This inspection took place on 19 October 2016 and was unannounced. Westminster House is a care home run by the local authority, which provides short term respite to people with learning disabilities. The home can accommodate a maximum of 10 people and on the day we visited there were three people staying. The accommodation was spread over two floors. All areas of the home were accessible via stairs. There were lounges/dining rooms on both floors of the home. There was accessible outdoor space from the ground floor. All bedrooms were for used for single occupancy and some had en-suite facilities.

The home was last inspected on 5 and 8 December 2015, when we found three of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breech of the Care Quality Commission (Registration) Regulations 2009. At this inspection we found improvements had been made in these areas.

There was no registered manager for the home. 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 previous registered manager left the provider in June 2016. Since that time an interim manager who manages one of the providers other homes had been in place at Westminster House. The provider had not commenced recruitment procedures for a new manager and was unable to say when this would occur.

People and their families were positive about the interim manager but were concerned about upcoming reduction in the number of people who could stay at Westminster House. People and their families were worried about access and availability of respite services and were uncertain about their future respite arrangements. The provider had not ensured they were fully involved or informed about the proposals.

Risks to individuals and the environment were pro-actively assessed and managed. Staff were knowledgeable about putting measures in place to reduce risks. Incidents were analysed to identify triggers and causes with measures put in place to reduce the risk and likelihood of reoccurrence.

Peoples’ care plans were person centred and included information about people’s preferences, routines and prompts for staff to support people to maintain their independence. Care plans were reviewed regularly or when people’s needs changed and were developed with people and their families.

Peoples’ medicines were managed safely. A system of auditing and recording was in place to help ensure people received prescribed medicines. People health was monitored and the provider sought advice from health professionals when people required medical assistance.

People’s dietary requirements and preferences were followed. Staff were knowledgeable about people’s individual needs and guidance around people’s specific requirements were clearly displayed in kitchen areas to reduce the risk that they would be not being supported appropriately.

Staff followed legislation designed to protect people’s rights and freedoms. Peoples’ choice, privacy and dignity were respected and upheld.

There were a suitable number of staff working at Westminster House. They had a thorough knowledge of people and cared for them with kindness and compassion. Many staff had worked at Westminster House for a number of years and had formed strong working relationships with people and their families.

The provider had made improvements to ensure a system as in place to support staff through training and supervision. Further improvements were planned where staff would receive an annual performance based appraisal.

Staff were knowledgeable about safeguarding procedures and could identify the steps needed to help to keep people safe if they had concerns. The provider pro-actively displayed and promoted the

Our previous inspection on 19 June 2013 identified that the provider had failed to regularly seek the views of service users regarding the standard of care and treatment provided. They had also failed to maintain accurate records in respect of each service user. We set compliance actions and the provider wrote to us telling us how they would become compliant.

During this inspection we saw there was now an effective quality assurance process in place which regularly monitored the quality of the service provided. We looked at the results of recently completed feedback questionnaires, including an easy read version for people with learning disabilities. All of the feedback we saw was positive. We also saw there was a staff meeting structure, where staff could raise any issues or concerns and there was an effective complaints procedure which facilitated learning from incidents.

At this inspection we found people’s personal records including medical records were accurate and fit for purpose. We spoke with three members of staff who told us they had access to all the necessary information for the provision of care, including policies and procedures.

We spoke with five people who used the service or their relatives and they told us they were happy with the level of care provided and staff were always available when needed. One person told us “I am very happy here. They look after me very well”. Another person said “I’ve been coming here for a long time. I really like it”.

We observed staff providing care and saw that people looked happy and relaxed. We reviewed six care plans and associated documents. We saw that although the care plans lacked consistency in structure they contained appropriate information about people’s care needs and preferences. Most of the plans we looked at contained a series of risk assessments. However, we found some of these had not been updated for a number of years. We spoke with the manager, who was new in post, they told us the care plans were under review and showed us the new format which was in the process of being implemented.

We saw the home was clean and well maintained and there was an effective process in place for dealing with medication. We spoke with four members of staff who told us there was enough staff to meet people’s needs. They confirmed they had received appropriate training and had the skills necessary to carry out their duties.

We saw there had been quality assurance systems in place but these had not been maintained and were not current. We also found that some records were not accurately maintained.

We spoke with one person who used the service and two family members. They told us that they were happy with the level of care provided and that staff were always available when needed. One family member said “they know him inside out. When we get in the car to come here, he is beaming”. Another family member said “I can’t fault them. They understand his needs. When he is here he is as good as gold”.

We observed staff providing care and saw that people looked happy and relaxed. We reviewed four care plans and associated documents. We saw that although the plans lacked consistency in structure they contained appropriate information about people’s care needs and preferences. Most of the plans we looked at contained a series of risk assessments. However, we found no evidence that these had been updated for a number of years.

We spoke with four members of staff and confirmed that they had received appropriate induction training and had the skills necessary to carry out their duties. Staff had received some safeguarding training and were able to say what action they would take if concerns were raised or observed.

We saw that there had been quality assurance systems in place but these had not been maintained and were not current. We spoke with an external community carer and two health professionals, who told us they were happy with the care provided at the home. They said that there was good communication and they were kept informed of changes in people’s condition.

Westminster House is a care home run by the local authority, which provides short term respite to people with learning disabilities. The home can accommodate a maximum of 10 people and on the days we visited the home, there were four and five people staying respectively. There were a total of 41 people registered to use the respite service, some of whom used it on a weekly basis and others less frequently. The inspection was unannounced and was carried out on the 02 and 08 December 2015.

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.

People were at risk of receiving unsafe or inappropriate care because care records were not always up to date and did not contain sufficient information to inform staff as to people’s individual needs.

Risks relating to people’s care and welfare were not always managed effectively and risk assessments were not up to date.

There was not an effective system in place to manage short term absences, such as staff sickness. Staff were not always supported to develop through supervisions and appraisals.

The registered manager did not always notify CQC, without delay, of incidents of abuse of allegations of abuse affecting people using the service.

Staff sought verbal consent from people before providing care. Staff were knowledgeable about the people they supported and when appropriate followed legislation designed to protect people’s rights and ensure decisions taken on behalf of people were made in their best interests. However, there were no records in people’s care plans to new enable staff to understand the ability of the person to make specific decisions for themselves. We have made a recommendation in respect of this.

We found the home was meeting the requirements of the Deprivation of Liberty Safeguards.

There were systems in place to monitor quality and safety of the service provided. However, some audits were completed on an informal basis and were not recorded. We have made a recommendation in respect of this.

People were supported by staff who had received the appropriate training to enable them to meet their individual needs. There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training.

Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain their family relationships. People’s families were involved in discussions about their care planning, which reflected their assessed needs.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people in a patient and friendly manner.

Staff were responsive to people’s communication styles and gave people information and choices in ways that they could understand. They were patient when speaking with people. Staff were able to understand people and respond to what was being said.

There was an opportunity for families, health professionals and regular visitors to become involved in developing the service and they were encouraged to provide feedback on the service provided. They were also supported to raise complaints should they wish to.

Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the full version of the report.