This inspection took place on 20 and 21 November 2017 and was unannounced. At our last inspection in February 2017 we found the service had met the requirement actions set at our previous comprehensive inspection in September 2015. We had left the Safe domain as ‘requires improvement’ and at this inspection we saw that the improvements found in February 2017 had been sustained.

Short Break Service is a ‘care home’ type of service. 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. The Short Break Service provides periods of respite care for people aged between 18 and 65 years of age with learning disabilities and who may also have profound physical disabilities. The service provides support to approximately 51 people through periods of planned respite throughout the year. At any one time the service can accommodate a maximum of 10 people. The service also supports people who need respite on an emergency basis. All the people who use the service live in the London Borough of Ealing.

The service is required to have a registered manager and there was one 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 2008 and associated Regulations about how the service is run.

The provider had systems in place to safeguard people from the risk of abuse and staff were confident they would report any concerns. Staff assessed risks for individuals and developed action plans to mitigate identified risks. The provider ensured risk assessments for systems, equipment and safe working practices were in place and that fire safety procedures were available and being followed.

Staff recruitment procedures were followed to ensure only suitable staff were employed by the service, to include any temporary staff who worked there. The numbers and skill mix of staff on duty were determined by the care and support each individual coming into the service required and were appropriate to meet these needs.

Medicines were being well managed and people received their medicines in a safe way. The service was clean and fresh and infection control procedures were being followed to protect people from the risk of infection. Staff reported and incidents, accidents and events, which were discussed so lessons could be learnt and action taken to minimise the risk of recurrence.

People were assessed by the local authority for their care and support needs and the registered manager carried out their own assessment to ensure the service could meet each person’s needs. The provider had good practice guidance, technology and equipment in place to enhance the care and support of people.

Staff received the training and support they needed to provide them with the knowledge and skills to care for people effectively. People’s nutritional needs and preferences were identified and being met. People had access to the Community Team for People with Learning Disabilities and other healthcare professionals to provide input and support for any healthcare needs they may have whilst using the service.

The environment was suitable and equipped to meet people’s needs and provide a well maintained, accessible and homely place for people to stay. 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.

People, relatives, and healthcare professionals told us they were happy with the care and support that staff provided to people. Staff understood people’s individual care and support needs and met these in a friendly and caring way. Staf

This unannounced inspection took place on 23 February 2017. The last inspection of the service took place on 10 and 11 September 2015. We rated the service as Good overall but identified two breaches of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 as the provider did not always operate systems and processes effectively to manage medicines and to assess risks to people’s health and safety. This may have placed people at risk of unsafe care.

At this inspection we checked risk assessments and medicines management. We found the provider had taken action and improved the way they managed medicines and assessed risks to people’s health and safety. This meant that the provider was now meeting legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ’Short Break Service’ on our website at www.cqc.org.uk.

Short Break Service is a respite provision for people aged between 18 and 65 years of age with learning disabilities and who may also have profound physical disabilities. The service provides support to approximately 50 people through periods of planned respite throughout the year. At any one time the service can accommodate a maximum of ten people. The service also supports people who need respite on an emergency basis.

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.

We found the provider had taken action to improve the safety of people using the service.

Risk assessments were in place for each person who used the service and identified individual risks and how these were to be minimised.

Systems were in place and being followed to manage medicines safely.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice.

We will review our rating for safe at the next comprehensive inspection.

On this occasion we did not talk to people who use the service as we we visited the Short Break Service to follow up on a Warning Notice we served on the provider, in relation to the environment of the home. This was due to us finding at our inspection on the 9 April 2013 that people who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises, due to there being exposed radiators and hot water pipes throughout the building. We also identified that there was water damaged areas to the ceiling of bedroom 1 and 2 and the main lounge.

Our findings from this inspection was that the provider had taken appropriate steps to protect the health, safety and welfare of people who use the service.

During our inspection we spoke with one person who uses the service and two staff. People who use the service told us they liked living at the home and enjoyed the food provided. We saw staff being respectful towards people and communicating with each person in different ways, depending upon their needs. Staff felt supported in their work, through training and regular team meetings.

As part of this inspection we checked whether Short Break Service had taken action in relation to:

Outcome 10 - Safety and suitability of premises

We imposed a Compliance Action imposed following our inspection on the 2 November 2012, where we identified that people were put at risk from exposed hot water pipes and radiators, which were too hot to touch.

At our inspection of the 9 April 2013 we found that people who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises, as the provider had not taken steps to provide care in an environment that was adequately maintained. We have taken enforcement action against the provider for this essential standard to protect the health, safety and welfare of people using this service.

At the time of our visit the people who were present were non-verbal in their communication. We observed staff being polite and courteous with people, where they understood the different ways that people communicated their needs, and they addressed these promptly. We contacted the close relatives of some of the people who use the service. They told us that they felt involved in the care of their relative and with changes that took place at the service. Relatives spoke about the service being ' a lifeline' to enable a period of respite for people who use the service. They said they felt assured that people were treated with respect and dignity, and a number said "..the staff are lovely..". One relative commented that "..I feel at ease that (person) has a good time, as they are always excited to go there...", whilst another relative said "...(person) really enjoys their time at the service...".

However, we identified that there were some areas of the environment that could put people who use the service at risk.

People who use the service told us they liked staying at the home for respite care, they liked the food served, and they liked the activities offered to them.

On the whole the relatives of people who use the service also were pleased with the service and wanted to point out that they ‘could not cope’ with the care of their son or daughter otherwise. The relatives considered that their children were well cared for by the service, their views and those of their children were respected, and real choices were given to the users of the service. The variety and choice of food and drinks were praised, and it was noted that meals to meet people’s cultural needs were readily available. Liaison between the service and day centres and Council transport was also praised, as was the cleanliness of the premises. Medication was said to be administered correctly. Complaints were always fully investigated and any Safeguarding Adults investigations were conducted according to the correct procedures.

Relatives had made suggestions to the provider for some areas of improvement, these included more attention to personal care, having an opportunity to provide feedback after a period of respite care, improvements to bathing and garden facilities and that review meetings take place on time. Relatives also told us that they were concerned with the continued use of temporary agency staff, they commented that some of these staff did not always read the support plans of people who use the service.

Relatives also told us that communication between relatives and the management of the service was good and that the management should be praised for providing a good service.

The inspection was carried out on 10 and 11 September 2015 and the first day was unannounced. The last inspection took place on 11 July 2013 and the provider was compliant with the regulations we checked.

Short Break Service is a respite provision for people aged between 18 and 65 years of age with learning disabilities and who may also have profound physical disabilities. The service provides a service to approximately 48 people through periods of planned respite throughout the year. At any one time the service can accommodate a maximum of ten people. The service also supports people who need respite on an emergency basis.

The service is required to have a registered manager in post. 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 manager had been in post since August 2015 and was in the process of applying for registration with CQC.

Individual risk assessments had not always been completed for all areas of risk, which could place people at risk of harm from unidentified risks.

Shortfalls were found in medicine stock recording so medicines were not always being safely managed.

People felt safe at the service and systems and equipment were being maintained to provide a safe place to live. Accident and incidents were investigated and action taken to prevent recurrence.

People were happy with the service and we received positive feedback from people and family members. There were appropriate numbers of staff on duty to provide the care and support each person required. Staff supported people in a gentle and courteous manner, respecting their privacy and dignity.

Staff recruitment procedures were in place and these were followed to ensure only suitable staff were employed at the service. Staff had received training and demonstrated an understanding of people’s individual choices and needs and how to meet them.

Staff understood safeguarding and whistleblowing procedures and were clear about the process to follow to report concerns. Complaints procedures were in place and family members were confident they would raise any issues they might have, so they could be addressed.

We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). DoLS are in place to ensure that people’s freedom is not unduly restricted.

People’s nutritional needs were identified and were being met. Information about health and social care professionals involved with people’s care and treatment was recorded so staff could access their help for people if required.

Care records reflected people’s needs, routines and interests and were reviewed to keep the information up to date. Staff were clear about people’s individual religious and cultural needs and any care and support they needed to meet these.

The manager was approachable and provided good leadership, promoting effective communication with people, family members and staff.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.