This inspection took place on 29 and 31 May 2018. The first day was unannounced, however we informed staff we would be returning for a second day to complete the inspection and announced this in advance.

The Hamlet provides residential and respite support for up to nine people with learning disabilities, autism, physical disabilities or mental health needs. At the time of the inspection there were seven people using the respite service and two people were receiving long term residential care.

At our last inspection of The Hamlet in February 2017 the home was rated as ‘Requires improvement’ overall due to not meeting all the regulations in relation to record keeping and staff training. At this inspection we found the service had taken all the required action and were now meeting the regulations.

People had been protected from the risk of harm and abuse. Staff understood what might be a safeguarding concern and how to respond to this.

The building and utilities had been maintained to a good standard with all necessary checks and certificates in place, including; gas, electrical, legionella and fire safety equipment.

Medication was safely managed, records were up to date and provided the necessary details in relation to all prescribed medicines including topical creams and dietary supplements and thickeners.

People’s needs had been assessed and care plans developed to ensure their needs were met as they preferred. Risk assessments provided guidance on how to support people to manage the risks in their daily lives.

Staff had received an increased level of training which had provided them with the necessary knowledge and skill to meet people’s needs safely. Staff reported feeling they had benefited from the training available.

The service was aware of its responsibilities in relation to the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards.

Staff were seen to be caring and supported people, kindly and respectfully. People living in the service said they thought the staff were kind and caring.

People received person centred care that was responsive to their needs. Care plans were reviewed and updated regularly.

The management structure was clear and staff reported being happy with the way the service was managed, they felt the manager could be relied upon to take appropriate action and was supportive and fair.

Audit and governance systems had been improved and ensured people received care and support consistently.

Relatives reported feeling able to approach the manager at any time and felt confident they would act on any concerns they raised.

The Hamlet is a respite service in Eccles, Salford that provides 24 hour support to people with a learning and physical disability. At the time of the inspection there were two people living at the service on a long term basis and one person staying on a respite basis. The manager also told us that some people used the service at weekends on respite.

We carried out our unannounced inspection of The Hamlet on 27 February 2017. Our last inspection of The Hamlet was in October 2015 where the service was rated as ‘Requires Improvement’ overall and for the key questions of Safe, Effective, and Well-led. The key questions for Caring and Responsive were rated as Good.

During this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance (two parts of the regulation), staffing and safeguarding people from abuse.

There was a registered manager in day to day charge of the service. 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.

We looked at how medication was handled and reviewed two MAR (Medication Administration Records) for people living at The Hamlet. One person had been prescribed double base gel for their skin condition, however there was no PRN (when required) protocol in place to advise staff as to when this needed to be applied. There was also no cream chart to guide staff as to which part of the body this needed to be applied to. This meant a new member of staff may be unsure of how to apply this safely due to not having appropriate documentation to refer to.

We looked at how risks were managed within the service and reviewed two people’s care files. We saw one person had risk assessments in their file with regards to road safety when out with staff, support with personal care and challenging behaviour. These detailed any actions staff needed to take to mitigate any risks. The second care file we reviewed did not contain any risk assessments. A member of staff told us this person approached different staff members and asked them for additional money which they used to purchase alcohol and had resulted in them previously exhibiting abusive and challenging behaviour. Risk assessments had not been put in place to identify this risk or show how the risk was managed. This meant staff did not have up to date information about people’s care and support.

The relative of a person we spoke with said their family member was safe living at The Hamlet. Staff had a good understanding of safeguarding, whistleblowing and how they would report concerns.

Staff recruitment processes were safe with appropriate checks had been undertaken such as holding job interviews, applying for references and carrying out DBS (Disclosure Barring Service Checks).

We checked to see if the home worked within the requirement of DoLS (Deprivation of Liberty Safeguards) and MCA (Mental Capacity Act). One person living at The Hamlet had had a DoLS in place but we found this had expired in December 2016. The registered manager was unaware of this and had not re-applied to the local authority in the required timeframe which meant the person was unlawfully detained.

We saw there were gaps in the training and there was no identified timeframe for completion of this training. The gaps included; MCA and DoLS, positive behaviour management, autism awareness and learning disabilities. The service is designed to support people with a learning disability so this training is fundamental in ensuring staff have the required knowledge and skills to meet people’s needs. This gap had been identified at our previous inspection and remained an area still outstanding. This meant the registered manager

The Hamlet is a respite service in Eccles, Salford and provides 24 hour support to people with learning difficulties. At the time of the inspection there were two people living at the service on a long term basis. The manager also told us that some people also used the service at weekends.

We carried out our unannounced inspection of The Hamlet on 27 October 2015. At the previous inspection in April 2014 we found the service was meeting all standards assessed.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Safe Care and Treatment and Good Governance.

There was a registered manager in day to day charge of the service. 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.

We found that staff recruitment procedures were generally safe, but that one member of staff had started their induction before an appropriate DBS check had been undertaken.

We found that people’s risk assessments were not always reviewed at regular intervals, some dating back to 2012 in relation to falls and bed rails. One person who used the service also used a hoist and an electric wheelchair; however we could not see that an appropriate moving and handling assessment had been completed. These concerns meant there had been a breach of Regulation 12 (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to Safe Care and Treatment.

The premises were not always safe on the day of the inspection. This was because there was nothing stopping people walking in off the street and gaining unauthorised access to The Hamlet. The main reception was unmanned and anybody coming through the main entrance could access the accommodation on the ground floor.

The people we spoke with said they felt safe as a result of the care and support they received and trusted the staff who looked after them.

People’s medicines were looked after properly by staff that had been given training to help them with this. However, there was not always clear guidance for staff about when to administer ‘when required’ (PRN) medicines.

We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe and found enough were available to look after people safely.

We looked at the training matrix to establish the kinds of training staff had undertaken. We found there were gaps on the matrix, which the manager told us was up to date. Some of these courses included Safeguarding, Moving and Handling, Infection Control and Health and Safety. The manager said the expectation was to update these courses each year. Additionally, the training matrix stated only three members of staff had completed any training in Learning Disabilities, which was the main specialism of the service and that not all staff had received training in Conflict Management. We raised these concerns with the manager.

The Mental Capacity Act 2005 (MCA 2005) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need, where there is no less restrictive way of achieving this. At the time of the inspection, there was nobody using the service who was subject to a DoLS.

We found that people living at the service were supported to receive adequate nutrition and hydration. Staff were aware of people’s dietary requirements and the support they required to meet these needs.

From looking at records, and from discussions with people who used the service, it was clear there were opportunities for involvement in many interesting activities both inside and outside the service.

The service had an appropriate complaints procedure in place. The procedure was available in an easy read format that could be understood by everyone who used the service. We looked at the complaints log and saw complaints had been responded to appropriately, with a response given to the individual complainant.

There was a system in place to monitor accidents and incidents. However we found no analysis of these was done which would identify any trends and prevent future re-occurrences. The manager said this was down to current time constraints.

We looked at policies and procedures and found that many needed to be reviewed.

There were systems in place to regularly assess and monitor the quality of the service. These included audits of care plans and medication. The manager also spent time speaking with people who used the service at several points during the year to ask them about the service and if it was to their satisfaction. These were clearly recorded within people’s support plans.

There were no systems in place to ensure that appropriate risk assessments were in place and reviewed at regular intervals, that the premises were safe and that all staff training was up to date. These were areas where we found concerns during the inspection. These concerns meant there had been a breach of Regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation Good Governance.

The Hamlet is a respite care home that provides short term care to up to nine people with a learning and or physical disability. Our inspection team was made up of an inspector, who addressed 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 who used the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns, and whistleblowing. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, although no applications have been submitted. Managers had been trained to understand when an application should be made.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

The registered manager set staff rotas taking account of people’s care needs when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure people’s needs were always met.

Recruitment practice was safe and thorough. Where staff had been subject to disciplinary action, matters had been appropriately dealt with and recorded. A comprehensive range of policies and procedures were in place to make sure unsafe practice was identified and people were protected.

Is the service effective?

People’s health and care needs were assessed with them. Where people had communication difficulties pictorial aids were used to help identify needs and concerns. Mobility and equipment needs had been identified in care plans where required.

The unit was located on the ground floor of the building and people’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been adapted to meet the needs of people with physical impairments.

Relatives confirmed they were able to visit their loved ones at any time and speak in private. They felt welcomed by accommodating staff.

Is the service caring?

People were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. People commented, “I like it here. I feel safe and the staff make me feel safe. They are really good at helping me.” A relative said, “I feel X is safe and well looked after. I’m very satisfied.”

People who used the service and their relatives completed quality assurance questionnaires. The service also undertook individual quality assurance meetings with people who used the service. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home was able to access organised activities at the Links Day Centre located in the same building.

People we spoke to were aware of the complaints procedure but had never had cause to complain. We looked at how complaints had been dealt with, and found that the responses had been open, thorough, and timely. People can therefore be assured that complaints are investigated and action was taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. A visiting social care professional said “My impression is that it is very well run and works very well with other agencies.“

The service had a quality assurance systems, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times.

We saw that people or their representatives were involved in making decisions about their care and treatment and that they were treated with respect and kindness. There was a good provision of equipment, the home was clean and fresh.

We asked two people about their experience of staying at The Hamlet. People told us. "They know what I like and I know them"; "Staff are very good." "They are nice here."

We found that people were offered choice and consulted about their care. People's rights and dignity were promoted. We saw that detailed records were available to inform support workers about people's needs and how they were to be met. We saw from people's records and talking to them that their needs were met.

Medicines were handled in people's best interest and safety. Individual risk to people was well managed. Staff were aware of how to safeguard people from abuse and there was good information for them to refer to.

The arrangements for listening to people's views and managing the home effectively ensured people's welfare was fully promoted.

Following an inspection visit in February 2012 the home was asked to make some improvements to maintain compliance. We carried out this visit to check what improvements had been made.

We spoke with two people receiving respite care at the home who told us: "They are alright here the staff are all nice." "It has been Okay the staff are great."

We looked at a sample of peoples' care plans and found that they were written from the person's point of view. We saw that peoples' preferences in relation to how they wanted their care delivered were recorded.

We found that care plans had been reviewed and that a system for gathering comments from people who used the service or their relatives had been developed although no responses had been received.