s safety, including allegations of abuse. Training provided to staff and information made available to them helped to ensure people were safeguarded from abuse and avoidable harm. The environment was clean and hygienic and equipment used at the service was regularly checked and tested to make sure it was safe.

A pre stay assessment was carried out prior to people commencing a stay at the service, and where necessary care plans were updated. Care plans detailed people’s wishes with regards to their care and support and they included important information about people’s preferred lifestyles. Care plans were regularly reviewed with the involvement of the person they were for and other important people such as family members and relevant health and social care professionals.

Processes for recruiting staff were safe and thorough to ensure staff were suitable for their role. People’s needs were understood and met by the right amount of skilled and experienced staff. Staff were available when people needed them and people told us that they liked the staff and that they were good at their job.

Staff ensured that people received the care and support they needed during their stay from other healthcare services. Staff were confident about what to do if they became aware of any concerns about a person’s health or wellbeing. Medication was managed safely and people received their medication at the right times.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood what their responsibilities were for ensuring decisions were made in people’s best interests.

Staff received an appropriate level of support and training relevant to the work they carried out and the needs of people who used the service. People who used the service told us they liked the staff and family members told us they had a lot of confidence in staff and that their relative had received the right care and support. Staff reassured people and were caring and kind in their approach.

The service was managed by a person who was described as being approachable and supportive. The quality of the service was regularly checked and improvements were made based on the findings of these checks and from seeking people’s views about the service.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

Staff had received training in relation to health and safety matters and they were confident about what to do in an emergency situation.

Changes to staffing arrangements took place without appropriate assessment of people’s needs therefore staff did not have all the information they needed to ensure people were safe at all times during their stay at the service.

People who used the service were cared for and supported by the right amount of appropriately qualified, skilled and experienced staff.

Systems for assessing and monitoring the quality of the service failed to identify the lack of appropriate checks on the environment and equipment used at the service therefore putting people’s health, welfare and safety at risk.

Is the service effective?

People who used the service responded positively to staff and we observed good relationships between staff and people who used the service.

There was a stable staff group at the service and they were familiar with the needs of people who used the service.

Systems for assessing and monitoring the quality of the service were not fully effective because they failed to identify the lack of proper assessment of people’s needs and care planning.

The lack of appropriate records in respect of people who used the service meant they did not always receive effective care and support.

Is the service caring?

During our inspection we observed that staff spent time with people who used the service and people told us the staff were kind. People responded positively to members of staff, which showed that good relationships existed between them.

One relative said, “My relative is well looked after by good staff.”

People who used the service and their relatives were complimentary of the staff and the service they provided. People’s comments included, “The staff are kind.” “My daughter has been going there for many years and has always enjoyed her stay.”

Is the service responsive?

Relatives of people who used the service told us that staff communicated well with them, one person’s relative said, “They get in touch if they have any concerns or need to know anything.”

The service did not respond appropriately to changes within the service by carrying out assessments of people’s needs.

Is the service well-led?

Staff had a good understanding of their roles and responsibilities and they were clear about the management structure of the service.

The registered manager of the service had recently left the service on a temporary basis and a senior member of staff had been appointed to oversee the day to day running of the service. At the time of our visit a new temporary manager was being appointed to manage the service.

Staff told us that a visit from a representative of the provider had not taken place for some time, therefore checks had not taken place to ensure that the service was being managed effectively and in the best interest of people who used the service.

We carried out an inspection on 22 October 2013 and published a report setting out our judgement. We asked the provider to send us a report of the changes they would make to comply with the standard they were not meeting.

We have followed up to make sure that the necessary changes have been made and found the provider is now meeting the standards included within this report. This report should be read in conjunction with the full inspection report.

We visited Atkinson Grove Chance for a Break as part of this review. We reviewed records and spoke to staff. This confirmed that they were now meeting the standards.

During our visit we used a number of different methods to find out what it was like for the people who had respite care at 3 Atkinson Grove. We spoke to four people about the home this included the manager, the supported service manager and two support staff. We also spoke to one of the relatives of the people who used the services at 3 Atkinson Grove by telephone.

We asked them if they thought the staff were competent and knew their job and they told us “oh yes, I wouldn’t leave her there if I didn’t think that”.

On the day we visited there were four people staying at the home, two of the people were at a day centre. All of the people had complex needs and were well known to the staff. Only one person was able to contribute to our report. We observed interaction between them and staff on duty and it appeared that people living there were happy and content. We found people were given the support they needed.

We asked staff what it was like working at 3 Atkinson Grove and they told us:

“Lovely, lovely atmosphere, caring, good team we’ve got a good bunch of staff”.

“I love my job, I love what I do…we really do care, we are dedicated to caring…to keep people’s dignity and respect. All of these practices we put in practice every day, every shift”.

We used a number of different methods to help us understand the experiences of people who used the service at Atkinson Grove Chance for a Break Service. This was because most of the people had complex needs which meant they were not able to tell us their experiences. We observed during our inspection that the people who used this service appeared happy and content.

During our visit we met individually with two of the people who used the service and we spoke over the telephone with four relatives. In addition we spoke with three members of staff who held various roles at Atkinson Grove. We also observed the support provided by staff and checked a sample of records.

At the start of our visit we observed that the people staying at Atkinson Grove were supported to engage in activities of their choosing. This included attending their regular day centre, going out and about in the community and spending time in the house.

Staff had a good understanding of people's support needs including how to meet their health and personal care needs and the different ways people communicated. Care records had been updated regularly to ensure information was up to date prior to people staying at the service.

We observed that the service was run as an ordinary domestic household. One relative told us, "It's just like home, we are totally pleased with everything.”

We also spoke with the Local Authority who said they had no concerns with Atkinson Grove.

We did not receive any direct comments about this outcome area.

All the people coming to stay in the home as guests arrive for their stay on a Friday afternoon every Friday afternoon the care workers hold a meeting with the people using the service about what they want from their stay and any particular plans they have.

Families and carers are contacted prior to the guests returning for their stay in order to determine if there are any changes in individual needs or if any particular event such as a hospital appointment are needed. Observations during the day showed that arrangements are available to meet people's medical needs.

When we arrived in the service, one of the people staying was going out for lunch with one of the care workers. The care worker discussed with him what he wanted to do and which paper he wanted to buy. On return the person spent the rest of the day reading his newspaper. Three of the people staying in the service at the time of our visit attended a day centre which they also attended when not staying in Atkinson Grove. The service supported the people staying with them to maintain their normal routines as they wished.

We have not received any referrals for safeguarding concerns from the service. The people we spoke with during our visit were happy to discuss any concerns with the management of the service. During our visit we observed care workers speaking to people living in the service in a warm and friendly manner. Their approach was supportive in manner and encouraging of a relaxed, domestic atmosphere.

Each person has a lockable space in their bedrooms where their medication is kept.. As people medicines are available in their bedrooms this means that care workers can make sure that they get their medication at a time that suits them and in a manner that suits their needs. Medication was not always correctly given.

People staying in the service told us that they liked the care workers and enjoyed their time in the service.