The inspection took place on 29 March, 4 and 5 April 2017. The first day of the inspection was unannounced, which meant the staff and provider did not know that we would be visiting. We informed the registered manager when we would visit for the second and third day of our inspection in order to meet a wide range of people who used the service and join a relatives meeting.

1 Lanark Close is registered to accommodate up to 16 people but the provider is operating the service as a 12 bedded care home providing short-breaks, a transitional service and a crisis bed for approximately 77 people per year who have a learning disability. Some of the people who used the service may have in addition to a learning disability a physical disability or mental health need. People normally arrive for their stay in the afternoon and depart on the morning their break finishes. But when people were in a crisis situation they could immediately access a stay at the service and were fully supported by staff to deal with any emotional distress as well as, with their consent, access to other organisations and services that could assist them during this stressful period. During their stay at the service people had access to hotel style accommodation, a gym, sensory room, games room, internal and external activities such as going to discos, the cinema and making crafts, as well as access to advocacy and mental health services.

There was a registered manager in post at the time of our inspection who had worked at the service since April 2014 and became the registered with CQC in October 2014. 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 most striking aspect of this dynamic service was the strong sense of leadership, commitment and drive to deliver a service which improves the lives of the people who use the service and their relatives in a fulfilling and creative way. The culture embedded in the service was an absolute commitment to deliver a person-centred and responsive short-break service, which relatives described as a lifeline for them as well as a fantastic place for people to use. We found that the registered manager had encouraged staff to constantly think about improvements. Staff told us that prior to and following people’s visits to the service they looked at what went well and how they could make the next stay even more special for each individual. We found that the management style had led to staff, people who use the service and relatives feeling they were an integral to and an essential partner in assisting to develop and enhance the service.

Although over 77 people use the service each year staff were devoted to ensuring each individual found their lives were enriched by they experience that they kept very up to date with each person’s life. Staff could readily discuss at length and in great detail each and every person who came to 1 Lanark Close, what they liked and their support needs. We found the staff empowered people to voice their wants and aspirations for their lives and then supported them to achieve these goals. It was evident that people’s voice was heard as following people and relatives giving feedback that the environment needed to be updated the provider had completed major refurbishment work and installed high quality baths, showers and furnishings. They had created more space for people to use by converting an office on the upstairs floor into a pool room as well as enhancing the gym, games room and sensory room. The standard of décor within the home was of a very high quality.

During their short breaks people were encouraged and supported to establish new friendships, to learn new skills and transfer these into their everyday

During the inspection we spoke with three people who used the service, one relative and five staff. People told us that they were treated well and that staff were good. People expressed satisfaction with the care and service that they received. One person said, "I like it here, it has helped me a lot, I can talk to the staff and they are very good."

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. Staff were attentive and interacted well with people. We saw that staff communicated well with people and explained everything in a way that could be easily understood. Staff encouraged and supported people to make choices and to be independent.

We found that there were good systems in place for the involvement of other health care or social care professionals.

We found the premises that people, staff and visitors used were safe and suitable.

We found there was an effective complaints system in place at the home although this could be enhanced further.

We found that whilst there was detailed care and support information in place for people using both of the service, this information was not always up to date.

We spoke with four people who use the service. One person told us they had a keyworker who had discussed their plans with them. They said, "My keyworker has given me assistance and supported me.”

People we spoke with said they would inform the staff if they were unhappy or had concerns.

One person said, "There is nothing I am unhappy with, if there was something I would tell the staff."

We spoke with people who use both the respite service and the rehabilitation service. People told us they were able to continue making their own decisions about aspects of care, support and activities.

One person said, "It is really nice here, it is peaceful, I have freedom, choices and make my own decisions". Another person said, "I make my own decisions about getting up and going to bed, I had a lie in this morning as I did not have to go to work".

We observed people locking their room doors when coming out. One person said they are given their key when they are admitted for respite care.

We inspected 1 Lanark Close on 2 and 20 January 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

1 Lanark Close is a service providing a rehabilitation service for three people in a self-contained flat as well as 13 places for respite care, which approximately 100 people use per year. All of the people who use the service have a learning disability and required varied levels of support, which at times includes support with personal care. The flat had recently been refurbished so the rehabilitation service was not operating at the time of the inspection. This was expected to recommence early in 2015.

The home had a registered manager in place and they have been in post for just under a year. 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 registered manager had ensured the service was fully refurbished. A sensory and games room as well as a gym had been created. The registered manager had taken action to ensure the bathrooms and all areas of the service had been redecorated and upgraded. However, the service had a commercial kitchen designed purely for heating up food and this facility did not allow people to enhance their cooking skills. The service had started a skills programme and cooking was one of the skills people needed to be assessed upon so the lack of an appropriate kitchen hindered this programme. The Health and Social Care Act 2008 regulations require that people are supported to be as independent as possible.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) training. The provider instructed the registered manager to apply for DoLS authorisations for all of the people who used the service and the requests would need to be made every time the each person visited. This had the potential to lead to over 5000 DoLS authorisations being sought each year. The people we met were all able to consent to using the service for overnight stays. At other times people lived in their family home and it was unclear as to the legal framework their guardians used to provide care and welfare at home. We found that the provider had not considered the role of the guardian and the ability of the person to consent before requiring staff to completing DoLS authorisations. We found that the registered manager was very aware of their responsibilities under the MCA and had discussed this issue with the provider. We found that action was being taken to ensure DoLS authorisation were sought appropriately.

The people who used the respite service often visited for one overnight stay or a couple of days. We found that people had been using this resource for many years. Thus, staff both delivered personal care and provided support to assist, to develop impulse control, and to manage people’s behaviour and reactions to their emotional experiences.

We met people who were visiting the service for the first time and others who spent a night at the service every month. We saw that people required different levels of support to communicate their views and we saw that staff readily understood individual various communication methods.

Four of the people we met were very able to tell us their experiences of the service. All four people were extremely complementary about the staff and found that there was always plenty to do. They felt coming for a break at the service was a real holiday. We also spoke at length with four relatives and again they were very positive about the service. They all felt that since the registered manager had come into post significant improvements had been made. People told us that the medication handover process could be simpler and the registered manager confirmed this was an area they were already working on as it had been very bureaucratic and burdensome for the carers.

We observed that staff had developed very positive relationships with the people who used the service. We saw that where people experienced high levels of anxiety staff were able to discreetly reduce the impact on the individual and those people around them. Interactions between people and staff that were jovial and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity.

People told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice. People were involved in a wide range of everyday activities. We heard that staff ensured action was taken if they felt unwell whilst using the service.

People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

We saw that people living at 1 Lanark Close were supported to maintain good health and learn about how to be healthy whilst using the respite service. People generally visited for very short periods of time but staff knew what to do in an emergency if someone became unwell. The person’s main carer was always first point of call if someone felt generally unwell and we saw that plans were in place for contacting them.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. Staff used these assessments to create plans to support plans for people to follow whilst they used the service. The people we spoke with discussed how they had worked with staff to create them.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control, food hygiene as well as condition specific training such as working with people who experienced learning disabilities and various communication methods. We found that the staff had the skills and knowledge to provide support to the people who used the service. People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. We saw that the number of people who used the service varied from day-to-day. This was reflected in the rotas but at least three staff covered the service during the day, with this going up to six at times and there were waking night staff when people were using the service.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.

The provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these and used them to critically review the service. This had led to the systems being extremely effective and the service being well-led.