This inspection of Hixberry Lane Short Break Service took place on 9 and 10 October 2018 and was unannounced. At their last inspection on 2 and 3 March 2016, they were found to be meeting the standards we inspected and were rated as overall Good. At this inspection on 9 and 10 October 2018 the overall rating remains Good.

Hixberry Lane Short Break Service 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. Hixberry Lane provides short term support without nursing care for up to four people who have a learning disability and who may also have a physical disability, mental health needs or other complex health needs. The service is owned by Hertfordshire County Council and the property is managed by Aldwyck Housing Association. Hixberry Lane is a four-bedroom ground floor unit with a communal lounge/ dining area which is situated beside a supported living service. There were four people at the service at the time of the inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy.

The service had a registered manager. The registered manager also managed the supported living service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 environment was clean throughout though lack of storage space could impact on infection control. However, communal areas required decorating to refresh them and make them more homely. The kitchen had been renewed but was not made adaptable for people using wheelchairs to access.

People were safe, happy and supported by staff with the necessary skills to do this. Staff had been trained to safeguard people from avoidable harm. People had access to safeguarding information in an easy read format to help keep themselves safe.

Risks to people’s health and well-being were identified, planned for and managed. There were sufficient competent and experienced staff to provide people with appropriate support when they needed it.

Personal emergency evacuation plan plans had been developed for each person and staff knew what support would be provided in the event of an emergency such as a fire.

People received care from staff who knew them well. People were involved in the planning, and reviews of the care and support provided.

Staff treated people with kindness, dignity and respect. Relatives were positive about the care and support provided.

Medicines were managed safely and people received their medicines in a way they had been prescribed.

Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

The service worked within the principles of The Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to maintain good health and had access to health and social care professionals when necessary.

Relatives knew how to make a complaint and were sure they would be listened to and any concerns acted upon.

Staff had developed positive and caring relationships with the people they cared for and knew them very w

The inspection took place on 02 and 03 March 2016 and was unannounced. At our last inspection on 06 December 2013, the service was found to be meeting the required standards that we looked at. Hixberry Lane is a residential care home that provides accommodation and personal care. It is a specialised service that provides short break respite care for up to four people who live with learning disabilities . At the time of our inspection three people were at the service on short breaks.

There was a manager in post who is registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Most of the people who stayed at the service during our inspection were unable to communicate with us verbally so we spoke with relatives, staff members and observed how care and support was provided in communal areas, for example in the lounge and kitchen.

People told us they felt safe when staying at Hixberry Lane. Relatives were confident that staff helped their family members stay safe, both at the service and when out and about in the community. Staff received training about how to safeguard people from abuse and were knowledgeable about the potential risks and how to report concerns.

Robust recruitment practices were followed and there were sufficient numbers of suitable staff available at all times to meet people’s individual care and support needs.

Plans and guidance were available to help staff deal with unforeseen events and emergencies in a safe and effective way. Where necessary and appropriate, people were supported to take their medicines safely and at the right time by trained staff. Potential risks to people’s health and well-being were identified, reviewed and managed effectively.

People who used the service and their relatives were positive about the skills, experience and abilities of staff who received training and refresher updates relevant to their roles. Staff also had regular ‘one to one’ meetings with managers to discuss and review their personal development and performance.

People were encouraged and helped to maintain good health and were supported to eat a healthy balanced diet that met their individual needs when staying at the service.

Staff obtained people’s agreement to the support provided and always obtained their consent before helping them with personal care. In the case of people who were non-verbal, consent was sometimes implied based on staff member's experience and thorough understanding of their needs and how they communicated. However, this was not consistently or accurately reflected in people’s care and support plans. Some people lacked capacity to make certain decisions for themselves but again this was not always made clear in their plans of care.

We saw that staff supported people in a kind and caring way that promoted their dignity and independence. Staff had developed positive relationships with the people they supported and where clearly very knowledgeable about their needs and personal circumstances.

People who received support, and their relatives wherever possible and appropriate, were involved in the planning and reviews of the care provided. The confidentiality of information held about people’s medical and personal histories was maintained at the service.

People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences and routines. People were supported to pursue interests and take part in meaningful activities relevant to their needs while staying at the service.

Relatives told us that managers and staff listened to them and responded positively to any concerns they had. Th

During our last visit in August 2013, we found that the provider was not compliant with the administration of medication. During this inspection, we found they were now compliant with ths regualtion. On this occassion we did not speak to the people using the service.

During our inspection on 20 August 2013, we noted that the only person currently staying at Hixberry Lane was spending the day in the day centre. Therefore, we were unable to speak with them. We revisited on 31 August 2013 as part of this inspection so that we were able to speak with three other people and receive feedback on their experiences whilst staying for short breaks in the respite unit.

Although the three people we spoke with have a learning disability, they were able to express that the staff ‘are good’ to them. One person said that they were ‘going to the cinema’ and shortly afterwards, the person left with a member of staff to catch the bus for the local cinema. One person told us that a member of staff assisted them to make a ham sandwich which they had for breakfast. A third person had been out in the morning, accompanied by a member of staff. The same person later had a corned beef sandwich as of choice, which the member of staff had made for them. We observed that all the three people were content and well cared for.

The three members of staff we spoke with said that people had been encouraged and supported to lead independent lives and that staff gave support and assistance accordingly. We noted that the premises were well maintained, clean and comfortable. The staffing level and skill mix of staff was adequate.

However, our inspection identified concerns relating to the safe administration of medicines.

People we spoke with told us that staff always treated them with respect, and they were happy with the care they received. They were satisfied with the social activities available to them, and felt involved in decisions about their care. Comments from people included, “Its nice living here” and, “Staff go for walks with me to help me exercise my leg".

During our visit we had contact with two people who came to stay at Hixberry Lane for planned respite stays. We met one person as they arrived. They were welcomed by staff and looked pleased to be there. People indicated that they were happy with their surroundings and were relaxed with the staff present who they looked to for guidance.

We found that there had been some changes to the management of the respite unit, which meant that the assistant manager at Hixberry Lane was actively monitoring the systems in place to support people who stayed on the respite unit and the staff who worked there. This included ensuring staff received regular supervision.

Overall we found that the standards we reviewed were being met.