This inspection took place on 27 and 28 September 2017 and was unannounced on the first day. Kingsbridge Road provides a respite service for up to 11 people with learning disabilities or autistic spectrum conditions across three ground floor flats with a shared garden. Each flat contains a shared lounge, bathroom and shower and kitchen. Two of these flats provide an unplanned respite service, and one flat provides a planned respite service. At the time of our inspection there were 10 people using the service.

We last carried out a comprehensive inspection in May 2016 where we found breaches of regulations relating to the safety of the premises and consent to care and rated the service “Requires Improvement”. We carried out a focussed inspection in November 2016 where we found the provider was now meeting these regulations and changed their rating to “Good”. At this inspection we found the service remained “Good”.

The service had 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.

Since our last inspection visit, we found that the service was supporting more people with complex, mental health needs. We saw that the provider had suitable measures in place to manage this, including working with other professionals to plan people’s support and managing risks in a way which protected and promoted people’s rights. There were measures in place to manage times when people’s behaviour could challenge. Incidents and accidents were monitored and measures put in place in response to these. Staffing levels varied in order to meet the needs of who was using the service at the time. The provider maintained safer recruitment measures and included people who used the service in interviewing and assessing a candidate. There were suitable systems in place to safeguard people from abuse.

We brought this planned inspection forward as the provider had reported a number of medicines incidents. We saw that an action plan was in place to address this, however some of the checks carried out on medicines were not always being applied effectively in a way which would detect mistakes. We have made a recommendation about this. We found that people’s medicines were checked in and out of the system and there were clear medicines support plans, including medicines which were given as needed.

The service was able to respond to people’s changing needs, through support planning and review. Circle of Support meetings took place as needed, and were used to review people’s support and ensure that decisions were made in people’s best interests when necessary. The provider had assessed people’s capacity to make decisions and worked to promote people’s rights.

People were supported to speak up through keyworking and everyday interactions and the provider maintained communication passports and other tools to promote this. People continued to have personalised programmes of activities. Managers had clear tools in place to ensure that people’s needs were met throughout the day, including shift plans and regular handovers between shifts.

The building remained in a poor condition in places and had not been designed for its current purpose, which the provider worked with the building’s owners to address. Although the condition was poor, the building was not unsafe and the provider had worked to promote a more homely environment. We found that sometimes health and safety checks were not overseen in a way which meant that issues of concern could be addressed promptly, however these were audited by managers. There were measures in place to promote fire safety, including tests of fire equipment and personal evacuation plans.

Managers were visible in the service

We carried out an unannounced comprehensive inspection of this service on 24 and 27 May 2016. Breaches of legal requirements were found regarding safe care and treatment and consent. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kingsbridge Road on our website at www.cqc.org.uk.

There was a registered manager 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.

At our previous inspection we found that the provider was not carrying out satisfactory health and safety checks and was failing to assess people’s capacity to make decisions about their care. We found that the provider was now meeting these requirements. Health and safety checks were taking place regularly with clear guidelines for staff and oversight by managers. Where checks had highlighted issues, these were followed up by the registered manager. The provider had taken steps to ensure that these took place by including these in shift plans, carrying out monthly and quarterly audits and clarifying responsibilities amongst staff.

The provider was acting in line with the Mental Capacity Act (2005) by carrying out assessments of people’s capacity to consent to their care. A new support plan had been devised which would help to ensure that everyone’s capacity was considered, but this was not in place for everyone who used the service. Where people could not sign their plans, the provider recorded discussions which had taken place with people to support them to understand decisions and to consent to their care. Where people were not able to consent to their care, the provider held meetings to ensure that they were working in people’s best interests.

This inspection took place on 24 and 27 of May 2016 and was unannounced on the first day. On the second day the provider knew that we would be returning. This was the first inspection for this service since the provider took over responsibility in July 2015.

20 Kingsbridge Road provides respite care for up to 11 people with learning disabilities and/or autistic spectrum conditions, including people with behaviour which may challenge the service. The building consists of three self-contained flats, each with a kitchen, lounge and communal bathroom and shower, with a shared courtyard and garden. These flats are divided between the planned and unplanned respite services. The unplanned service provides accommodation at short notice for people who are unable to stay at home due to unforeseen circumstances.

The service had 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.

The environment was not in good condition, and the provider showed us how they had worked with their landlord to take steps to address this. We saw that a number of vital health and safety checks were carried out, however there were still areas where these were not adequate to ensure people’s safety. Staff had a good understanding of their responsibilities to safeguard people who used the service, and the provider took appropriate action to report and act on concerns where people may be at risk. Risks to people who used the service were assessed, reviewed and managed effectively.

We saw that the provider was not always acting in line with the Mental Capacity Act (2005), and was not carrying out assessments of people’s capacity to consent to their care. Where people may be at risk of being deprived of their liberty, the provider had assessed these risks and taken the necessary action to notify the local authority and CQC.

The service provided person-centred care through the use of support planning and tools to ensure that activities were in line with people’s needs and wishes. This had resulted in a detailed and varied activities programme which relatives of people who used the service spoke highly of. Staff had a good knowledge of people’s support needs and preferences, which were recorded in support documents and reinforced by regular discussions at team meetings. Staff made the time to speak to people and allowed people to do things at their own pace. Staff had received sufficient training to carry out their roles and were well supported by their managers.

The service had tools in place to ensure good communication with people who used the service, including the use of photographs and personalised accessible documents such as activity plans. These were used to support people to make choices and develop good relations with staff.

The provider reviewed people’s support regularly through the use of circle of support meetings, where people and their families met with the staff team and other professionals involved in their care in order to discuss aspects of their care. These were carried out regularly in a way which responded to people’s changing needs. Managers engaged with people’s families in a number of ways through the use of coffee mornings, and held meetings with people who used the service to discuss how they wanted changes to take place. People were supported to eat a varied diet and where necessary to access medical appointments. Essential information about these appointments were relayed to staff.

Staff were recruited in line with safe recruitment processes and in a way that ensured they shared the organisation’s values. Staffing levels were sufficient to safely meet people’s needs, including providing 1:1 support in the building, and 2: