Shady Trees offers a nursing respite service for up to 25 adults aged 18 and over who have learning disabilities and other complex physical health needs. The home is registered to provide accommodation for people who require personal or nursing care. Up to four people can be accommodated at any one time. Shady Trees is part of St Anne's Community Services, a Voluntary Sector Service.

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, the home had a registered manager, although they were working at a ‘sister’ home which needed management support. An interim home manager was in place and they were in day-to-day charge of running Shady Trees.

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 last inspection we rated the service overall as good. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Relatives were satisfied their family members were safe in the care of staff at Shady Trees. The storage, administration and disposal of medicines was found to be safe. The recruitment of staffing was safe and staffing levels were calculated to meet people’s care needs. Risks had been assessed, monitored and reviewed to minimise the risk of harm to people.

Technology was used to meet people’s care needs and there were plans to further develop this. 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 received prompt access to healthcare. Some meals were prepared using ingredients which met specific cultural needs. Following our discussions, the registered manager took immediate action to ensure people’s representatives were able to formally consent to this.

Staff were patient with people and knew their care needs as well as individual preferences. Privacy and dignity was maintained and staff ‘champions’ had been appointed to promote best practice.

Care planning was well managed with detailed records of people’s preferences and routines. This information was updated prior to admission and feedback was provided to relatives after each stay. Complaints were responded to appropriately and people were supported to access the local community.

Quality management systems were effective. There was evidence of continuous improvement and an open culture had been developed by the management team. Systems were in place to gather feedback from relatives who said the home was well-led. The home worked in partnership with other agencies and followed up-to-date legislation.

The inspection of Shady Trees took place on 29 February 2016 and was unannounced. The service had previously been inspected in October 2014 and found to be requiring improvement in relation to ensuring people were not being deprived of their liberty unlawfully, a lack of consistent auditing and some staff needed refresher training in some areas. We found on this inspection that there had been considerable improvement in all areas.

Shady Trees offers a nursing respite service for up to 25 adults aged 18 and over who have learning disabilities and other complex physical health needs. The service is registered to provide accommodation for people who require personal or nursing care. Up to four people can be accommodated at any one time and there were 18 people registered at the time of inspection to use it. Their respite allocation varied from 24 – 95 days with most people using the service between 50 and 72 days a year.

The service had a registered manager in post who was present on the day of inspection. 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.

People were supported by staff who understood how to identify and act on any possible safeguarding concerns. The service had detailed and specific risk assessments showing how to support people safely with minimal intervention.

The service was able to adapt its staffing levels according to the needs of people in the service and medication was administered and stored appropriately. The service had developed robust protocols to ensure errors were minimised and people received their medication when required.

People were supported by suitably trained and qualified staff who had access to regular line management support. The service was also compliant with the requirements of the Mental Capacity Act (MCA) 2005 with regards to seeking people’s consent and ensuring that a Deprivation of Liberty Safeguard was in place where a person’s was restricted to ensure their safety.

We saw the service supported people with their nutrition and hydration as per individual need and that external health and social care support was obtained where needed. We did see, however, that pressure relief was not always offered as specified in a person’s care record and that verbal handovers between day services was not safe due to the high risk of information being missed or forgotten. The registered manager took immediate action to remedy this.

Staff were spoken of very highly by relatives of people using the service and we saw positive interaction between staff and people returning from day care. Staff spent time with people and worked at their own pace ensuring they were included in activities. We saw the service actively promoted dignity and respect.

Care records were detailed, identifying a person’s support needs and reflecting their usual routine at home. This was important as the service was for respite only and the registered manager was keen to unsettle people as little as possible. Every attempt had been made to look at how people communicated and responded to different situations which helped the service promote their independence.

The service had a positive, open and honest approach, and people were made to feel comfortable on arrival. The registered manager provided clear direction for all staff and was hands on in their approach. It was evident they knew the service and the people who used it very well and was proud of what they had achieved in terms of gaining people’s trust who had initially been reluctant to attend. Although there were issues with some of the audits, we appreciated the service was subject to the wider ongoing organisational changes and we were confident that issues raised within this par

We carried out this inspection on 21 October 2014. This was an unannounced inspection. At the last inspection, the service was found to be fully compliant.

Shady Trees offers a nursing respite service for up to four adults at any one time, aged 18 and over who have learning disabilities and other complex physical health needs. The home is registered to provide accommodation for people who require personal or nursing care. Shady Trees is part of St Anne's Community Services, a Voluntary Sector Service.

It is a condition of registration that the provider has a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The provider had previously sent us a notification form to inform us that the registered manager would be absent from the service for some time and had identified an interim manager, who would manage the service until the registered manager returned. The interim manager was present on the day of our inspection.

We found people were safe and protected from abuse. Staff we spoke with were knowledgeable about safeguarding and abuse and were able to tell us the steps they would take, should they have any concerns.

We found staffing levels at the service were adequate and staff were appropriately skilled and qualified to carry out their roles. We found people’s care was provided effectively by staff who were knowledgeable and kind, having built up positive, caring relationships with people who lived at the service. However, we found there were some issues around staff training, where required refreshers were overdue.

We looked at medications at the home and found they were managed appropriately. We carried out a stock check of four medications and found these to be correct. However, we did find some issues with medications and the recording of.

We carried out observations and saw that staff sought consent from people when carrying out tasks or activities. However, we found issues around consent, where people were, at times, deprived of their liberty.

We saw that people were supported to maintain a healthy lifestyle, including adequate nutritional intake and regular, appropriate access to health services. We saw in care records that people, their relatives and relevant healthcare professionals were involved in care planning.

We found regular questionnaires were sent out to people who used the service and their relatives to obtain feedback about the service. However, we saw that there was no formal recording of complaints, however large or small. This meant we were unable to evidence the service listened to and learned from people’s experiences.

We found staff felt well supported and managed. Staff said they felt confident speaking with the interim manager and were able to raise any issues or concerns they had. However, we found issues with how the service was managed and monitored through the use of auditing and governance procedures. We found several auditing records were incomplete or had not been carried out.

You can see what action we told the provider to take at the back of the full version of the report.

On the morning of our inspection there were four people staying at Shady Trees on respite. We found that people staying at the home on weekdays needed to access a day service or school between the hours of 10am until 3.30pm, as Shady Trees was closed.

When we arrived at the home at 9am on a Saturday morning there were two people in the lounge having their breakfast. We observed staff assisting them to eat and drink; this was relaxed and unhurried. Staff talked with people as they helped them.

We saw people appeared relaxed in their surroundings and frequently laughed or smiled. We observed positive interactions between people and staff. For example, staff gently reassured and supported people if they became unsettled or anxious.

We saw people's individual needs were assessed and care and support was developed from an assessment of their needs. People appeared clean, well-dressed and well cared-for.

There were sufficient numbers of staff with the right knowledge, experience, skills and qualifications to support people; there was a qualified nurse on duty at all times.

During our visit we spoke with two nurses, one support assistant, one person using the service and one relative. The other three people using the service on the day of our visit were unable to speak with us due to their complex health needs. On the Monday after the visit we gave feedback about the inspection findings to the nurse on duty; the registered manager of the service was on holiday.

Everyone we spoke with was very complimentary about the service and quality of care provided. They confirmed there were enough staff working there to support people in the way they needed to be.

The support assistant we spoke with told us “It can be relaxed like today, or more hectic. If someone has a seizure then that puts the pressure on.”

The relative we spoke with said “I am really happy with the home; I have no complaints at all.”

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to and observed staff interaction with the people who used the service and we looked at care plans.

The staff we spoke to told us that they enjoyed working at the unit. They enjoyed the variety of the work. They felt that the people who used the service were treated with dignity and respect. They felt they were being supported by their manager and by their colleagues within the team.

We saw that the care plans of the people who used the service had been developed in a way that ensured their health and well being. We saw that risk assessments that had been developed were regularly updated and reflected the needs of the individual.

We saw that staff received regular supervision and annual appraisals, where their training needs would be identified.

All the staff we spoke to told us that they had received training in Safeguarding and we saw that there was a corporate policy in place to support staff.