We inspected Rusthall Respite on 12 December 2016. This was an announced inspection. The provider was given 48 hours’ notice because the location was a small care home for adults who are often out during the day and we needed to be sure that someone would be in.

Rusthall Respite provides a respite service for up to five adults who have a learning disability. At the time of the inspection they were providing personal care and support to one person.

The service had a registered manager in place. 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.

The provider had systems in place to protect people from the risk of harm. Staff understood how to keep people safe and knew the people they were supporting very well. People’s finances were managed and audited regularly by staff. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were enough staff to keep people safe. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service. Staff were skilled and experienced to meet people’s needs because they received appropriate training, supervision and appraisal.

The service met the requirements of the Deprivation of Liberty safeguards. However people were not supported in line with the principles of the Mental Capacity Act 2005. The provider was not recording written consent from people. We have made a recommendation on recording consent for people.

Care was personalised and delivered to a good standard. People received good support to make sure their nutritional and health needs were appropriately met. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs.

The service had good management and leadership. The provider had a system to monitor and assess the quality of service provision.

Our last inspection on 3 and 9 September 2014 found that people were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained by the service. People’s care records did not always reflect their current needs. Personal emergency evacuation plans (PEEPS) had not been completed for each person who used the service or been reviewed regularly.

We asked the provider for an action plan which we received on 26 September 2014. The action plan outlined how improvements would be made within a set time frame.

At this inspection, we found that action had been taken and the provider had achieved compliance with Regulation 20 of The Health and Social Care act 2008.

We looked at people’s care records, personal emergency evacuation plans, some records of checks audits and organisational quality assurance information.

We used the information to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found

Is the service safe?

Staff were provided with current information and guidance about how to support people in the event of an emergency at the service.

People’s personalised care records and risk assessments had all been reviewed so that staff knew how to reduce identified risks to people.

Staff made checks on the safety of the service and action was taken if equipment needed repairing or replacing.

Is the service effective?

Staff were given the information they needed to understand how to meet people’s individual needs and provide them with an enjoyable stay at the service.

People were consulted about how they liked their care and support to be provided. Staff supported them in line with their wishes.

People were involved in menu planning and chose what they wanted to eat and drink. Pictorial information was available to help them choose if necessary.

Is the service caring?

Staff were provided with information about people’s emotional needs and how to meet them.

Staff supported people to do things for themselves and promoted their independence.

People had up to date information about the service in ways that they could understand.

Is the service responsive?

People had newly drawn up, regularly reviewed care plans that were personalised to reflect their current needs.

People chose the activities they would like to do during their stay at the service. The service had two vehicles which enabled plenty of community activities to take place.

People were given information about how to report any concerns about the service.

Is the service well led?

The registered manager had been in post since September 2014 and had reviewed care and other records to make sure they were accurate, properly completed, and provided people with the information they needed about the service.

Checks and audit’s took place so that the provider could monitor the quality of the service and address any shortfalls.

Is the service caring?

People were supported by staff who were familiar with their needs and who were kind, respectful and patient. Staff told us that they liked providing people with an enjoyable experience at respite. We saw that people were comfortable with staff and staff understood people’s communication methods.

Is the service safe?

Systems were in place to make sure that identified risks to people’s safety were assessed and guidelines were put into in place to minimise them. Staff understood how to report safeguarding concerns, and confirmed that they understood what could constitute a safeguarding matter. Incidents were recorded so that any trends could be responded to.

Is the service effective?

A person told us that they enjoyed staying at the service, and records showed that people had opportunities to choose a range of activities to do whilst there.

Systems were in place for regularly checking the quality of the service. These included organisational and internal audits and checks that care records stated current needs.

Is the service well led?

Interim management systems were in place and action was taking place to recruit a new manager. Staff reported that some management changes had been unsettling, but that they felt staff support systems were improving. The organisation had arranged for a full time seconded manager to be in place from late July whilst recruitment took place.

Is the service responsive?

The service assessed people’s needs and developed a care plans to make sure their needs were met. It made sure people attended their usual day activities at the right time and with any items they needed for their day. The service took action if there was concern about a person’s health needs and sought advice from health professionals.

The inspection was carried out by one inspector over a total of six hours. We returned to the service for a second day as no people were staying there on the first day that we inspected. We spoke with two members of staff and three relatives. Some of the people who used the service had complex needs which meant that they were not always able to tell us about the service.

We used the information to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found

Is the service safe?

Equipment in use had been well maintained and serviced when it needed to be. The service was clean and hygienic.

There were sufficient staff on duty to meet people’s needs. Additional staffing was provided if people needed this to keep them safe.

People’s personal emergency fire evacuation plans for staff to follow in the event of a fire had not been reviewed regularly. We saw that a person with complex needs had no evacuation plan in place.

There were systems in place to make sure that any accidents, incidents were reported and reviewed. We saw that effective measures were put into place when necessary as a result.

Is the service effective?

People’s needs had been assessed before they moved into the service. People and relatives were involved in the process and introductions were personalised.

Relatives told us that people liked staying at the service and enjoyed the activities they took part in. A relative told us their relative had said they had had a “Brilliant time” at the service recently.

The service liaised with health and social care professionals and made sure that people attended planned day activities when they needed to.

Is the service caring?

Staff were patient and attentive towards people who used the service and we observed good interactions between people and staff.

Staff understood people’s individual methods of communication and were aware of their individual interests.

Is the service responsive?

The provider had responded to the need to recruit new permanent staff, this included management staff and support workers. This meant that people would be supported by staff they were familiar with.

The provider and management team had responded to the need to improve some systems and procedures. These included procedures for booking respite for people, medicine storage and reviewing records.

Is the service well led?

The service had a new manager and a deputy manager had been recruited to support them. A senior manager visited the service regularly and the organisation had responded to the need to employ new permanent staff.