This comprehensive inspection took place on 11 and 13 July 2018. As this is a small service and people are not always staying there, we gave two days’ notice of our visit to ensure someone would be available. The service was rated Good following our focused inspection in August and September 2017 and there were no ongoing breaches of the regulations.

West View Short Term Break Service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

West View Short Term Break Service is a short stay respite care home without nursing that accommodates up to three adults with learning disabilities at any one time. Accommodation is provided in individual ensuite bedrooms, two of which are downstairs and are adapted for people with mobility needs. Some people who use the service have complex learning and physical disabilities. They may also have different ways of communicating or making their needs known. At the time of the inspection around 20 people had planned short breaks at the service over the

year. They were all funded by statutory services.

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.

The service had a registered manager. 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.

People were treated with kindness, respect and compassion. Their privacy, dignity and independence were respected.

Staff communicated with people in the way they preferred, calling them by their preferred names and being alert to signs that people were happy with whatever was going on at the time.

People were protected from abuse and neglect. Staff understood and met their responsibilities to safeguard people.

Risks to people's personal safety had been assessed and plans were in place to manage identified risks in the least restrictive way possible. People each had a personal emergency evacuation plan that set out clearly the assistance they would need from staff and emergency services personnel in event of a fire or other emergency.

The premises and equipment were kept clean and in good order. People’s individual needs were met by the adaptation, design and decoration of the premises. The ground floor and garden were wheelchair accessible. Both downstairs bedrooms had ceiling tracking hoists that extended into the ensuite shower rooms.

As far as possible people had the same room whenever they came to stay and the furniture was arranged according to the person’s preference. This helped them feel comfortable and familiar with things, and also to manage visual or mobility impairments as independently as possible.

Peoples' medicines were managed and administered safely.

There were systems to ensure that lessons were learned when things went wrong.

People’s assessments and care plans were reviewed and updated in consultation with them and their families prior to each stay. Assessments and care plans were comprehensive, detailed and individualised.

When people were referred to the service, information was obtained from them, their families and their professionals. They visited for meals and had trial overnight stays to help them, their representatives and the staff assess whether the service was suitable for them.

People received personalised care that was responsive to their needs. Care plans reflected p

West View Short Term Break Service is a short stay respite care home without nursing that accommodates up to three people with learning disabilities at any one time. Accommodation is provided in individual en-suite bedrooms, two of which are downstairs and are adapted for people with mobility needs. There is a communal lounge, dining area, kitchen and garden. Some people who use the service have complex learning and physical disabilities. They may also have different ways of communicating or making their needs known. At the time of the inspection fifteen people had planned short breaks at the service over the year. They were all funded by the local authority.

The service had a registered manager who was the regional manager for the provider. This was a temporary arrangement until the new service manager, who had started in post two weeks before, applied to be registered. 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 inspection took place on 10 and 11 August 2017 and 14 September 2017. We announced our visit the day before to be sure the people we needed to speak with would be available. As there was no-one staying at the service on 10 August, we returned the next day to meet people who had arrived that day.

At a previous inspection in June 2016, the service had not been meeting the requirements of the regulations and CQC took enforcement action, issuing warning notices in relation to good governance and record keeping, and safe care and treatment. The service received an overall rating of Inadequate and the provider was placed into special measures by CQC.

We carried out a further unannounced comprehensive inspection on 6 February 2017. Actions had been taken in response to most of the shortfalls and serious concerns identified at the last inspection and the service was taken out of special measures. Whilst there had been significant improvements, breaches of legal requirements were found. There was an ongoing breach of the regulations in relation to good governance and record keeping. There were also two new breaches, in relation to suitably skilled agency staff and notifying CQC of incidents as required by the regulations. In addition, there were some areas for improvement. CQC took further enforcement action in relation to the ongoing breach, imposing a condition on the provider’s registration.

After the comprehensive inspection, the provider wrote to us saying what they would do to meet legal requirements in relation to these areas.

We undertook this focused inspection to check they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for West View Short Term Break Service on our website at www.cqc.org.uk.

During this inspection the service demonstrated to us that improvements had been made and maintained to meet the regulations in relation to good governance, record keeping, staffing and notifications. We have therefore removed the additional condition we imposed on the provider’s registration.

The service had a well-established staff team, who knew people who came to stay at the service well. Agency staff were rarely used, as vacant shifts were usually filled by regular staff working overtime or the provider’s own bank staff. Agency staff profiles were held at the service. These showed the recruitment checks undertaken by the agency and the training they had had, including training and competence in handling medicines.

Action had been taken to ensure medicines administration records and care plans relating to medicines were up to d

West View Short Term Break Service is a short stay respite care home without nursing for up to three people with learning disabilities. 12 people used the service and they were all funded by the local authority. The 12 people had planned short breaks through the year. Some of the people who use the service have complex learning and physical disabilities. They may also have different ways of communicating or making their needs known.

There was a registered manager at the service who was the regional manager for the provider. This was a temporary arrangement until the new service manager applied to be registered. The service manager was responsible for the overall management of this and one other care home and two supported living services in the locality. 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.

At the last inspection in June 2016 the service was not meeting the requirements of the regulations and CQC took enforcement action. The service received an overall rating of Inadequate and the provider was placed into special measures by CQC.

This inspection was unannounced on 6 February 2017. There was one person staying at the service at the time of the inspection.

Whilst there had been significant improvements found at this inspection we also identified shortfalls. There was one ongoing breach, two new breaches of the regulations, and some areas for improvement. You can see some of the action we have asked the provider to take at the end of this report.

The governance systems in place were not yet fully effective, as they did not fully assess and monitor the quality and safety of the service, and did not fully assess or mitigate the risks to people. Some records were not accurately maintained. This was an ongoing breach of the regulations.

The agency staff on duty and some other agency staff that had been used were not suitably qualified and did not have the experience, skills and knowledge to support people using the service. Recruitment and training information was not available for three agency staff that had worked at the service over the last month. This was a breach of the regulations.

The service had not notified CQC of incidents as required by the regulations. This was a breach of the regulations.

There were overall improvements in the safety of the service. The management, administration and storage of the medicines was safe. However, improvements were needed in people’s PRN ‘as needed’ medicines plans and the dating of when creams were opened. In addition there were some further areas of improvement needed in the safety and maintenance of the environment.

One concern had not been recorded in line with the complaints and concerns policy. This was an area for improvement.

Improvements had been made and people were supported to make decisions and their rights were protected when they lacked mental capacity to make a specific decision.

People’s needs were reassessed and care plans had been updated and included all the information staff needed to be able to care for people. Easy to access information about people was not available for agency staff. This was an area for improvement.

Staff were caring and treated people with dignity and respect. People and staff had good relationships. Relatives told us staff had the right skills and knowledge to meet their family member’s needs. All the relatives spoke highly of the staff team and said staff were caring and compassionate. Staff kept relatives informed and made sure that people remained in contact with their families and cares during their stays at the service.

Staff received an induction, core training and some specialist training so they had the skills and knowledge to me

The inspection was unannounced on 2 June 2016. There were three people staying at the home in the morning of the inspection. One person returned home that day.

West View Short Term Break Service is a short stay respite care home without nursing for up to three people with learning disabilities. 15 people used the service and they were all funded by the local authority. The 15 people had planned short breaks through the year. Some of the people who use the service have complex learning and physical disabilities. They may also have different ways of communicating or making their needs known.

There was not a registered manager at the service. The manager had been in post since January 2016 and was in the process of applying for their registration. 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 inspected West View Short Term Break Service in April 2013 and did not identify any concerns. At this inspection we identified five breaches in the regulations and other areas for improvement.

We identified serious shortfalls in people’s medicines management and this placed people at risk of not receiving their medicines as prescribed. The storage and recording of medicines were not safe. The manager took immediate action in response to our feedback about the safety of people’s medicines. However, this did not mitigate the risks to other people who used the service and the shortfalls were remained a serious concern.

Any risks to people’s safety were not consistently assessed and managed to minimise the risks to them. People particularly at risk were those people with complex needs. In addition, some people were placed at risk of infection because of the lack of infection control systems in place for sterilising specialist feeding equipment. This was a breach of the regulations.

People’s needs were not reassessed when their circumstances changed and care plans were not updated or did not include all the information staff needed to be able to care for people. Staff did not always follow care plans that were in place for some people. These shortfalls were a breach of the regulations.

Some people were being deprived of their liberty unlawfully. This was because no Deprivation of Liberty Safeguards (DoLS) applications had been made. This was a breach of the regulations. The manager took action and applied for authorisations for the people who were next due for stays at the home.

Staff still did not fully understand or adhere to the principles of the Mental Capacity act 2005. This was because people’s capacity had not been assessed or any decisions recorded that were in people’s best interests. This was a breach of the regulations.

The home had not been well led following changes and uncertainty in the management at the home. The provider’s systems in place for assessing and monitoring the quality and safety of the service were not effective. This was because the shortfalls we found had not been identified and acted on by the provider. The improvement plan that was in place was not effective and did not mitigate the risks to people’s safety and well-being. There were multiple shortfalls in the records kept about people and this meant we could not be sure about the safety and quality of the care and support being provided. These serious shortfalls were a breach of the regulations.

There was a very stable staff group who knew people well and have supported them over many years. Staff were very kind and caring but had not benefitted from any consistent leadership or management over the last two years.

Staff had not received the formal one to one support sessions or annual appraisals they needed. Plans were in place for staff to have formal suppor

West View Short Term Break Service is a short stay home for up to two people with learning disabilities. The service opened in January 2013.

There were two people staying at the service at the time of the inspection. We observed staff interacting and supporting both people as they arrived at the service. Both people had complex ways of communicating and did not communicate verbally. We spoke with one care worker, one agency worker and the manager.

We observed that staff and the two people were relaxed with each other; they laughed and enjoyed each others company. All staff knew each person's likes and dislikes and had good relationships with them. They understood how the two people communicated and responded to their non verbal cues and gestures.

Medicines were managed safely and people received their medicines as prescribed.

There were sufficient suitably qualified staff to support the people and the manager told us that staffing could be increased to meet the needs of individuals.

The records at the service were well maintained, accurate and securely stored.