This announced inspection took place on 23 February and 5 March 2018.

Support for Living Limited - 19 Haymill Close Shortbreak Service is a 'care home' type of service. The service provides support to 22 people through periods of planned respite care throughout the year. At any one time the service can accommodate a maximum of 3 people staying overnight. The accommodation is provided in a bungalow where all people have their own rooms.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 provider for Support for Living Limited - 19 Haymill Close Shortbreak Service is Support for Living Limited under the brand name of Certitude. In this inspection report we will refer to the provider as Certitude.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good.

Relatives described staff as caring towards people. There had not been recent relatives meetings or events and some relatives had missed this support. However, the registered manager had identified this and had taken steps to address this by inviting relatives to see the new refurbishments when they were completed.

Staff knew how to recognise safeguarding adults concerns and the registered manager reported and where necessary investigated concerns appropriately.

The registered manager assessed people’s individual staffing needs to ensure there were sufficient staff on duty. The provider had robust recruitment processes and the registered manager was in the process of recruiting more permanent staff.

People had risk assessments that identified the risks and the measures required to keep them safe from harm. People staying at the service had complex behavioural support needs and there was good guidance for staff to manage behaviour that might challenge the service. The staff worked closely with the provider Certitude’s intensive support team and the local authority psychology team to work successfully with people.

People prior to placement were robustly assessed and they had detailed care plans that contained clear guidance for staff about meeting their needs.

Care plans informed staff how people communicated their wishes. Staff respected people and maintained their privacy and dignity.

Staff had received appropriate supervision and training to support them to undertake work with people who had complex needs.

People were supported to have maximum choice and control of their lives and staff provided care in the least restrictive way possible; the policies and systems in the service supported this practice.

The registered manager undertook checks and audits and Certitude’s quality assurance team analysed and monitored the data from the audits to maintain a high standard of service.

Certitude held events to celebrate staff achievements and to recognise their contribution to the success of the organisation.

The provider promoted the rights of people with learning disabilities and worked with a number of other agencies to address the issues facing people.

This inspection took place on 13 November 2015 and was unannounced. The last inspection of the service was on 15 and 16 May 2014 and there were no breaches of Regulation identified.

Support for Living – 19 Haymill Close Shortbreak Service provides short term accommodation and personal care for up to three adults with physical and learning disabilities in order to give their carers a break from their caring responsibilities. At any one time the service can accommodate a maximum of three people for overnight stays. There were six people using the service at the time of our inspection, three of whom were using the service for an evening session of respite only. 25 people regularly used the service at the time of our inspection, for regular and emergency respite for a number of days per year based on local authority assessment of needs. People who used the service lived in the London Borough of Ealing.

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 2008 and associated Regulations about how the service is run.

People at the service were safe. Risk assessments were carried out and staff had detailed guidance on how best to manage and minimise any risk identified.

People were protected from avoidable harm or abuse by staff that knew and understood the principles of safeguarding and how to report abuse. People using the service behaved in a way which showed they felt safe.

People were supported with their medicines in a safe way by staff that had been appropriately trained.

There were sufficient levels of trained and well supported staff to meet people’s needs. Relatives told us staff had a good understanding of their family member’s needs and preferences.

People’s consent to care was sought by the service prior to any support being provided. People were supported to make decisions and choices about their care and support needs. The provider met the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people’s rights were protected.

Care was provided in a personalised way which met individual needs. People engaged in social activities of their choice. The staff worked closely with family members so that each respite session was positive.

Care plans were person-centred and regularly reviewed to ensure they were up-to-date and reflected people’s needs. Throughout the inspection, we observed that staff cared for people in a way that took into account their diversity, values and human rights.

The service supported people that were moving between services to ensure a smooth and safe transition.

The culture in the service was open, inclusive and transparent. Staff were supported, felt valued and were listened to by the management team. Staff and relatives were confident to raise any concerns they had and encouraged to share their views and suggestions that could make improvements to the service.

The service worked proactively with key organisations to ensure people received care and support which was joined up.

There were effective systems in place to monitor and improve the quality of the service provided. Where improvements were needed, plans were put in place and action taken to make improvements.

We spoke with two people using the service, the relatives of four other people and four staff working in the service. People using the service or their representatives told us they were happy with the standards of care and support provided. One person told us “I like it here, I can watch TV and I go out.” A relative told us “I don’t worry when my [relative] is here. If anything happens they call me straight away.” Another relative told us "it's a lifeline, I just wish more time was available."

We looked at the support plans for three people using the service. We saw the plans detailed people’s health, social and personal care needs and how these would be met during their stays. Support plans were updated regularly and, where possible, people were involved in reviewing the care and support they received. Where people did not have the capacity to consent to their care, the provider acted in accordance with legal requirements.

The provider had policies and procedures for safeguarding people using the service. Care workers understood the procedures and were trained to identify possible abuse. A member of staff told us “I report to my manager if I had any concerns.”

There were sufficient staff working in the service to meet people’s care and support needs. One member of staff told us “you have to work together but it’s a good team.”

The records we saw were up to date and securely stored.

During our visit we spoke with three people who use the service and one relative. The people who use the service were positive about the time they spent at the service, where they told us about the activities they got involved in, such as bowling or going to the park. The relative told us that they were confident that the service met people’s needs and that there was a consistent staff team who had a good understanding of each person’s needs.

We saw staff responding promptly to people’s needs, and being flexible where people changed their minds about what they wanted to do. Staff also encouraged and involved people in planning activities at the service.

Staff enjoyed working at the service and received support and training for their role, which ensured that people got the right support.

People using the service had profound learning difficulties. They were not able to tell us fully about the care they received and experienced.

During our visit we observed and found people were receiving care and support that met their individual needs and preferences.

We observed that people using the service had choices in all aspects of their daily living. They had their privacy and dignity respected.

We heard people laughing and engaging in light banter with staff. A relative said “I am very grateful for the service I get”. Another said they were ”happy with everything”.

We saw that people and their representatives were enabled to give feedback on the quality of the service provided.

We met four people using the service, spoke with two relatives, one healthcare professional and seven staff. The staff included the manager, deputy manager, service manager and four care staff.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

Relatives we spoke with told us they felt their family member was safe and well cared for when using the respite service. They both said their family members were “safe” and “secure” at the service. Arrangements were in place for the safe management of medicines.

Staff had undertaken training which allowed them to care for people safely. Staff had a good understanding of people’s needs and any triggers that resulted in behaviour that challenged the service. We observed throughout our inspection that staff respected people’s dignity and protected their rights. Risk assessments were carried out, centred on the person and these promoted people’s welfare and independence while ensuring their safety. Systems were in place to manage incidents and accidents, so that the staff and provider learnt from them.

Staff had undertaken training on the Mental Capacity Act 2005 and were aware of their responsibilities in relation to Deprivation of Liberty Safeguards (DoLS). No DoLS applications had been submitted and staff were aware of the importance of ensuring they acted in people’s best interests.

Is the service effective?

There were sufficient numbers of staff with the right skills and experience to meet people’s needs effectively. Care plans we viewed provided staff with detailed guidance on how to care and support people. They were centred on the person, their individual needs, choices and preferences.

People’s health was monitored and appropriate referrals were made to other professionals if people’s needs changed. The service was proactive in seeking guidance and support from other professionals to support people’s health and wellbeing.

Staff received effective training, supervision and appraisal.

Is the service caring?

We observed staff treating people with dignity, respect and consideration throughout our visit. Staff had a good understanding of people’s individual needs, preferences and communication skills. People were encouraged to make decisions and choices where they were able to.

The relatives we spoke with told us they were happy with the care and support that the service provided. Comments we received included “they are very good at keeping me informed” and “I’d be dead without this service, it is the only thing that I have got which allows me a break”.

Is the service responsive?

The staff team worked closely with other healthcare professionals such as the behavioural therapist to promote people’s safety. Where people had raised any concerns or complaints these were investigated and the outcome shared with the complainant. Comments we received included “any concerns I have raised have been listened to and addressed”.

Sufficient numbers of staff were on duty to meet people’s needs and these were kept under review so that the service could respond when people’s needs changed.

Is the service well-led?

The service was led by a registered manager, and she was supported by a well-established staff team Staff we spoke with were positive about the support and guidance they received from the management team. The manager demonstrated good leadership skills and was supportive to people using the service, relatives and staff. Staff had a good understanding of their roles and responsibilities.

There were systems in place to monitor the quality of the service so that where required areas for improvement were identified and addressed