1181 Holderness Road is located in the east of the city of Hull and is registered to provide care and accommodation for up to a maximum of eight people with a learning disability or autistic spectrum disorder for the purpose of respite care. Accommodation is provided in a large detached house.

We undertook this unannounced inspection on the 21 and 25 May 2017. At the last inspection on 18 April 2016, we found improvements were required with the quality assurance system in place as this did not always show what actions had been taken, when areas for improvement were identified through audits and surveys.

A revised quality assurance system had recently been introduced which consisted of seeking people's views, carrying out audits and observations of staff practice. This had been introduced to identify shortfalls so actions could be taken to address them. However, this had not identified that the keys to the medication cabinet were not being stored securely in line with the provider's medication policy. Although medicines were found to be stored in a locked cabinet, the keys were left on a shelf and easily accessible. At this inspection we found the registered provider had taken action to address these issues.

At the time of our inspection four people were accessing respite services. Not all of the people who were using the service were able to tell us about their experiences. We relied on our observations of care and our discussions with staff, relatives and those people using the service who were able to speak with us. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who were unable to talk with us.

The service had 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 registered manager had only recently moved to the service and had been working there since February 2017.

We found areas of the building were in need of redecoration and refurbishment.

Medicines were, administered and disposed of safely. Training records showed staff had received training in the safe handling and administration of medicines.

Positive interactions were observed between staff and the people they cared for. People's privacy and dignity was respected and staff supported people to be independent and to make their own choices. Staff provided information to people and included them in decisions about their support and care.

We found staff were recruited safely and there was sufficient staff to support people. Staff received training in how to safeguard people from the risk of harm and abuse and they knew what to do if they had concerns.

Staff had access to induction, training, supervision and appraisal which supported them to be skilled and confident when providing care to people. This included training considered essential by the registered provider and also specific training to meet the needs of the people they supported.

Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support and what to do if people lacked the capacity to agree to it. When people were assessed as not having capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interests.

We found people’s health and nutritional needs were met and they accessed professional advice and treatment from community services when required. People who used the service received care in a person centred way with care plans describing their preferenc

1181 Holderness Road is located in the east of the city of Hull and is registered to provide care and accommodation for up to a maximum of seven people with a learning disability or autistic spectrum disorder for the purpose of respite care. Accommodation is provided in a large detached house.

We undertook this unannounced inspection on the 18 March 2016. At the last inspection on 11 April 2015, the registered provider was compliant with the regulations we assessed. Six people were accessing respite services on the day of our inspection.

Not all of the people who were using the service were able to tell us about their experiences. We relied on our observations of care and our discussions with staff and those people using the service who were able to speak with us.

The service had 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 registered manager informed us they would be moving to manage another service within the organisation and another manager would be taking over responsibility for the service. They told us that a date for these changes had not yet been confirmed.

We found improvements were required with the quality assurance system in place as this did not always show what actions had been taken, when areas for improvement were identified through audits and surveys. A revised quality assurance system had recently been introduced which consisted of seeking people’s views and carrying out audits and observations of staff practice. This had been introduced to identify shortfalls so actions could be taken to address them. However, this had not identified that the keys to the medication cabinet were not being stored securely in line with the provider’s medication policy.

Although medicines were found to be stored in a locked cabinet, the keys were left on a shelf and easily accessible. Medicines were, administered and disposed of safely. Training records showed staff had received training in the safe handling and administration of medicines.

Positive interactions were observed between staff and the people they cared for. People’s privacy and dignity was respected and staff supported people to be independent and to make their own choices. Staff provided information to people and included them in decisions about their support and care. When people were assessed by staff as not having the capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interest.

Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support and what to do if people lacked capacity to agree to it.

We found there were policies and procedures in place to guide staff in how to safeguard people who used the service from harm and abuse. Staff received safeguarding training and knew how to protect people from abuse. Risk assessments were completed to guide staff in how to minimise risks and potential harm. Staff took steps to minimise risks to people’s wellbeing without taking away people’s rights to make decisions. People lived in a safe environment and staff ensured equipment used within the service was regularly checked and maintained.

People’s health and nutritional needs were met and they accessed professional advice and treatment from community services when required. Meals provided to people were varied and in line with risk management plans produced by speech and language therapists and dieticians. We observed drinks and snacks were served between meals. People who used the service received

The inspection was carried out by an adult social care inspector. 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 caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and the staff supporting them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

• Is the service caring?

We observed interactions throughout the day between the person who used the service and the member of staff supporting them. The member of staff encouraged the person who used the service to participate in a range of activities and offered assistance and guidance compassionately and patiently.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

• Is the service responsive?

Staff knew the people they cared for and understood their preferences and personal histories.

Staff listened and acted in respect of the person's views and decisions. The person who used the service was given information at the time they needed it, in a way they could understand.

We saw that people's care needs were kept under review and care plans were updated when required.

• Is the service safe?

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The registered manager sets the staff rotas, they take people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met.

• Is the service effective?

Advocacy information was available. This meant that people who used the service could access additional support when required.

The people who used the service had their health and care needs assessed. We saw the care plans reflected their current needs.

Relatives confirmed that they were able to see people throughout the day.

• Is the service well led?

The staff we spoke with told us they were clear about their roles and responsibilities. Staff had completed training so they were confident to carry out all aspects of their role. This helped to ensure that people received a good quality service at all times.

The service had a quality assurance system and records we looked at showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

What people who used the service and those that matter to them said about the care and support they received.

A relative we spoke told us, “It’s (the home) always clean.”

A relative we spoke with said, “The staff are great, they have all built good relationships with him (the person who used the service) so he trusts them” and went on to say, “I am involved with all the meetings and decisions, I meet with the manager here and also go to all his appointments, hospitals and doctors.”

During this visit we spoke with one person who had recently stayed at the home. We also contacted relatives of people who regularly stayed at the home. We received positive comments from people we spoke with.

We looked at three people's care records which included their care plans, risk assessments and health plans. These were clear, person-centred, detailed and provided up to date information on how their diverse needs should be met. The person we spoke with told us, “Staff treat me well, they help me, they are friendly.”

We saw that people who used the service were safeguarded from abuse because staff had received training and there was guidance for staff to follow if they witnessed or became aware of anything.

We saw staff had received adequate training which helped them to care for the people who used the service and to meet their needs. Comments from relatives we spoke with included, “Staff are great, very helpful” and “I have confidence in the staff, they understand my daughter’s needs.”

People had opportunities to comment on the service through meetings and surveys. The person we spoke with told us they felt comfortable talking with staff about any concerns they had.