The inspection took place on 17 February 2017 and was unannounced. At our last inspection on 18 February 2016, the service was rated as requiring improvement. At this inspection we found that the provider had made the required improvements in relation the concerns previously identified. Tewin Road provides respite (short stays) accommodation for up to six people. At the time of our inspection six people were staying at the home.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People felt safe, happy and well looked after at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally.

Safe and effective recruitment practices were followed to help ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe.

Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

People and relatives were positive about the skills, experience and abilities of staff who worked at Tewin Road. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff obtained people’s consent before providing personal care and support, which they did in a kind and compassionate way.

Staff had developed positive and caring relationships with the people they cared for and knew them well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported with meaningful activities relevant to their needs, both at the home and in the wider community.

Complaints were recorded and responded to in line with the service policy.

People, relatives and staff were complimentary about the registered manager and how the home was run and operated.

The inspection took place on 18 February 2016 and was unannounced. At our last inspection on 29 November 2013, the service was found to be meeting the required standards in the areas we looked at. Tewin Road provides respite (short stays) accommodation for up to six people. At the time of our inspection six people were staying at the home.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that people were not having best interest meeting to ensure their choice and the least restrictive options.

People told us that they felt safe, happy and well looked after at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe. Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

People and relatives were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff obtained people’s consent before providing personal care and support, which they did in a kind and compassionate way.

Staff had developed positive and caring relationships with the people they cared for and knew them very well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community. They felt that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives, staff and people were complimentary about

We spoke with one of the two people present at the time of the inspection and four visiting parents. They told us that they were very happy with the care offered at Tewin Road and to leave their relative in their care for the weekend. We were told that they had experienced other services and were aware of how “good and caring” the staff at Tewin Road were. They said that the staff were experienced, trained and caring and that there was always sufficient numbers of staff on duty to ensure a good social life was provided to the people.

We saw that care plans had been reviewed on a regular basis, staff were recruited appropriately and the premises had been well maintained and domestic in style.

We spoke to three people who use the service and the relatives of two people who use the service. The people who use the service told us that they are happy with the care they were receiving.

We were told that the staff ask people what they want to do. They said that they were asked about their care and support and how they wanted it delivered.

They told us that they were very busy when they spend time at Tewin Road. One person said that they enjoy doing the housework especially cooking and hoovering. They all said that they get one of their favourite rooms while they are staying there and said that this was important to them.

All the people we spoke with were very positive about the staff and stated that the staff would do anything for you and that they were kind and caring.

One person said that it would be good if the service could offer a room with an ensuite bathroom as they liked to be private and didn’t like to share a bathroom with the opposite sex.

When we visited Tewin Road on the 06 March 2012 we were able to have conversations with two people who were having day care or who were being accompanied by staff to meetings. Where verbal communication was limited, we were able to communicate non-verbally and to observe the way they experienced support and interacted with care staff.

We observed that people being supported by Tewin Road were given realistic and 'open' choices by the cars staff team, for example a range of options for day care activity and how and when support was to be given in meetings they were attending.

All of the interactions and communication we were part of or observed between care staff and people receiving support from Tewin Road were appropriate, respectful, unhurried and enabled the person concerned to make their wishes clear about how their support and care was provided.

One person told us that care staff were 'good'. During the time we were talking to them, they were at ease, discussing with care staff what they were going to do that morning and were engaging in relaxed and informal conversations with care staff.

When we spoke on the 13 and 14 March to the main family carers of a number of people who use Tewin Road for their respite care, they told us that the person concerned enjoyed their time at Tewin Road, looked forward to their periods of respite care and that they were looked after very well by the care staff, most of whom they knew well.

On this occasion we did not speak to people who use Tewin Road for their respite care about safeguarding people from abuse or supporting staff.

Whilst we did not talk specifically with people who use Tewin Road for their respite care about assessing and monitoring the quality of service provision, when we spoke to several of their family carers who made the arrangements for their respite care they told us that they were regularly asked for feedback on the service and that they all felt able to raise any concerns or ask questions about the quality of care should they choose to do so.