This inspection took place on 7 and 11 June 2018 and the first day was unannounced. We visited Hall Lane Resource Centre (Respite Care, Short Breaks Service) on 7 and 11 June 2018 and spoke with family members, a person who attended the respite service and a social care professional on 8 June 2018.

Hall Lane Resource Centre (Respite Care, Short Breaks Service) was last inspected by CQC on 31 August and 7 September 2017 and was rated inadequate overall. The overall inadequate rating resulted in the service being placed in special measures, as this is the Care Quality Commission’s standard process.

At the last inspection we found multiple breaches of regulations in relation to Regulation 12 - safe care and treatment; Regulation 13 - safeguarding service users form abuse and improper treatment; Regulation 9 – person-centred care; Regulation 16 - receiving and acting on complaints; Regulation 18 - staffing; Regulation 10 - dignity and respect and Regulation 17 - good governance.

At this inspection we found improvements had been made. We identified a continued breach of Regulation 17 HSCA RA Regulations 2014, good governance. There was a lack of oversight of some aspects of the service and issues we found had not been identified by the auditing processes in place. These needed to be more robust. We judged the service was compliant with all other regulations.

Hall Lane Resource Centre (Respite Care, Short Breaks Service), referred to throughout this report as Hall Lane, is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hall Lane provides short breaks (respite care) and accommodation for up to ten people, younger and older adults, with a learning disability or autism. The service is based on the first floor and shares the building with a day service on the ground floor and office space for managers, also on the first floor. There are ten bedrooms, one with en-suite facilities, a main lounge and a quieter lounge, a communal kitchen and easily accessible bathrooms incorporating wet rooms. On the day of our inspection there were six people staying at the home, four of these being emergency placements. However, there were around 60 people who used the service in total.

Care services for people with a learning disability and autism should be 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 services can then live as ordinary a life as any citizen. Hall Lane was not a new service. Whilst this service was not full at the time of our inspection it can cater for up to ten people at any one time. It was accessed by people both local to the area and living further away due to the nature of the service. Those that were able to accessed the local community independently.

The service had a registered manager in place. They had been newly appointed to this role since the last inspection, and had previous management experience of the short breaks service. 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.

After our last inspection the service had placed a voluntary suspension on new admissions so that it could work on improving and ensuring people were kept safe. People accessing Hall Lane on a respite basis were already known to staff. We noted one emergency admission had taken place immediately prior to this inspection despite the voluntary suspension still

Hall Lane Resource Centre provides respite and short break accommodation for people who require support with personal care. The centre can accommodate up to 10 people. The centre is located in a residential area of Baguley, close to local shops and transport links. At the time of our inspection, there were five people living in the centre on a short stay basis.

There was a registered manager in post at the time of our inspection but they had not been in work for approximately eight months prior to our inspection. They were not present at the inspection and the inspection was supported by an acting manager who supported the centre on a part time basis.

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.’

During this inspection, we found breaches of Regulations 9, 10,12,13,16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering our enforcement options in relation to these breaches.

We looked at three care plans. Two of the three care files we looked at failed to clearly identify people’s needs and risks. We found that some of the risks in relation to people’s care had not been risk assessed and some of the risk management information was contradictory and confusing for staff to follow. This placed people at risk of receiving inappropriate or unsafe care. By day two of the inspection, the acting manager had taken some steps to address this.

We saw that in two out of the three care files we looked at staff had information on the person’s likes and dislikes, personal hygiene preferences and daily routines. There was also some good information on people’s personal history and their ability to communicate. In one of the files we looked at, sufficient information in all these areas was missing. By day two of the inspection, action had been taken to address this.

We found that improvements with regards to how the service assessed the capacity of people to participate in and consent to the planning and review of their own care was required in order for it to comply in full with the Mental Capacity Act. We saw however that no major life decisions had been made about people’s care. For example, a deprivation of liberty safeguard or do not resuscitate decision. Care plans contained sufficient information about how people communicated their wishes for staff to determine if they consented to their day to day care.

We found that safeguarding incidents were not always recorded, investigated or reported appropriately. Incidents of a safeguarding nature had not always been identified and responded to and the provider lacked a robust system to protect people from the risk of abuse.

Medication was not always stored securely. Prescribed creams and other prescribed medication such as antibiotics were found on display in people’s bedrooms. This placed them at risk of unauthorised use. Some people’s medication administration charts were confusing and open to interpretation. This meant there was a risk that staff would not have the same understanding of how to administer the person’s medication in order to ensure it was administered safely. We found gaps in the administration of one person’s lunchtime medication. When we investigated this further, we found that the service had no protocols in place to ensure the person received this medication when they were away from the service.

There was mixed feedback from the people and relatives about whether the number of staff on duty was sufficient to meet people’s needs. Staff supervision records showed that staff had raised concerns about poor staffing levels and the impact this had on the ability of the service to provide safe