Orient St Adult Respite Unit is a care home and provides respite care for up to five adults with learning disabilities. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Orient St Adult Respite Unit shares the building, some facilities, the registered manager and staff with a respite unit for children and young people with learning disabilities; which service is regulated by the Office for Standards in Education, Children’s Services and Skills (Ofsted).

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.

At the time of our inspection, Orient St Adult Respite Unit was providing support to four people.

At the last inspection on 13 May 2016, the overall rating for the service was Good.

There was a registered manager in post. 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 2008 and associated Regulations about how the service is run.

We carried out this unannounced inspection of the service on 3 July 2018. At this inspection, we rated the service Requires Improvement overall for the first time. This was because aspects of the service were not safe and well led. Staff felt that there were not always sufficient numbers of them deployed to care and support for people. Staff worked under pressure to meet people’s needs and there were not effective systems in place to manage emergency admissions. The provider had started recruiting additional staff to resolve the staffing level concerns. Checks and audits were carried on the quality of care. However, improvements were not always done in a timely manner.

People received their medicines when needed. However, staff did not have sufficient guidance on how to manage ‘when required’ medicines. Staff underwent medicines management training and a competency assessment.

Risk assessments and management plans were appropriate for people who used respite services on a regular basis. However, risk assessments for emergency admissions at the service did not always reflect people’s needs and the support they required.

Staff understood safeguarding procedures to follow to identify and report abuse to protect people from harm. The provider’s recruitment procedures were appropriate in ensuring that only staff deemed suitable delivered care to people.

Staff received support, training and supervision to enable them to deliver care. The registered manager monitored staff performance and development needs.

People were treated with kindness and compassion. Staff respected people’s dignity and privacy. People enjoyed positive caring relationships with the staff who provided their care.

People had access to healthcare services and the support they required to maintain their health and well-being. Staff involved people in menu planning, meal preparation and maintaining a healthy diet. People were encouraged to develop their daily living skills and to do as much as possible for themselves.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff continued to deliver care and support in line with the requirements of the Mental Capacity Act 2005. People received the support they required to consent to care. Staff acted in people’s best interests when they were unabl

The unannounced inspection took place on 13 May 2016. Orient St Respite Unit provides respite care for up to four adults with learning disabilities. The service shares the building, some facilities, the registered manager and staff with a respite unit for children and young people with learning disabilities.

We last inspected the service on 29 May 2014 where the service met all the regulations inspected.

At the time of our inspection the service had one person using the service and three people were referred for respite care at the service later that day. People stayed at the service for three days to one week, but could stay more or less depending on their needs. Respite stays were booked in advance but emergency and short notice stays could be arranged when necessary. Some people using the respite service continued to attend day services during their stay which meant there were sometimes less people at the service during the day.

There was a registered manager in post. 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 and associated Regulations about how the home is run.

People, their relatives and healthcare professionals told us the service was safe. Staff understood the types of abuse that could happen to people and their responsibility to report any concerns and take action to protect them from harm.

People told us staff listened to them and respected their privacy. Staff had complied with the law in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) when people lacked mental capacity. Staff knew how to protect people’s rights.

Staff were supported in their roles through regular supervision and appraisal. People received their support from staff who had received relevant training and had the knowledge to deliver their care effectively.

People told us they enjoyed their stay at the service because staff met their needs. There were sufficient staff to meet people’s needs effectively. Staff knew people well and provided their care and support in a caring manner. People received sufficient food to eat and drink and had a choice over what they wanted to eat, how they wanted to spend their time and which staff supported them. People were involved in the local community and enjoyed a range of activities.

People were supported by suitable staff who had been recruited using a robust procedure. People received the support they required with their medicines from staff who were assessed as competent to administer medicines safely. Staff had identified risks to people’s health and wellbeing. Support plans were in place for staff on how to manage the identified risks and the action to take to minimise those risks whilst enabling people to be as independent as possible.

People enjoyed good relationships with staff. Staff ensured people, their relatives and friends were made welcome at the service. People looked forward to coming back to the service again for their break. People received care which took into account their choices and preferences. Staff encouraged people to be as independent as possible.

People’s needs were thoroughly assessed and their support was reviewed before they returned to the service for another stay. Staff had up to date information about people’s needs and the support they required. People’s needs were met and relatives were happy about how responsive the service was, particularly when managing emergencies at the service. People knew how to make a complaint and felt able to use the complaints procedure in place.

People, staff and healthcare professionals told us the registered manager led the service effectively. The registered manager used effectively the audit systems in place to monitor the quality of the service and support pr

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Staff were knowledgeable in recognising signs of potential abuse and the relevant reporting processes. There were processes in place to ensure people’s safety whilst using facilities shared with the provider’s children’s service. There were systems for protecting people from financial abuse.

All activities were risk assessed to ensure they were safe for people to do. Individual risk assessments were undertaken and management plans were in place about how to minimise the risk from occurring.

People’s needs, interests and abilities were identified and taken into consideration during group bookings to ensure there were appropriate staffing numbers to ensure the safety of people who used the service.

Is the service effective?

People who used the service told us they enjoyed going to the service and that it “gives me a break and my family.” Relatives of people who used the service described the service as “a fantastic place,” “a wonderful service,” and “the staff are great.”

Staff were knowledgeable about people’s support needs, their interests and preferences. Staff spoke with people who used the service and their relatives before they stayed at the service to identify any changes in people’s health and support needs.

People were asked about what they wanted to eat at the start of their stay and this was catered for. People were provided with additional support and adaptive crockery and cutlery as required enabling them to eat and drink independently.

Is the service caring?

People who used the service told us they liked the staff and enjoyed going to the service.

People were involved in decisions about their care and their views were listened to. People were given choice about what they wanted to do whilst at the service. Meetings were held at the beginning of their stay to identify what they wanted to do during their time at the service and they were supported by staff as required.

Staff were knowledgeable on people’s cultural and religious needs and staff supported people to meet those needs.

Is the service responsive to people’s needs?

One staff member told us, “It’s great being able to respond to people’s needs and help them with activities when they want it.” People were supported to access the community and to undertake activities in line with their wishes. Staff encouraged people to be independent. It was identified before people’s stay if they were in the process of learning new skills to increase their independence and staff supported them to continue developing their skills, for example, learning how to make a cup of tea.

There were systems in place for people who used the service and their relatives to feedback on service provision. At the time of our inspection there had been no complaints received and the relatives we spoke with told us they had not needed to complain or raise any concerns regarding the quality of service provision.

Is the service well-led?

There were systems in place to monitor the quality of service provision. The most recent checks did not identify any concerns with the quality of service provision. This included checking health and safety processes, emergency procedures such as fire evacuation drills, and identifying any concerns or training requirements within the staff team.

There was a process for recording incidents. However, for low level incidents there was not the process in place to record the action taken to ensure the safety and welfare of people who used the service. The manager was in process of reviewing this system and implementing a new recording tool.

Four people stay at the unit for up to a week at any one time. We spoke with two of the three people using the service on the day of our visit. They told us about some of the things they did while they were there, such as watching television, making cakes and going on trips in the service’s minibus. They said they liked it there and they liked the staff.

People were able to make choices about how they spent their time at the unit. Decisions about care and support were made in people’s best interest and were described in care plans that were developed with the person and their family carers.

Staff we spoke with felt well supported by other staff and their manager, and had access to good quality training.

We found there were arrangements in place for the safe storage and administration of medicines. Records were well kept and fit for purpose.

Forty people currently use the service, with four people staying at the unit at any one time. We spoke with two of the four people using the service on the day of our visit. They showed us the different things they did while they were staying at the respite unit. They said they liked it there and they liked the staff.