We undertook an unannounced inspection of Tanners Wood on the 10 April 2017.

The service provides short breaks and respite care for up to eight people with a learning disability and/or physical disability. On the day of our inspection, there was one person using the service who had gone out for the day and all other people had returned home after respite.

At our last inspection on 25 May 2016, we identified that the service was in breach of three regulations. The provider had not ensured that people had consented to their care and treatment, not all people had risk assessments in place, and records were not kept up to date. We found that the service was not meeting the required standards and was therefore rated as a service that requires improvement. During this inspection we found that the provider had successfully implemented a change in processes and the regulations were now being met and improvements had been made.

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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who knew them well. Relatives we spoke with had described the staff as kind and caring. People were supported to go into the community and pursue their interests.

People had been assessed, and care plans took account of their individual needs, preferences, and choices. Staff supported people to access health and social care services when required.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service. The provider also had effective quality monitoring processes in place to ensure that they were meeting the required standards of care.

We undertook an unannounced inspection of Tanners Wood on the 25, 26 and 31 May 2016.

The service provides short breaks and respite care for up to eight people with a learning disability and/or physical disability. On the days of our inspections, there were between two and three people using the service.

At our last inspection on 20 May 2014, the service was not meeting two of the required standards that we looked at. During this inspection we found that these standards had not been met, we also identified further breaches of regulations because people’s care was not planned and delivered in a way that ensures their safety. Additionally, there was no evidence that people consented to their care and the provider’s quality monitoring processes were not always used effectively to drive improvements. You can see what action we told the provider to take at the back of the full version of the report.

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.’

The staff had undertaken some risk assessments, however these were not always regularly reviewed to minimise potential harm to people using the service. There were appropriate numbers of staff employed, however staff we spoke with told us that often they were reallocated to other adjacent services, resulting in administrative tasks not being completed.

The provider had a robust recruitment process in place which ensured that staff were qualified and suitable to work in the home. Staff had undertaken appropriate training and had received regular supervision and an annual appraisal. Medicines were administered safely by staff who had received training.

We found that people, their relatives and /or other professionals were not always given the opportunity to be involved in reviewing people’s care and the service did not have a process in place for staff to follow to ensure that people and/or their representatives were given the opportunity to be involved in care planning and review process.

People had access to healthy foods and were supported to eat and drink well. During our inspection we saw that people were encouraged to drink plenty of fluids to stay hydrated. People who required medical attention by ways of attending an appointment and/or been seen at the home by a doctor during their stay, the service support people to do so.

The management team were not always proactive in supporting staff to deliver a good service. In particular, they had not been given the time needed for them to undertake important administrative tasks such as reviewing people’s care plans to ensure that people were receiving safe and proper care.

During this inspection we set out to answer our five key questions; Is the service caring,

responsive, safe, effective and well led?

Below is a summary of our findings.

Is the service safe?

By safe, we mean that people are protected from abuse and avoidable harm. We observed that staff had the skills, and experience necessary, and were able to demonstrate they knew how to support people safely and minimise risk.

We found that care records were not always current and this may have put people at risk. We saw from the records we reviewed that all of the staff had received training in the protection of vulnerable adults. We spoke with staff who demonstrated their awareness of different types of abuse, and explained the process they followed if they needed to raise any concerns.

Is the service effective?

By effective, we mean that people's care, treatment and support achieved good outcomes

and promoted a good quality of life which is evidence-based where possible.

We reviewed the care records for the three people who used the service at Tanners Wood. We found that they contained basic information which was in some cases dated and no longer relevant. This lack of current and person centred information meant that people's needs may not have been met in accordance with their current requirements.

We observed however, that staff supported people, where possible in an 'enabling way', to empower people to retain as much independence as possible. Evidence of consent was not always apparent, in relation to the care and support people received.

Is the service caring?

By caring, we mean that staff involved and treated people with compassion, kindness,

dignity and respect. We observed that people were supported by staff who knew them well and were able to care for them as individuals. We saw that the staff were patient and kind with people who used the service.

Is the service responsive?

By responsive, we mean that services are organised so that they meet people's needs. We

observed the staff to be responsive when interacting with people.

Staff were aware of people's needs and they responded appropriately when people required help.

Is the service well-led?

By well-led we mean that the leadership, management and governance of the organisation

assured the delivery of high-quality person-centred care, which supports learning and

innovation, and promotes an open and fair culture.

The previous registered manager had left the service and the current manager was in the process of being registered with the Care Quality Commission. The previous manager’s name is still recorded on this report because it had not been deregistered at the time of the inspection.

We found that improvements were required in some areas and noted the manager was very receptive to feedback as part of the inspection process. The manager was in the process of reviewing a number of aspects of the service, including support plans and other care documents and these were a work in progress so we could not assess the impact of this work, during this inspection.

You can see our judgements on the front page of this report.

We carried out this follow up inspection on 12 April 2013, to check whether the service had made improvements to become compliant in relation to the essential standard for safety and suitability of premises.

During our inspection in November 2012 we had found that the premises and the surrounding grounds had not been adequately maintained to ensure that people live in a safe and comfortable environment.

During this follow-up inspection, we found that the provider was meeting this essential standard of quality and safety.

During our site visit, we met seven people using the respite facility. Some of the people we met had spent the day in their respective day centres. People communicated with us with sounds and gestures and with expressions of contentment. One person who was able to communicate verbally told us that they enjoyed their stay at Tanners Wood and that the staff were 'good and helpful'.

The majority of the people we met were not able to answer questions about the service because of their learning disability. However, their gestures, sounds and facial expressions indicated that they were happy and content with the staff and the care provided.

We observed that staff interacted well with people, and understood each person's ways of communicating. Staff had knowledge of people's preferences, and had provided assistance appropriately.

During our site visit, we found that the provider was non-compliant with one of the standards inspected. The premises and the surrounding grounds had not been adequately maintained to ensure that people live in a safe and comfortable environment.