We carried out an unannounced inspection of the service on 31 October 2017. Nottinghamshire County Council is the registered provider of Holles Street Short Breaks Service. This service provides respite care and support for up to ten adults with a learning disability. On the day of our inspection five people were using the service and there was a registered manager in place.

At the last inspection, in September 2015, the service was rated Good. At this inspection we found that the service remained Good. The rating for the Caring domain has changed from Good to Outstanding.

People continued to feel safe and staff ensured that risks to their health and safety were reduced. There were sufficient staff to meet people’s needs in a timely manner and systems were in place to support people to take their medicines. Safe recruitment systems were in place.

Staff received relevant training and felt well supported. People were asked for their consent and appropriate steps were taken to support people who lacked capacity to make particular decisions. People were supported to eat and drink enough to maintain good health.

Positive and caring relationships had developed between people and the staff who cared for them and staff went the extra mile to provide support which centred on the person and individual goals. Staff took the time to get to know people well and to understand what worked for them and they empowered people to have independence and autonomy. People were treated with dignity and respect by staff who understood the importance of this.

People received person-centred and responsive care from staff who had a clear understanding of their current support needs. Care plans were in place which provided clear information about the care people required. People knew how to make a complaint and there was a clear complaints procedure in place.

There was an open and transparent culture which enabled people and staff to speak up if they wished to. The management team provided strong leadership and a clear direction to staff. There were robust quality monitoring procedures in place.

Further information is in the detailed findings below.

This inspection took place on the 9 September 2015 and was unannounced.

Holles Street Short Breaks Service provides respite care for up to ten adults with learning disabilities who live in Nottinghamshire. The service is in Worksop, Nottinghamshire.

The service has a registered manager. 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.

On the day of our inspection, we found that people who used the service and those supporting them knew who to report any concerns to if they felt they or others had been the victim of abuse. Staffing levels were based on the assessed need of those using the service at the time to ensure that there were sufficient staff. These staff had received the training they needed to provide care well and were supported by the leadership at the home. Medicines were stored and handled safely.

Risks assessments were in place to identify and reduce the risk to people’s safety as part of each support plan. The Mental Capacity Act 2005 had also been considered when determining a person’s ability to consent to each aspect of their support. Applications required under the Deprivation of Liberty Safeguards (DoLS) were in the process of being made in order to reduce the risk of people being unlawfully restricted. People were able to choose what they ate and maintained good links to their healthcare providers if they needed them.

Staff were kind and attentive to the needs of those they were supporting, responding to people’s needs in a timely manner. We saw that efforts were made to ensure that people felt at home when staying at Holles Street and maintain the routines and contacts that were important to them. Activities were planned around the needs and interests of those using the service.

Everyone we spoke to had confidence in the leadership of the service who shared clear expectations with the team. People were encouraged to give feedback on the service provided There were systems and process to ensure standards are maintained.

Due to the complex needs of the people using the service we used a number of different methods to help us understand their experiences when we undertook our visit.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with one person who used the service and asked them for their views. We also spoke with two care staff and a team leader. We also looked at some of the records held in the service including the care files for four people who were using the service when we visited. We observed the support people who used the service received from staff.

We found people who used the service were respected and involved in their care. A staff member said it was the culture of the service to promote people’s independence.

We found people received care and support that met their needs. Some care plans were written with the assistance of specialist advisors when there were complex issues to consider.

We found that suitable arrangements were in place to manage people’s medication and ensure they received any medication they needed. We saw the current medicine administration records were fully completed for the period of time people had stayed at the service. One person who used the service confirmed a cream was applied as prescribed.

We found there were sufficient and suitable staff employed. The team leader showed us how they planed the rota and how it could be adjusted at short notice if more staff were needed to ensure people were safe.

We found there was an effective system for identifying and responding to any complaints or comments made. Staff told us they dealt with any little issues a family member or carer raised when dropping off or collecting people who used the service.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with one person who used the service and a visiting relative and asked them for their views. Due to the complex needs of the people who used the service we used a number of different methods to help us understand their experiences when we undertook our visit.

We spoke with three care workers, a team leader and the registered manager. We looked at some of the records held in the service including the care files for three people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people gave consent to their care and treatment and received care and support that met their needs. We saw staff attending to people’s needs in a caring and sensitive manner. A relative told us they received a pre-admission phone call from staff at the service to find out if there were any changes to the person’s care.

We found people were safeguarded from abuse. A relative told us, “I believe they (the person who used the service) are safe here.”

We found the staff team were supported through training and the provider assessed and monitored the quality of the service. A relative told us, “I can’t fault them for what I have seen. They show concern and talk to me if I have any concerns.”