This inspection took place on the 15 December 2016 and was unannounced. Canterbury Adult Support Unit is registered to provide accommodation and personal care for up to five people. It is a respite service, offering overnight stays for people with learning disabilities, who usually live with family members or carers. The service also provides day services and people who use the respite service can choose to use these day services. At the time of the inspection there were four people staying at the service. Canterbury Adult Support Unit was last inspected on 7 May 2014 where one area of concern had been identified relating to the recruitment of staff. The service was re-inspected on 14 August 2014 where recruitment was no longer a concern.

Downstairs there was a kitchen, dining room, lounge, one bedroom, a bathroom and a games room. Upstairs there were more bedrooms, and bathrooms. There was a garden to the rear of the service with seating which people could access freely. People using the service had a range of physical and learning disabilities. Some people were living with autism and some required support with behaviours that challenged.

The service had a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission (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 2008 and associated Regulations, about how the service is run. The registered manager was present throughout the inspection.

Some care plans needed to be further developed so staff had more detailed information about people. Staff could demonstrate a good knowledge and understanding or people’s individual needs, meaning the impact this had on people was minimal. However, if new staff were employed they would be reliant on other staff to guide some of their practice. Other parts of the care plans were detailed and informative.

The registered manager had not always kept detailed records in regards to checking new staffs competency or the action they had taken when given feedback about how the service could improve.

There were enough staff with the right skills and knowledge to support people. They had good support and supervision to fulfil their roles effectively and felt well supported by the registered manager and other staff. People were protected by the service using safe and robust recruitment processes. Staff said that the morale in the service was high. Staff understood the aims and values of the service and demonstrated they cared about the people that used the service.

There were safe processes for storing and administering medicines. Medicines were administered by trained staff and were regularly audited to ensure errors were identified quickly.

Accidents and incidents were recorded and audited to identify patterns and the registered manager used this as an opportunity to learn and improve outcomes for people. The risk of harm to people was reduced as risk assessments had been implemented.

Appropriate checks were made to keep people safe. Safety checks had been made regularly on equipment and the environment.

Staff were trained in safeguarding and understood the processes for reporting abuse or suspected abuse. They were aware of the procedures for whistle blowing and felt confident in raising any concerns.

People's healthcare needs were managed well. If people became unwell when using the service staff supported them to attend a nearby medical walk in centre or took them to their usual doctor’s surgery.

People had choice around their food and drinks and staff encouraged them to make their own decisions and choices.

The registered manager demonstrated a clear understanding of the process that must be followed if people were deemed to lack capacity to make their own decisions and the Mental Capacity Act (MCA) 2005. They ensured people’s rights were p

During our visit of 7 May 2014 we found that the staff recruitment procedure was not robust. This was because references were not always obtained before people started work and the reason for any gaps in people’s employment history had not always been established. The manager sent us information on 5 June 2014, which set out the plan of action that they would take to improve the service.

At our visit to the service on 14 August 2014 we found that shortfalls in staff recruitment, which had been identified at the inspection of 7 May 2014, had been addressed. The service had a written protocol in place to ensure that references were obtained before people started work at the service and to investigate and record any gaps in people’s employment histories.

We considered our inspection findings to answer 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?

People were treated with dignity and respect because staff understood how to apply these principles.

Safeguarding procedures were in place and staff understood how to safeguard the people they supported.

We looked at the recruitment of new staff. This showed that not all of the required checks were being carried out before new staff started work at the service. This put people receiving support at potential risk of harm. We have asked the provider to tell us what they are going to do meet the requirements of the law in relation to recruiting new staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People’s health and care needs were assessed with them or their relatives and they were involved in writing their plans of care. Care plans were up to date and reflected people’s current needs.

It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs. Staff’s training was monitored to ensure that it met the needs of the people living at the service.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff included people in day to day life in the home and praised their achievements. In the service’s questionnaire, one relative had commented, “We find the service excellent, friendly and very welcoming; they always keep the relatives up to date all the time”.

People using the service, their relatives and professionals completed satisfaction surveys. The results of these surveys were that people were generally satisfied with the service that they received.

Is the service responsive?

People said that they could talk to staff if they were unhappy or had a concern and that they would be listened to. Records showed that verbal concerns were recorded and taken seriously.

People’s needs had been assessed before they used the service.

Records confirmed people’s preferences, interests and cultural needs had been recorded and care and support had been provided in accordance with people’s wishes.

People had access to activities that that they could choose in and outside the home.

Is the service well-led?

The service had a quality assurance system and records showed that this identified actions that needed to be taken.

Staff told us that they were clear about their roles and responsibilities and that the management team were approachable.

Up to five people can use the service for overnight stays. More people can use the service for day care. We spoke to four people who used the service, two in some detail and two briefly. All said or indicated that they were pleased with how the service met their respite needs.

One person said ‘They made sure they spoke to my carers and got my diet right’. ‘I do lots when I am here, we all do. We go shopping, do games, go to the town and look around, go bowling, and see each other’. One person commented about the manager ‘She is good at sorting out problems. I know who the person in charge is, I know I can speak to them’. Another person told us ‘I would say it is very nice place, very nice people, manager is a very nice boss and everyone is comfortable here’.

We used Makaton signing to discuss support with another person, and they signed they liked staff. Did staff listen and did they feel safe? We were told ‘Yes, they did’.

We found that the service assessed and monitored care plans. They kept records up to date made changes to the support to keep people safe and independent. We found that the environment was clean, tidy and safe. We found that people looked forward to coming to the service and staff were respectful.

We found that people who used the service for the first time are encouraged to try it out and make sure it is right for them. Families are encouraged to visit and see the service, and see that it is very much an ordinary home.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences.

We spoke with two people living at the home and three members of staff including the manager. One person told us they enjoyed staying at the home and the staff supported them to go out and visit places. People appeared relaxed and we saw staff interacting with people in a friendly and caring manner.

We found that there were care plans, health files and person centred plans in place for all people that used the service and that these were regularly reviewed and changes made as necessary. We found that people were encouraged to be as independent as possible and to make their own decisions. Where this was not possible we found that best interest meetings and mental capacity assessments had taken place.

Records showed that staff had been properly recruited, trained and supervised and that the service had systems in place to safeguard people. We found that the service monitored quality of care regularly and acted on any issues that had arisen. We found that there were a suitable number of experienced staff on duty to support people.