The inspection took place on 31 January 2019 and was unannounced. The previous inspection was undertaken in February 2018 when the service was rated Requires Improvement in safe, effective and well-led and therefore Requires Improvement overall.

Since that inspection the provider had completed an improvement action plan and we found improvements had been made in a number of areas. For example, all the requirements referred to within the fire risk assessment had been completed and water temperatures were taken regularly. Since the last inspection staff had received training in food hygiene. There was now a medicines policy in place and risk assessments had been completed as required. All staff employed now had an up to date Disclosure and Barring Service (DBS) check in place. Service user forums were being undertaken on a monthly basis and activities books implemented to help ensure all people who used the service had access to interests and activities.

Although improvements had been made in many areas, we did find some issues at this inspection. For example, some of the water temperatures recorded were above the recommended levels and no action had been taken about this. Some audits had been recorded as having been done into the future, i.e., although the inspection was undertaken on 31 January 2019 there were completed documents for the first two weeks of February.

The service is a two-storey property that has been suitably adapted. The service is situated in The Haulgh area of Bolton and is close to Bolton Town Centre and local amenities, public transport and motorway networks. Take A Break With Choices is a respite service that can provide care and support for seven people. At the time of the inspection there were five people using the service.

There was a registered manager in post. The registered manager is also the owner and the nominated individual. 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 service is run.

People said they felt safe at the service. The service had CCTV in place in communal areas to help ensure people’s safety. There was a CCTV policy in place and notices to alert people to its installation. There was an appropriate safeguarding policy and staff had undertaken safeguarding training.

Recruitment procedures were robust, staffing levels were sufficient during the day to meet people’s needs and there was one staff member on a sleepover at night.

Fire safety and health and safety measures were in place and there were up to date certificates for gas and electrical safety and legionella testing.

The water temperature in one of the sinks was too hot and there were used toiletries and razors in an unlocked cupboard in the bathroom. These could pose a risk to people who used the service.

Medicines were managed safely. Accidents and incidents were logged and followed up appropriately. Infection control measures were in place, but there were some minor infection control issues that needed to be addressed.

Care files included relevant health and personal information. There were some inconsistencies, but in the main care files were well ordered and clear.

Staff completed a full induction and training was on-going. Staff supervisions were undertaken regularly.

The food offered was nutritious, choices were given and there were plenty of supplies of fresh food on the premises. The building was well adapted for people whose mobility was restricted.

The service sought consent as required and worked within the legal requirements of The Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People told us they were happy at the service. We observed people being cared for with kindness and compassion and peo

We inspected Take A Break With Choices on 28 February 2018. The inspection was unannounced.

The service is a two storey property that has been suitably adapted. The service is situated in The Haulgh area of Bolton and is close to Bolton Town Centre and local amenities, public transport and motorway networks. Take A Break With Choices is a respite service that can provide care for seven people.

There was a registered manager in post. The registered manager is also the owner and the nominated individual. 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 service is run. The service has a service manager who facilitated the inspection. The registered manager was on site but chose not assist with the inspection.

There were two people staying at the service at the time of the inspection. Take A Break With Choices is a ‘care home’. 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.

This service is also a domiciliary care agency providing personal care to four people living in their own houses and flats in the community. Not everyone using Take A Break With Choices receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We last inspected Take A Break With Choices on 24 August 2017 and the service was rated as ‘Inadequate’. This meant the service was placed in ‘Special Measures’. When a service is placed in ‘Special Measure’ we inspect the service again within six months of the last report being published to see if the service has improved. Placements by the local authority to the service and the domiciliary service were suspended. This imposed suspension, by the local authority remains in place.

At the inspection on 24 August 2017 we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to failing to ensure that robust procedures and process were in place to make sure people were protected, there was a lack of risk assessments, staff had not received appropriate training, a lack of suitable activities and communal involvement and a lack of systems in place to assess and monitor the quality of the service. An action plan was received from the provider on 17 November 2017 with actions and timescales provided.

At the inspection on 28 February 2018 we worked through the action plan with the service manager and found that the breaches had mainly been addressed and the service had improved.

We received information from the Greater Manchester Fire Safety Enforcement Officer that following a visit to the service on the 6 February 2018 they would be sending a ‘notification of deficiencies letter’ which provided recommendations for improvement. The findings included: The need for a more suitable fire risk assessment. There was no smoke detection in the garage and the fire officer asked the provider to confirm that fire resistance from there to the accommodation above is adequate. Some of the bedroom doors did not close fully unaided, due to maintenance required (door sticks on carpet). That the provider considered the suitability of the keypads on the doors, especially if access needs to be gained to assist in an emergency and suggested they consider availability of evacuation chair to assist from disabled rooms if main office area becomes compromised due to fire. We will liaise with the fire safety officer to check that the recommendations for i

We carried out this announced inspection on 24 August 2017. The service is a two storey building and is close to Bolton town centre and local amenities. Bedrooms and bathrooms were on both floors. A domestic stair lift provided access to the first floor if required. A communal lounge and dining room were situated on the ground floor.

Take A Break With Choices provides respite care for up to seven people. Whilst the provision is meant to be for respite and therefore time limited the people accommodated had been there for several months with no indication as when they would be moving on to alternative permanent care. At the time of the inspection there were five people staying at the home.

The service also provides care and support to people in their own homes. Four people were receiving care in their own homes and support was provided to people with tasks such as shopping and cleaning.

There was a registered manager at the service. The registered manager is also the provider. 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 service is run.

At the previous inspection on 10 and 15 of February 2016 the Care Quality Commission (CQC) Inspectors found breaches in Regulation 9 – person centred care, Regulation 11 – need for consent, Regulation 12 safe care and treatment, Regulation 17 good governance and Regulation 18 staffing.

On 06 June 2016 a focused inspection was carried out with regard to information suggesting the Provider was operating above the number of beds specified on the registration certificate. The inspection found the Provider was in breach of a condition of registration and was accommodating more people than she was registered to care for. This breach of condition is currently being considered by the Commission as to what action to consider.

At this inspection on 24 August 2017 we found that some policies and procedures needed updating for example the medication policy.

Risk assessments were tick box sheets and did not clearly identify risks to individuals. For example where a risk had been identified, in an area such as falls or medicines, there was no individual risk assessment outlining the specific risks, actions taken, equipment or techniques used to minimise the risks and review of the risk.

There was no evidence of a fire risk assessment, testing of emergency equipment or fire drills taking place. We noted that some fire doors were propped open. The registered manager was unaware that personal emergency evacuation plans (PEEPs) should be in place.

We asked for the recording of water temperatures to ensure that water was discharged at the appropriate temperature. These could not be provided by the registered manager. There was no legionella certificate the registered manager was unaware of what this was and why it was required.

We noted that infection control procedures were not adhered to. There were cloths towels in communal bathrooms and toilets which allow for the transfer of bacteria. Paper towel dispensers were empty which meant that good hand washing and drying techniques were not supported.

There was no food hygiene standard awarded for the service. The registered manager did not know this was required. It is the responsibility of the registered person to register the service with the Environmental Health agency.

The registered manager was unaware of what a dependency tool was despite the PIR stating, ’We use a dependency tool to ensure that there are always enough competent staff on duty with the right mix of skills’.

Staff rotas for August and September 2017 were requested. The rotas supplied were insufficient and did not detail the names of staff or dates worked.

The provider was unable to provide us with inf

We carried out an unannounced focused inspection of this service on 14 June 2016. Prior to this inspection we received information that the home were in breach of a condition of their registration with the Care Quality Commission (CQC), which stated the registered provider must only accommodate a maximum of five service users at Take A Break With Choices.

Take a Break with Choices provides respite care for a maximum of five people and also provides domiciliary care and support to people in their own home. The home and office are situated close to Bolton town centre. The service is a day centre for social and recreational purposes and also provides other social and recreational services such as cleaning, shopping and befriending to people living in the community.

There was a registered manager at the home. 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.

During our inspection visit, we identified that there were seven persons living at the home. Together with one of the home managers, we looked at each bedroom that was occupied. Each room was clean and well furnished, there were adequate toilets and bathrooms available throughout the home for the people who used the service.

We also looked at staffing rotas and spoke to visitors and people who used the staff about staffing arrangements at the home. People told us that they believed there was sufficient staff during the day and night to meet their needs.

We looked at seven care files, and established that up until the 25 May 2016, five people had been living at the home. On this date a further person was accommodated at the home. On the 31 May 2016, another person was admitted to the home. This demonstrated that since the 25 May 2015, the service had been in breach of their requirements of registration with the Care Quality Commission, which stated the provider must only accommodate a maximum of five service users.

We suspect an offence under Section 33 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 may have been committed by the service. We are currently considering our enforcement option in respect of this offence.

This announced inspection was carried out on 10 and 15 February 2016. At our last inspection on 21 April 2015 the service was found to be meeting all regulatory requirements. At this inspection we found five breaches of regulations in relation to safe care and treatment, need for consent, staffing, good governance and person-centred care.

Take a Break with Choices provides respite care for a maximum of five people and also provides domiciliary care and support to people in their own home. The home and office are situated close to Bolton town centre. The service is a day centre for social and recreational purposes and also provides other social and recreational services such as cleaning, shopping and befriending to people living in the community.

People we spoke with told us they felt safe using the service. Staff demonstrated a good understanding of how to safeguard vulnerable people. The service had a safeguarding adult’s policy in place but this was in need of updating. The service had a whistleblowing policy in place and staff told us they were aware of the policy and how to use it.

We looked at how the service managed people’s medicines. We looked at the medicines administration record (MAR) charts for one person who used the domiciliary service and saw MAR charts were available and properly completed. We looked at the medicines records held for one person who used the respite service and found the service was unable to produce any documentary evidence of a best interest decision regarding the service taking control of administering the person’s medicines.

There were risk assessments in people’s files but these had not always been signed and dated and had not all been recently updated. There was no evidence to identify that the service had completed their own risk assessments for every person who used the service either on, or prior to admission.

This was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment because the service had failed to assess the risks to the health and safety of people receiving the care or treatment and had failed to do all that is reasonably practicable to mitigate such risks. You can see what action we told the provider to take at the back of the full version of the report.

We found people were receiving care from care staff that were deployed consistently in a way that met people’s needs. People who used the service told us they felt that staff had the right skills and training to do their job. We found there were suitable recruitment procedures in place and required checks were undertaken before staff began to work for the service. There was a staff induction programme in place, which staff were expected to complete when they first began working for the service. There were gaps of several months between staff supervisions in some of the staff personnel files we looked at.

Some people who used the domiciliary service lived alone and staff required the use of a key to access their property which were appropriately stored in a ‘key safe’ outside the house.

We found that the premises were generally clean throughout but the service was unable to locate any records of cleaning schedules.

The service liaised with health and social care professionals involved in people’s care and worked alongside other professionals and agencies in order to meet people’s care requirements where required such as social workers.

People’s care files had consent forms in them but these were not signed and dated which meant it was not clear if the person or their representative had consented to receiving care and treatment.

This was in breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, need for consent, because care and treatment of people must only be provided with the consent of the relevant person. You can see what action we told the provider to take at the back of the fu

This was an announced inspection carried out on the 21 April 2015.

Take A Break With Choices provides respite care for a maximum of five people and also provides domiciliary care and support to people in their own home. The home and office are situated close to Bolton town centre. The home is also a day centre for social and recreational purposes and offers other services such as cleaning, shopping and befriending.

There was a registered person in place. ‘Registered person’ are required to be registered with the Care Quality Commission. ‘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.

This new service had not been previously inspected by the Care Quality Commission.

One person who had used respite care at the home told us; “The care is good, they always listen to me and I do feel safe living here.” A relative told us; “When I leave X, they are waving and smiling. I know they are happy and ok. I have complete piece of mind.”

People and relatives who used the domiciliary care service told us their loved ones were safe and they trusted staff coming into their homes to provide care.

During the inspection, we checked to see how people were protected from abuse and avoidable harm. We found suitable safeguarding procedures were in place, which were designed to protect vulnerable people from abuse and the risk of abuse.

We looked at the service whistleblowing policy, which enabled staff to raise any concerns about abuse or poor practice. Staff we spoke with were able to demonstrate a good understanding safeguarding vulnerable people.

We reviewed a sample of six recruitment records. These clearly demonstrated that staff had been safely and effectively recruited.

We looked at how the service managed people’s medicines and found that suitable arrangements were in place to ensure the service was safe. We found accurate records were maintained of when staff administered medicines. We found all staff administering medication had received training, which we verified by looking at training records.

We looked at the training staff received to ensure they were fully supported and qualified to undertake their roles. Staff told us they were subject of an induction programme when they started with the service, which prepared them for their role.

Staff also confirmed they received regular on-going training. This included first aid, infection prevention and control, nutrition and diet, mental capacity and refresher training in the common induction standards, which included person centred care, safeguarding and health and safety. Most staff had also undertaken National Vocational Qualifications (NVQ) in social care.

Staff were able to confirm, which we verified from records, that they received regular supervision every three months in line with the service supervision and appraisal policy.

We spoke with staff to ascertain their understanding of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Most staff had received training in the MCA and DolS and had an understanding of the legislation, though most stated they would welcome further training. We spoke to the provider and deputy manager about this matter. They confirmed that following their recent experience with the submission of a DoLS application, they were in the process of sourcing training for all staff.

We looked at the way the service managed consent for any care and support provided. People told us that before any care and support was provided, the service obtained consent from the person who used the service or their representative.

Both people who used the service and their representatives told us that staff were kind and caring. One relative of a person who used the service said “No concerns the owner is a second Mum to X. I have never known X being so happy. I just wish she could stay here full time. This is the one place I feel most at ease with. In the last four months, X has completely changed and is a different person.”

Whether observing people on respite care in the home or staff supporting people in they own homes, we found the interaction was positive and caring.

We found the service undertook an initial assessment of people’s needs before providing support. One relative told us the management spoke to them and got to know them and so was able to identify the staff most suitable to deal with their loved one.

As part of the inspection, we looked at the seven care files of people who were currently using the service. Care plans provided clear guidance on people’s individual support needs.

Relatives and people who used the service confirmed that the service was responsive to people’s changing needs. One person who used the service told us; “The carers are very responsive. When we have needed extra help they have always obliged.”

We looked at the service’s policy on complaints and found it provided clear instructions on what action people needed to take if they had any concerns. The service told us they had not received any formal complaints.

We found the service sent out questionnaires every 12 months to people who used the service and staff to find out what they thought of the quality of services provided. We looked at some of these completed questionnaires and saw that favourable comments had been made about the service. However, the service was not able to demonstrate how issues or concerns raised had been addressed.

Both people who used the service and staff confirmed that an open and transparent atmosphere existed and that management were approachable and that they wouldn’t hesitate to speak with them if they had any issues.

The service undertook a range of checks to ensure they were meeting the required standards of safety, which included weekly fire alarm testing, health and safety checks and temperature monitoring of fridge and freezers.

We spoke to the manager and deputy manager about whether spot/competency checks on staff were undertaken and whether medication audits were undertaken to ensure medication was being managed safely. We were told that staff were checked in respect of their competency to deliver care and medication and that medicines were checked, however these were not formalised or recorded. We were assured by the service that such checks would be formally documented in future.

The service had policies and procedures in place which covered all aspects of the service, such as challenging behaviour, health and safety, infection control and mental capacity act. Staff were required to sign and acknowledge the content of each policy.