This inspection took place on 26 April 2018 and it was unannounced. We last inspected the service on 10 and 17 January 2017. At that time we found a breach of regulations in relation to safe care and treatment, around the control of medicines and the management of risks. We also found a breach of regulations in relation to safeguarding service users from abuse and improper treatment.

Following that inspection, we asked the provider to complete an action plan to show how they would make improvements in the areas of safe and well led. At this inspection we found the provider had made the improvements required in accordance with their action plan, so the key questions of safe and well led were found to be rated good. During this inspection we found the service to be meeting the requirements of the current regulations.

Chorley & South Ribble Short Break Services is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Chorley & South Ribble Short Break Services is located in a residential area of Leyland. It provides short term accommodation for up to four adults, who have a learning disability, physical disability or sensory impairment and require support with their personal care needs.

All accommodation is at ground floor level. Bedrooms are of single occupancy and have ensuite facilities, two of which are larger in size and have ceiling tracking and specialist facilities suitable for those with a physical disability. There is ramped access to the home and also to the garden area. On road parking is permitted. Public transport links and local amenities are also nearby.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the time of our inspection there were 44 people who stayed in the home regularly for short breaks. On the day we inspected the home there were four people staying at Chorley & South Ribble Short Break Services. A team leader was in charge of the home on our arrival. The registered manager, who had been in post for 18 months was on annual leave. However, staff notified her of our presence and she did attend the inspection.

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.

At this inspection, we found that people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Mental capacity assessments had been conducted and Deprivation of Liberty Safeguards had been submitted to the Local Authority, as was deemed necessary. We observed verbal consent was obtained before any activity took place. However, this was not always formalised. We made a recommendation about this.

We found recruitment and disciplinary procedures to be robust and these were being followed in day-to-day practice. People’s human rights were being protected and anti-discriminatory practices had been adopted by the home. This helped to safeguard those who stayed at Chorley & South Ribble Short Break Services.

Staff members were very knowledgeable about those in their care. We found new staff to have completed induction programmes and regular supervision sessions were subsequently conducted. Annual appraisals were in the process of being developed. A wide range

Chorley & South Ribble Short Break Services provides short breaks for up to four adults with a learning disability, physical disability or sensory impairment. All accommodation is on the ground floor. Two bedrooms are larger in size, have ceiling tracking and specialist en-suite facilities, suitable for people with physical disabilities. There is ramped access to the home and also to the garden. The home is situated in a residential area close to the centre of Leyland.

The service is managed on a day to day basis by a Team manager and is provided line-manager support by the registered manager. 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.

When we last inspected the service in November 2015, we found concerns relating to consent, safe care and treatment, safeguarding people from abuse and good governance. We took action to ensure the provider made improvements to the service.

During this inspection, we looked at how people were protected from bullying, harassment, avoidable harm and abuse. We looked at records relating to incidents of abuse within the home. We found that there had been an incident where a person who accessed the service had been physically abusive towards three other people who were at the service at the same time for respite.

During this inspection, we found care plans that we viewed contained a range of risk assessments, which addressed areas such as safety when bathing and financial support. We found that these risk assessments had been reviewed on a regular basis. However, when tracking the care of one person with behaviours that challenge, we found there were some gaps in this process. For example, risk assessments had not been embedded in relation to behaviours that pose a risk to others.

When we inspected the service in November 2015, we found medicines were not managed safely and we made a recommendation about this. We looked at people’s care plans during this inspection and again found several issues around medicines management.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff.

When we inspected the service in November 2015, we found the service did not always gain valid consent to care, in line with national guidelines and legislation. At this inspection, we found that the service had started to implement mental capacity assessments. Assessments we looked at were comprehensive and demonstrated that staff had a good awareness of the Mental Capacity Act (MCA).

We looked at nutritional care records and found that people’s likes and dislikes had been recorded throughout their support plans Daily records had been maintained for people’s nutritional intake and this information was sent home with them.

During this inspection, we observed two people receiving support for a short period during the morning of the inspection. Staff interacted with both service users in a kind and considerate way.

We received positive comments about the staff and about the care that people received. People’s support plans showed their circle of support. Support plans were written with easy read pictures to facilitate people with learning disabilities.

The care plans we viewed contained evidence that referral assessments had been carried out prior to a person being offered short stay placements at the service. We found that information throughout many care plans held a good standard of person centred detail.

We looked at the complaints that had been received since the last inspection and found evidence that complaints had been dealt with and any lessons learnt were implemented.

During this inspection, we found the service

We inspected this service on 24 November 2015, this inspection was unannounced. The service was last inspected 29 August 2013 where we found the provider met the regulations we looked at.

Chorley & South Ribble Short Break Services provides short breaks for up to four adults with a learning disability, physical disability or sensory impairment. All accommodation is on the ground floor. Two bedrooms are larger in size, have ceiling tracking and specialist en-suite facilities, suitable for people with physical disabilities. There is ramped access to the home and also to the garden. The home is situated in a residential area close to the centre of Leyland.

The service has a manager who is currently undergoing the registration process to become the registered manager. 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.

We found that the principles of the Mental Capacity Act 2005 (MCA) were not embedded in practice. The service did not have sufficient systems in place to enable assessment of a person’s mental capacity prior to requesting their consent. We have made a recommendation about this.

We found that the incident records for safeguarding incidents had not always been completed. Support plans and risk assessments had not been implemented or reviewed following these incidents. We found that risks were not always well managed and were not kept under review to ensure that people were protected. Support plans contained information that was out of date or there was significant gaps between updates. One person’s support plan was implemented in 2008 and was then not reviewed until 2015.We found that incident reporting was not always undertaken, investigated and reviewed. Trends and analysis data was not available

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We looked at medicine administration and found that the service was not following best practice principles when recording medicines that came into the service. We found that improvements needs around medicines management and a recommendation has been made in relation to this.

People spoke positively about the management team and said that they were approachable. We found a positive culture at the service was reported by all the staff members that we spoke to.

There was effective communication between all staff members including the managers. There was an established staff team who knew about people’s individual care needs and were passionate about their jobs and caring for others.

We found that there were safe recruitment policies in place and these were followed to help ensure staff were recruited safely. We looked at how the service provided a safe environment for people. We found the service to be clean, tidy and well designed. We found that the service did not always follow safeguarding reporting systems as outlined in its policies and procedures.

People who used the service could follow their own interests and engage in activities both in the home and in the community. We saw that staff had good skills to communicate with people on an individual basis.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to consent, safe care and treatment, safeguarding people from abuse and good governance.

You can see what action we have asked the provider to take at the back of this report.

We saw that staff were very pleasant in their manner and communicated well with those living at the home. The atmosphere was relaxed and friendly.

People using the service told us; “I like it here.” And “I enjoy my stays.”

Meals were planned around the individual needs and preferences of whoever was staying at the home. People were supported to get involved in meal preparation according to their wishes and abilities. Staff had received training in order to meet the specific nutritional needs of certain people using the service.

The home was well maintained and people using the service told us they were happy with the accommodation.

Staff were recruited effectively and received appropriate training, support and supervision. This helped to ensure care was delivered safely and to an appropriate standard.

Relatives who had recently completed feedback surveys about the home commented; “Couldn’t be bettered.” “We can ring to discuss any worries” and “All grand.” It was clear from this feedback that relatives were satisfied with the quality of the service provided.

There were effective systems in place to gain feedback about and monitor the quality of the service provided. Risks within the home were identified, monitored and managed.

People and relatives of people who used the service told it was "welcoming" and "homely". They said that the staff were approachable and friendly, and care was individual to each person's needs. Staff regularly checked on this before, during and after each visit. They said staff were "very thorough" in planning and delivering care.

Staff told us it was a "great place to work". They described being well supported and receiving good supervision and training.

We saw that care plans were personalised. The plans reported how to manage risk and also the personal strengths and preferences of people using the service.

We observed a range of interactions and activities within the home which showed policies, procedures and care plans were being followed in a caring respectful manner. We observed how the environment had been designed to meet the diverse needs of people using the service.

We examined a range of documents including care plans, feedback forms and various types of reports. These provided evidence that the service valued and used feedback.

There were two guests staying at the home at the time of our visit. On arrival one person was having breakfast, with the other person still in bed as they had chosen to have a lie in and have a later breakfast. Personal preferences such as this are respected by staff.

One person was having problems with their hearing aid making communication difficult, however they did indicate that they were happy and appeared to have a good rapport with staff. The other person spoke positively about the service and the staff team. Comments included; “Staff are really good here, brilliant”, “Staff are nice, they are all funny”, “I love it here, I get to socialise a lot more,” “I like cooking. Staff show me how to do it, instead of burning stuff” and “I get to bake cakes and make tea.”

During our visit, we observed staff supporting guests to make decisions regarding activities for the day, showing that community participation and independence are being promoted. Staff appeared to know the guests well and the atmosphere was warm and relaxed, with ongoing dialogue between guests and staff.

We spoke to the main carer of an individual who has been using the service for several years. This relative told us that they were extremely satisfied with the service and that they were very happy with the support provided, saying “If **** could come more often she would” and that any “glitches” are quickly sorted out by staff.

We also looked at some returned surveys which contained many positive comments about the service; including “The staff are respectful and kind”, “Very approachable and friendly staff” and “We as a family are very grateful for all you do for us.”