Ten Acre Respite service is registered to provide accommodation and nursing care for up to 4 people with learning disabilities at any one time. CQC regulates both the premises and the care provided, and both were looked at during this inspection. We gave short notice of the inspection so we could make sure that people who used the service and staff would be available to see us.

There was a registered manager in post. 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 last inspection took place in August 2016 when the service was good in each domain area and rated good overall. On this visit we found the provider had not maintained this rating.

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.

We found some shortfalls in the administration and oversight of medicines.

Some audits were not robust in identifying, responding to and improving medicines issues and the environmental audit had failed to identify an issue we found on inspection.

Staff were seen to be kind and caring and there were enough of them to keep people safe and to meet their care needs.

Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff told us they felt supported by the registered manager and were receiving formal supervision where they could discuss their on-going development needs.

Care plans were up to date and detailed exactly what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified.

Staff knew about people's dietary needs and preferences and there was a choice of meals available.

We found the service was working within the principles of the Mental Capacity Act 2015 and Deprivation of Liberty Safeguards. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

The registered manager provided staff with leadership and was described as approachable.

People's feedback was used to make changes to the service.

We found two breaches of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 4 and 12 August 2016. The home was previously inspected in September 2014, and at the time was meeting all regulations assessed during the inspection.

Ten Acre is a care home providing respite care for younger people with a learning disability. It can accommodate up to four people at any one time. It is registered to provide accommodation and nursing care for people who use the respite service, it is also registered to provide personal care to people living in the community.

The service had a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run.

People who used the service, and their relatives we spoke with, told us they were happy with how care and support was provided at the home. They spoke positively about the staff and the way the home was managed. A relative told us, “They [staff] treat them (people who use the service) like they are one of their own, it is great care.”

We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required.

During their stays people were involved in menu planning, shopping and meal preparation. We saw snacks were available throughout the day and people had access to drinks as they wanted them.

Staff respected people’s privacy and dignity and spoke to people with understanding, warmth and respect.

There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. Staff had received a structured induction into how the home operated, and their job role, at the beginning of their employment. They had access to a varied training programme that met the needs of the people using the service.

People’s needs had been assessed before they went to stay at the home and we found they, and their relatives had been involved in the planning the care. The care files we checked reflected people’s main needs and preferences so staff had clear guidance on how to care for them.

People had access to activities which provided regular in-house stimulation, as well as occasional trips out into the community during their stay.

There was a system in place to tell people how to make a complaint and how it would be managed. We saw the complaints policy was easily available to people using and visiting the service. The relatives we spoke with said they had no complaints, but said they would feel comfortable speaking to staff if they had any concerns. Although no concerns had been raised the registered manager told us if concerns were raised they would be investigated and resolved in a timely manner.

There were systems in place to monitor and improve the quality of the service provided. The registered manager was introducing more robust systems at the time of our inspection and these needed to be embedded into practice.

Our inspection looked at our five questions; 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. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found adequate quality monitoring systems were in place. This ensured the risks to people were identified and reduced, to be able to continually improve.

Care and treatment was planned and delivered in a way that helped to ensure people’s safety and welfare. In most cases records were in place to monitor any specific areas where people were more at risk and explained what action staff needed to take to protect them.

The company had policies and procedures in place to help protect people who used the service from abuse. We found staff had received training in relation to safeguarding vulnerable people from abuse.

There was enough qualified, skilled and experienced staff to meet people’s needs. Staff told us there was enough staff on duty to ensure people were able to go out in the community and participate in activities they wanted.

Is the service effective?

People’s health and care needs were reviewed, and people were involved in the reviews. Two relatives we spoke with both told us the service provided was brilliant. One relative told us, “There is nothing I can fault.”

Audits and reviews had taken place; the audits were thorough and detailed. We saw that any shortfalls had been identified and addressed.

Is the service caring?

We observed care workers interacted positively with people who used the service. One relative told us, “The staff understand how to communicate with my relative and give them time to respond.”

Another relative told us, “The staff understand my relative’s needs, they have taken time to learn how they communicate and what different signs and gestures mean”.

Care files contained information about people’s needs and preferences. We saw care and support had been provided in accordance with people’s wishes.

Is the service responsive?

We found people were encouraged to express their views and were involved in making decisions about their care and treatment. The staff we spoke with gave us good examples of how people were involved in making decisions about the care and support they received

Is the service well-led?

The manager and provider followed a robust quality monitoring system that identified shortfalls and ensured they were rectified. The provider had identified a number of areas which required improving. There was a detailed action plan in place that the manager was working through to ensure improvements were carried out.

Staff told us they worked very well as a team. They told us they had regular meeting ensuring communication was good. Staff we spoke with told us they enjoyed working at Ten Acre; they were supported and worked well as a team.

Staff told us they received regular supervision and could at any time raise any concerns or ideas and they were listened to. Staff were clear about their roles and responsibilities. We saw they had access to policies and procedure and were kept up to date with any changes to make sure they reflected how the service operated

The manager was new in post and was in the process of registering as the registered manager with CQC.

The registered manager for the service had not been at work for three months. At the time of our visit we were told the deputy manager had been overseeing the service. Staff and relatives we spoke with told us this had not affected the service provided.

People we spoke with told us they enjoyed their respite stays at the service, they felt safe and were well looked after. They told us the staff were lovely and they helped them do activities. We also spoke with relatives and they told us that the service was very good and staff were very knowledgeable on their relative’s needs. They told us if they had any problems or just wanted advice they could speak to any member of staff. One person told us, “Anything no matter how minor is always dealt with immediately.”

People who received a service and their relatives told us that staff treated them with respect, listened to them, gave them choices, made them feel safe and supported them. One person told us. “I love it.”

Evidence showed people were protected from the risk of infection because appropriate guidance had been followed. We also saw the environment was clean and well maintained.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff also received appropriate professional development.

There was an effective system to regularly assess and monitor the quality of service that people received.

We could find little evidence that people had been involved in making decisions about their care and support. We were told by one staff member that people were not routinely involved in planning their care, and that care plans and risk assessments were devised without involvement from the person they concerned.

We saw that people experienced care delivered in an unhurried manner, and that staff talked through care tasks that they were carrying out with the person they were supporting.

We found that there were a number of areas that were not cleaned to an appropriate standard. There were also defects and areas of damage that meant that the home and equipment could not be adequately cleaned. Audits of hygiene had not routinely taken place

Several fire doors were propped open using door wedges. We asked why the doors were propped open and they said that this was so they could hear people and this kept them safe. None of the fire doors which were propped open would close in the event of the fire alarm sounding.

Staff received regular supervision and appraisal, and were supported to carry out training over and above their mandatory training.

People’s records were detailed and contained information about how staff should provide care and support to ensure that people’s needs were met. We identified some errors and omissions with record keeping, which we discussed with the senior staff present on the day of the inspection.