Isabel Court is a specialised short break service that provides respite care for adults with a learning disability and people with a physical disability. Hertfordshire County Council is registered to provide accommodation and care at Isabel Court for up to three people at any one time.

At the last comprehensive inspection in April 2015 the service was rated as Good. In October 2016 we received concerns in relation to staffing, medicines management and overall management of the service. As a result we undertook a focused unannounced inspection at that time and we found the concerns to be unsubstantiated, the rating remained as Good. At this inspection we found the service remained Good.

Relatives of people who used the service told us that they felt people were safe using the short break respite service. Risks to people’s health and wellbeing were appropriately planned for and managed. Robust recruitment processes were followed. People’s relatives told us that there were enough competent staff to provide appropriate and safe support when people needed it.

Staff had received appropriate training, support and development to carry out their role effectively.

People received appropriate support to maintain healthy nutrition and hydration. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). People were supported to make choices to have maximum control of their lives and staff supported them in the least restrictive way possible.

People’s relatives told us that people were treated with warmth and kindness by staff who respected their privacy and upheld their dignity.

People’s relatives were given the opportunity to feedback on the service people received. People received personalised care that met their individual needs and were given appropriate support and encouragement to access a variety of activities. People’s relatives told us they knew how to complain and were confident they would be listened to if they wished to make a complaint.

The management team had a robust quality assurance system in place and shortfalls identified were promptly acted on to improve the service.

The inspection took place on 20 October 2016 and was unannounced.

Isabel Court is a specialised service that provides short break respite care for adults with a learning disability and people with a physical disability. Hertfordshire County Council is registered to provide accommodation and care at Isabel Court for up to three people at any one time. The home is located in Hoddesdon, Hertfordshire.

The home had a registered manager. 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.

We carried out an unannounced comprehensive inspection of this service on 30 April 2015. After that inspection we received concerns in relation to staffing, medicines management and overall, management. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Isabel Court on our website at www.cqc.org.uk

People, their relatives and staff felt that the service provided at Isabel Court was safe. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. However, staff did not demonstrate an awareness of how to escalate safety concerns beyond Isabel Court.

People and their relatives told us that people’s needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely. There had been incidents of repeated medicine errors in recent times and actions had been taken to help promote safe practice in this area.

The provider had arrangements in place to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People’s relatives were comfortable to speak with the registered manager if they had a concern and were satisfied that they would be listened to.

Staff did not always feel that they were listened to and staff morale was low. The registered manager and the provider’s senior management team were actively engaged in making changes to the way staff were deployed in a bid to change the negative culture within the service.

The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

Isabel Court is a specialised service that provide short break respite care for adults with a learning disability and people with a physical disability. The home provides this service to around 40 individuals on a regular basis, with up to three people being cared for at any one time. Stays at the home are booked in advance in consultation with the senior staff and the manager.

There were three people in residence at the time of the inspection. One person was out of the home undertaking an activity and we spoke with the other two people individually. One person told us that the home was, "A really nice place." Both people commented that the, "Staff are very nice," and both stated that they, "Like it here."

People told us that they thought the facilities were good and one person commented that they liked having a television in their bedroom. The accommodation was appropriately designed, clean and suitable to meet the needs of the people living there. Risks within the home had been appropriately assessed.

We saw that support plans and risk assessments were informative and up to date. Staff were aware of their contents, which enabled them to deliver appropriate and safe care. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. Staff recruitment, induction and training systems were robust. We saw that the provider took account of a range of comments and different views to improve the service.

Some people using the service at Isabel Court were not able to tell us about their experiences so we used a number of different methods to help us understand.

We spoke to the relatives of three people who all made positive comments about the service provision at Isabel Court. They told us they were confident that staff supported people’s personal care and health needs. One person said, “[Person’s name] always comes home nice and clean, you just know people are well looked after.”

Relatives told us how the bookings for the respite service were carefully managed by the staff team to ensure people were able to share the accommodation with people they knew and were comfortable with.

A relative of a person using the service told us, “When staff speak about [person’s name] they are always very respectful.”

Family members told us they were confident that the service promoted the safety of the people who used the short stay service.

People said they thought the staff were, “All lovely” and told us that people using the service were always happy to go there.

The inspection took place on 30 April and 06 May 2015 and was unannounced. At our last inspection on 04 November 2013, the service was found to be meeting the required standards. Isabel Court 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 three adults who live with learning and physical disabilities. At the time of our inspection there were three people staying at the home on respite breaks.

There was a manager in post who is in the process of registering 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.

The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that a number of DoLS authorities had been granted in compliance with the MCA 2005.

People told us they felt safe at the home. Staff had received training in how to safeguard people against the risks of abuse and knew how to report concerns both internally and externally. Flexible arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs. Safe and effective recruitment practices were followed to check that staff were of good character, physically and mentally fit for the role and able to meet people’s needs.

We saw that plans and guidance had been put in place to help staff deal with unforeseen events and emergencies. People were supported to take their medicines on time and as prescribed by staff who had been trained. Potential risks to people’s health and well-being had been identified, discussed with them and their relatives and reduced wherever possible.

The environment and equipment used, including mobility aids and safety equipment, were regularly checked and well maintained to keep people safe.

People were positive about the skills, experience and abilities of the staff who looked after them. We found that staff had received training and refresher updates relevant to their roles. Senior staff held regular supervision meetings with staff to discuss and review their development and performance.

People told us that their day to day health and support needs were met and they had access to health and social care professionals when necessary. We found that people had been provided with appropriate levels of support to help them eat a healthy balanced diet that met their individual needs and preferences.

Staff worked closely with people’s relatives to understand how to communicate with them effectively. We saw that staff obtained people’s consent before providing them with personal care and support. However, we found that the guidance given to staff about whether or not people had capacity to make their own decisions lacked consistency.

We saw that people were looked after in a kind and compassionate way by staff who knew them and their relatives well. Information about local advocacy services had been made available for people who wished to obtain independent advice or guidance.

We found that staff had developed positive and caring relationships with the people they looked after. They provided help and assistance when required in a patient, calm and reassuring way that best suited people’s individual needs.

People and their relatives told us they had been fully involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about people’s medical and personal histories had been securely maintained.

We found that personal care was provided in a way that promoted people’s dignity and respected their privacy. People told us they received personalised care that met their needs and took account of their preferences. We found that staff had taken time to get to know the people they looked and were knowledgeable about their likes, dislikes and personal circumstances.

There were opportunities available for people to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community. People and their relatives told us that staff listened to them and responded to any concerns they had in a positive way. However, although complaints were responded to in a positive way, we found they had not always been recorded and managed in a consistent manner.

People, their relatives and staff were complimentary about how the home operated and the supervisory arrangements. However, some relatives were not familiar with the manager and some staff felt they were not sufficiently visible.

Measures were in place to monitor the quality of services provided, reduce potential risks and drive improvement. However, the manager had not personally and regularly checked key aspects of service provision in a formalised or structured way.