This inspection was unannounced and took place on the 20 and 22 November 2017.

We last carried out a comprehensive inspection on 21 September 2016. At that inspection we found the service to be in breach of the regulations relating to identifying and managing risk, person centred care, management of medicines and quality assurance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; is the service safe, responsive and well led to at least good. At this inspection, we found that improvements had been made in all areas.

Hall Field Guest House 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.

Hall Field Guest House is a large detached property on the outskirts of Stockport town centre. It provides accommodation and personal care people for adults who have learning disabilities. People who stay at Hall Field Guest House have permanent alternative accommodation but stay at the home for short stays or respite. At the time of our inspection there were 80 people registered to use the service. The home can accommodate up to six people at any one time. There were four people using the service on the first day of our inspection and five on the second.

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.

The service had a registered manager in place. A registered manager is a person who has 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 leaving the service and was going to deregister with CQC. Whilst they were working their notice period they were working at another service the provider ran. The provider had recruited a new manager who was going to apply to be the registered manager. They had worked at Hall Field Guest house for three years. Everyone we spoke with was complimentary about the new manager and the way they ran the service.

The new manager was present during our inspection. We found them to be enthusiastic, caring and committed to providing good quality person centred care. We saw that people who used the service responded well to them.

Risk assessments were in place for the general environment. Appropriate health and safety checks had been carried out and equipment was maintained and serviced appropriately.

The management and administration of people’s medicines was safe demonstrating people received their medicines as prescribed.

Care records were detailed and person centred. They described people in positive ways and included information on how to promote peoples independence, including things the person liked to do for themselves. They contained information based on people’s needs and wishes and were sufficiently detailed to guide staff in how to provide the support people required. Records had been reviewed regularly.

There was a robust system of quality assurance in place. Weekly and monthly checks and audits were carried out by the manager and other managers of the service. These were used to assess, monitor and review the service.

Staff were aware of their responsibilities in protecting people from abuse and were able to demonstrate their understanding of the procedure to follow so that people were kept safe.

There was a safe system of recruitment in place which

This inspection took place on 21 September 2016 and was unannounced. The service was previously inspected in October 2013 and at the time was meeting all regulations assessed.

Hallfield guest house is a beautiful Victorian property close to the centre of Stockport, with six en-suite guest rooms, one of which is fully accessible for those who have physical disabilities. The guest house also features a dining room and a large and comfortable living room where guests are able to watch TV, play games, and take part in activities. Hallfield Guest House is based in Offerton in Stockport and is registered to provide accommodation for up to six people who require nursing or personal care. At the time of our inspection there were four people receiving a respite service at the home. Respite care is planned or emergency temporary care provided to caregivers of a child or adult with special needs.

There was a manager in post and a new manager had been employed with an application in progress with the Care Quality Commission (CQC) to be the registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People's care plans included information about their care and support including associated risk assessments, however, where there was evidence of additional risks for example the use of bed rails, and risks to evacuate people in the case of an emergency, risk assessments had not always been completed. We saw actions as a result of identified risks for legionella had been recorded but these had not always been completed.

Care records were not always detailed and person centred information had not been completed to provide care workers and others involved with the persons care with information on the persons background. Where care plans had actions documented to provide person centred care with people those actions had not always been completed. Care and support did not always reflect their personal preferences.

Care workers had received training in the administration and management of medicines and policies and procedures were in place to provide them with further guidance. Despite this, we found that information available to administer people’s individual medicines safely was not always completed accurately and was not always reflective of people’s current needs.

Checks were completed that included quality assurance audits but despite these measures in place we found that they were not always effective in identifying the concerns we highlighted for risk, medication and people’s records.

We found other checks on the home and the environment had been completed by the registered provider and these checks were up to date. They included fire risk assessments and electrical equipment checks.

A process was in place to record and manage accidents and incidents and this helped to prevent re-occurrence and helped to keep people safe from avoidable harm.

The registered provider had in place an electronic rota that ensured sufficient care workers were on duty to keep people safe and meet with their individual needs. The registered provider had completed pre-employment checks to help ensure only those care workers assessed as being suitable to work with vulnerable people had been recruited.

People told us they felt safe. Care workers understood how to recognise and report signs of abuse and harm to people and up to date guidance was available.

People we spoke with told us they felt supported and that care workers had appropriate skills to meet their needs. Care workers received training that provided them with the skills and knowledge to undertake their role and enabled them to meet people’s individual care and support needs. They were supported in their role by managemen

We visited the head office of Independent Options and Hallfield Guest House which is a respite care facility. During our visit we spoke with the registered manager who had overall responsibility for the short breaks service which consists of Hallfield Guest House and 55a Beech Avenue. We also spoke with three support workers and three of the people who were staying at Hallfield at the time of our visit. The support workers told us that they enjoyed working at Hallfield and the people who stayed there looked forward to seeing their friends and the staff team.

We spoke by telephone with the three family members of the people who were staying at the home during our visit. One person told us “On the whole everything is OK but sometimes communication could be improved”; another person told us “ I am involved in my relatives care plan and any reviews that take place”.

We also looked at the care plans for the people who were present when we visited and found that they contained information to enable the support workers to meet the person’s needs.

There had been an investigation recently into an incident at the short breaks service provided at Beech Avenue. This investigation had resulted in systems being improved across the short breaks service to ensure that the most up to date care plans were available to the support workers and that they were read by them.

Independent Options provides a variety of services for people who have a learning and/or physical disability. The company's head office is located in Hazel Grove, Stockport. We visited the office on the 23rd and 24th August 2012 to look at the care files of the people who used the company's services and the staff files of the people who worked for the company. The same documentation was used across all the services.

We visited Hallfield Guest House which is one of two residential care homes that provide a short breaks service. Many of the people who use this service also use other services provided by Independent Options.

We spoke with a senior support worker and two support workers who were on duty at the time of our visit. We also spoke with five people who were using the services of Hallfield Guest House.

The five people who were staying at the home at the time of our visit had limited communication skills but were able to indicate that they liked staying at Hallfield Guest House and that they liked the staff team.

We spoke over the telephone with one family member and one person’s adult placement carer who they lived with. They said that they were happy with the service. One person said; “X is happy to go to Hallfield and the staff are lovely”. Another person said; “The service has always been very good and X likes going and likes the staff.