This comprehensive inspection took place on 21 November 2017 and was announced.

Tregarne and Chy Koes is a residential home that provides respite personal care and support to younger adults and older people for up to 15 people. Tregarne and Chy Koes are two separate units. At the time of our inspection two people were receiving respite care at Chy Koes and five people were receiving respite care at Tregarne. People used the service for various short term periods to provide respite for them and their families who were their main carers.

Tregarne and Chy Koes is situated close to the centre of the town of St Austell with all amenities being a walk or short drive away. The service provides single room accommodation for up to 15 adults with a learning disability and or physical disability who need assistance with personal care. Up to ten people can be accommodated at Tregarne and up to five people at Chy Koes. Occupancy levels vary each week due to the nature of the service. The service is a purpose built home on one site but included two separate buildings. There are range of aids and adaptations in place to support people with a range of disabilities which impact on their mobility and movement. Each person has their own room which have en-suite facilities including bathing facilities. There are additional toilets located in both services.

There was 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 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.

Staffing levels were based around the needs of people using the service. Due to fluctuating occupancy levels, staffing the service needed to be flexible. Staff were responding to this and proposed changes in staffing shift patterns were currently in consultation with the provider and unions.

Staff had been recruited safely, received on-going training relevant to their role and supported by the registered manager and team leaders. They had the skills, knowledge and experience required to support people in their care. Staffing levels were sufficient to meet the needs of people who used the respite service.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

People’s rights were protected by staff who under stood the Mental Capacity Act and how this applied to their role. Nobody we spoke with said they felt they had been subject to any discriminatory practice for example on the grounds of their gender, race, sexuality, disability or age. There was a strong focus on protecting people’s human rights.

Care records were generally organised, detailed, personalised and comprehensive care records were regularly updated and reviewed with involvement from people and their families. However, both units used their own recording system. The registered manager is working towards unifying both systems to ensure continuity. Care and support plans included person centred daily observation records that identified the care and support interventions that had been provided around care and support for the person being supported.

We observed positive exchanges between staff and people who used the respite service. There was a culture on promoting dignity, respect and independence for people. People told us staff treated them as individuals and delivered person centre

This was an unannounced inspection, carried out on 1 October 2015. As the service provides respite support to people we checked in advance to ensure the service was open on the planned day of our visit. We gave the provider 24 hours’ notice of our inspection. The service was last inspected on 28 August 2013 when it was found to meet regulations.

Tregarne is a respite service that provides care and support for people who have a learning disability. Tregarne can accommodate up to 10 people although due to the nature of the service this fluctuates on a daily basis. The service is owned and operated by Cornwall Council.

People using the service had a range of learning, sensory and physical disabilities and there were a range of aids and adaptations in place which met those needs. These included a sensory room.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

There were two people using the service during the inspection visit. They told us they liked using the service and that they had short breaks every week. Comments included, “I’ve been coming here for ages. I like it here” and “[staff names] are very kind, they are making me my favourite tea”.

We observed that people were relaxed, engaged in their own choice of activities and appeared to be happy and well supported by the service.

We walked around the service and saw it was comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect. Staff demonstrated they had an excellent knowledge of the people they supported and were able to appropriately support people without limiting their independence. We saw many positive interactions and people enjoyed talking to and interacting with staff. One staff member said, “I have worked here for a long time, it’s a very rewarding place to work”. People told us that staff supported them to maintain their independence and we saw evidence of this within the care documentation we viewed.

Staff were trained and competent to provide the support individuals required. They were supported through a system of induction and training. Staff told us the training was thorough and gave them confidence to carry out their role effectively. The staff team were supportive of each other and worked together to support people. Staffing levels met the present care needs of people that used the respite service.

We found people and others who were important to them, were involved in the planning of their care and documentation was written in person centred way.

Where people did not have the capacity to make certain decisions, the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People had a choice of meals, snacks and drinks chosen by themselves, which we saw they enjoyed. People had a daily choice of meals which varied due to the various day care facilities people used. Some people were involved in meal preparation. The two kitchens had been designed to accommodate people using wheelchairs, or those who required seating to prepare meals, by lowering work surfaces and cupboards.

There were systems in place to ensure people who used the service were protected from the risk of harm and abuse and the staff we spoke with were knowledgeable of the action to take if they had concerns in this area.

There were arrangements in place to ensure people received their medicines safely and staff were knowledgeable of these.

People knew how to complain and we saw people had the opportunity to discuss how they felt about the service. Each person had a key-worker who checked regularly if people were happy with the service they received. One relative told us, “[The person] has been going for a long time, they do a good job and If I wasn’t happy about something I would know who to go to”.

We saw evidence that comprehensive quality assurance processes were regularly undertaken to ensure the service was being monitored. This ensured a service culture which was open to challenge and learned from issues affecting the quality of the service if they arose.

We spoke with four people who were staying at Tregarne at the time of the inspection, four relatives of people who used the service and four members of staff. People staying at Tregarne told us they like going there, comments included, “It’s nice here” and “My room is nice”.

Care plans contained detailed information regarding peoples support needs. However, information was sometimes duplicated.

People were protected from the risks associated from the unsafe use and management of medicines because there were robust systems in place.

Staff had received training relevant to their roles. Management was supportive of staff.

Staffing levels were adequate to meet people’s care needs.

People who lived at Tregarne were complimentary about the staff team. Comments included, “staff are kind” and “staff are very nice, helpful, kind”.

One person told us Tregarne is “a home from home”, another person told us “it’s a very nice place”.

During our inspection we found, people’s privacy, dignity and independence were respected and people experienced care, treatment and support that met their needs and protected their rights.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines and the provider had an effective system to regularly assess and monitor the quality of service that people receive.

We found there were enough qualified, skilled and experienced staff to meet people’s needs. However, peoples training needs were not always updated and training undertaken by staff was not always in line with peoples associated care needs.