Creative Support - Balshaw Respite Service is located in a residential area of Chorley. It is a care home for people who have a learning or physical disability.

The purpose of the service is to provide respite care on a short term basis for up to five people. Patterns of people's stays can vary. Some people will choose to use the service for a few days on a regular basis where as other people may decide to take less but longer stays.

There are some amenities and public transport links close by. The city of Preston, the market town of Chorley, Bamber Bridge village centre and Leyland are within easy reach. Limited on road parking is permitted.

The last inspection of this location was conducted on 14 May 2014, when all five outcome areas assessed at that time were being met. This inspection was conducted on 30 September 2016. We gave the home short notice of our visit. This was to make sure someone would be at the home on the day of our inspection.

A registered manager was not in post at the time of our inspection, but a temporary manager was managing the day to day operation of the home. We were told that steps were being taken to appoint a suitable permanent 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 of the Health and Social Care Act and associated regulations about how the service is run.

The care planning system was, in general person centred providing clear guidance for staff about people's needs and how these needs were to be best met. The plans of care had been reviewed periodically. However, we noted some occasional gaps in the signing and dating of records and although the care plan for one person showed regular family involvement it had not been agreed in writing by the individual’s appointee or representative of the home. We have made a recommendation about this.

Risks to the health, safety and wellbeing of people who used the service had been appropriately assessed and managed effectively. Where risks were identified these were addressed through robust care planning. However, we noted an occasional gap in dating, signing and recording of information. We have made a recommendation about this.

Fire procedures were easily available, so that people were aware of action they needed to take in the event of a fire and records we saw provided good information about how people needed to be assisted from the building, should the need arise.

A range of internal checks were regularly conducted and environmental risk assessments were in place, showing that actions taken to protect people from harm had been recorded. However, some of the fire doors did not fit well into the door frames, which created a fire hazard. We were told this issue was being addressed by the company. We have made a recommendation about this.

Records showed that equipment and systems within the home had been serviced in accordance with the manufacturer’s recommendations. This helped to protect people from harm. Evidence was available to demonstrate that good infection control protocols were being followed in day-to-day practice.

Records showed that Mental Capacity Assessments had been conducted, in order to determine capacity levels. However, it was not always clear how outcomes had been achieved. We have made a recommendation about this.

The rights of people who were not able to consent to their care was consistently protected as the service worked in accordance with the Mental Capacity Act and associated legislation. People's privacy and dignity was consistently respected.

The service had reported any safeguarding concerns to the relevant authorities. However, there was an isolated incident where staff had noticed a bruise of unknown origin on a person's arm. This had not been referred under safeguarding procedures because the individual w

We carried out the inspection to help answer our five questions; Is the service safe? Is the service caring? Is the service effective? Is the service responsive? 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 using the service, their relatives, 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 safe?

Risks to the safety of people who used the service were identified and addressed. Staff had clear guidance to help maintain people’s safety.

There were clear policies and staff guidance in place relating to important health and safety areas, such as infection control. Staff were provided with training in these areas to help ensure they had the skills to support people in a safe manner.

Care was taken to ensure that appropriate background checks were carried out for any new staff member. This helped ensure people received their care from staff of suitable character.

Systems were in place, which enabled managers to identify risks and learn from adverse incidents such as accidents or safeguarding alerts.

Is the service caring?

We spoke with three people who used the service or their main carers. People told us they were satisfied with the standards of care provided at the service. People said they were confident in the staff to meet the needs of their loved ones. One comment we received was, “It is a real comfort to be able to leave (name removed) with the staff and know that she will be well cared for. We don’t have to worry about anything.’’

People were satisfied with the way staff kept them informed and felt they would always be kept up to date about any significant events. One person told us that staff always sent home a diary of the activities his relative had taken part in, which he appreciated.

There was only one person using the service at the time of our inspection. This person was not able to tell us her views verbally but we noted that she appeared comfortable and relaxed in her surroundings. Staff were seen to support the service user in a kind and respectful manner.

Daily records showed that support staff encouraged service users to make decisions and express choices.

Is the service effective?

Comprehensive care plans were in place for each service user, which had been developed following a through pre-admission assessment. This meant staff had a good level of information about people’s needs and the support they required.

Daily care records demonstrated that staff provided support in accordance with people’s individual needs and wishes.

Evidence was available to show that the service worked effectively with external professionals, such as community health care workers. The service had recently received an award for effective joint working.

There was a detailed programme in place for the induction and training of all staff. This helped ensure that staff had the necessary skills to perform their duties.

Is the service responsive?

All the main policies and procedures for the service were available in an easy read format. This demonstrated that the provider had taken the needs of people who used the service into account when producing information.

We found that managers and staff actively sought the views of people who used the service and their representatives. There were a number of forums designed to ensure that people received up to date information and were able to express their views and opinions.

There was a complaints procedure in place which had been developed to meet the needs of people who used the service. There were systems to ensure that any lessons from complaints or adverse incidents were learned.

Is the service well led?

The service had a manager, who was registered with the Care Quality Commission.

Training programmes within the service included induction training for new managers, which helped ensure they had the necessary supervisory skills.

There were a variety of systems in place to enable managers to monitor quality and identify risk. This helped ensure that people continued to receive a safe and effective service.

The manager responded to feedback from people, such as suggestions for improvement.

Adverse incidents such as safeguarding alerts and accidents were monitored by senior managers. This helped ensure that any patterns or themes were identified and addressed.

The manager reported any issues of concern, such as safeguarding concerns to the correct authorities and in a timely fashion.

During the inspection we were able to speak with a number of people who used the service, or their main carers, either at our visit or by phone. Everyone we spoke with made very positive comments about Balshaw Respite Service, which included;

‘’They take him out on all kinds of activities.’’

‘’Excellent staff!’’

‘’I am so grateful. I couldn’t fault any one of them.’’

One service user said, ‘’The staff are kind to me, they always do their best for me.’’ Another, when asked if he liked staying at the home said, ‘’Oh yes! Of course I do!’’

During this visit we looked at a number of areas including capacity and consent, care and welfare of people who used the service, medicines management and staff training. We had identified concerns about some of these areas during a previous inspection. We found that the provider had taken robust action in response to our previous concerns and that they were compliant in all the areas we inspected.

At the time of our visit there was only one person using the service. He was not able to give us detailed feedback but when we asked him if he liked being at the home he responded with an enthusiastic ‘yes!’

We observed staff supporting the service user in a cheerful, friendly manner. We saw that he interacted comfortably with staff and was content in their company.

We contacted the main carers of three people who use the service and asked them about their experiences.

The feedback we received was extremely positive. Comments included;

‘’Fantastic, brilliant!’’

‘’I would give them 100%.’’

‘’It’s worth so much to be able to go away and be secure, knowing I don’t have to worry.’’

‘’He doesn't speak but I know by his face he's completely relaxed there and happy when he sees the staff.’’

No one that we spoke with had any concerns about the service. Everyone said they would feel able to raise any concerns that did arise. People described staff and the manager as very approachable. One person said; ‘’I would have no hesitation in picking up the phone if I was worried about anything at all.’’

Whilst we received very positive feedback from people who used the service we did identify some concerns in relation to the way the service approached the assessment, care planning and staff training in relation to people with complex health care needs. These areas of concern are detailed in the report under the relevant outcome areas.

We spoke with a number of people who use the service (or where appropriate their representatives) and received some very positive feedback.

Everyone we spoke with expressed satisfaction about the service provided and spoke highly of care workers and the manager.

People said they had confidence in care workers and the manager to care for them (or their loved ones) in a safe and effective manner. We were also told that care workers treated people they were supporting with kindness and respect and had a good understanding of individual residents’ needs.

One person we spoke with commented ‘’The staff all seem brilliant. They seem to really care and they enjoy what they are doing which makes such a difference.’’ Another person spoke about their loved one commenting ‘’I can be at ease when they are there because I know they are being well looked after. Its such a valuable service to us.’’

We asked people if they felt they were involved in making important decisions about their (or there loved one’s) care. People felt that the manager of the home took time to involve them and discuss any changing needs. One person commented that the manager took time to understand what was important to them in the way their service was provided. People also told us that they would feel able to approach the manager if they had any concerns or wanted to change any part of their care plan.

Several people we spoke with felt that the provision of activities at the home had improved recently. One person said of their relative, '‘He seems to be involved in lots more things these days. I think they are doing more with people now.’’

Many people we spoke with commented on the quality of the accommodation provided. People told us that they felt the home was maintained and furnished to an excellent standard and that the facilities for people who use wheelchairs were also very good.

People told us that they thought that staff did a very good job of keeping the home clean and tidy for the benefit of people staying there. One person commented ‘’It is a beautiful house but very homely and welcoming as well.’’

At the time of our visit there was only one person using the service. He appeared to be relaxed and content in his surroundings and clearly got along well with his support staff.

We asked him if he was enjoying his stay and he told us ''Yes, I like it here.'' He also told us that he wanted to come to the home again in the future.