We conducted an announced inspection of 120 Harrowdene Road 15 November 2018. 120 Harrowdene Road is a supported living service for women with learning disabilities and other associated disabilities, such as autism, mental health needs and cerebral palsy. People using the service live in a shared house with wheelchair accessible accommodation on the ground floor. At the time of this inspection four people were using the service.

At our last inspection of 17 March 2016, we rated the service as Good. At this inspection we found the evidence continued to support the rating of Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had 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.

Procedures were in place to ensure that people were safe from harm, Personalised risk assessments for people were up to date. Staff members had received training in safeguarding of adults from abuse and understood their roles and responsibilities in ensuring that people were safe.

People’s medicines were managed safely. They were stored and administered appropriately. Accurate records were made when medicines were given. Staff members had received training in the safe administration of medicines. Risk assessments of people's ability to manage their own medicines had taken place and these were reviewed regularly.

People had personalised support plans and risk assessments in place. These were reviewed regularly and updated to reflect any changes in needs. Support plans had been developed in easy to read picture assisted formats. Information about people's cultural, religious and communication needs were included in their plans. People were supported by staff members of the same gender.

People’s support plans and risk assessments included guidance for staff on supporting people’s communication needs. Staff members communicated with people in ways that they understood, using, for example, pictures, objects and gestures along with words where appropriate.

All staff members working at the service had been safely recruited. References and criminal record checks were taken up prior to their appointment. New staff members received an induction to ensure they had the knowledge required to prepare them for their role. All staff members were provided with a range of training sessions which were relevant to their work. This training was regularly refreshed to ensure that staff maintained their skills and knowledge. All staff members had received regular supervision from a manager.

People were supported to eat and drink a healthy range of foods. People told us that they chose the food that they wished to eat and were supported by staff to shop for this,

Support was provided to ensure that people’s health needs were met. Staff at the service liaised regularly with other health and social care professionals.

The service was meeting the requirements of the Mental Capacity Act (2005). People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. A Deprivation of Liberty Safeguards (DoLS) assessment for one person using the service had been made by the Court of Protection which is the authorising body for this type of service. People were offered choices about what they wanted to do. Two people told us that the service was supporting them to be more independent in their daily lives. St

This was an announced inspection which took place on 17 March 2016. The service was last inspected in July 2014 when it was found to be meeting all the regulations we reviewed.

Ms Kayte Regina Pinto is a domiciliary care service which provides supported living to people living at 120 Harrowdene Road. 120 Harrowdene Road is staffed on a 24 hour basis and provides personal care and support to four women with a learning disability and mental health problems.

The service had 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.

People who used the service told us they felt safe with the staff who supported them. They told us there were always staff available to support them to participate in the activities which were important to them.

Recruitment processes were robust and should help protect people who used the service from the risk of staff who were unsuitable to work with vulnerable adults.

We saw that risks to people's safety and well-being were regularly assessed. Care records included information for staff to follow to ensure all identified risks were appropriately managed.

Support plans we looked at were personalised and included good information for staff about the goals people wished to achieve as well as how they wished their support to be provided.

Staff had received training in the safe administration of medicines. The competence of staff to administer medicines safely was regularly assessed.

Systems were in place to ensure the safety and cleanliness of all the premises where people who used the service lived.

Staff told us they had received the training and support they needed to carry out their role effectively. New staff received a comprehensive induction to the service. There were systems in place to track the training and supervision staff had received.

All the staff we spoke with told us they enjoyed working in the service and felt valued by their managers.

Staff felt able to raise any issues of concern in supervision or in staff meetings.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005; this legislation is designed to protect the rights of individuals to make their own decisions wherever possible. The registered manager was aware of the action to take to protect the rights of people who were unable to consent to their care and support.

People who used the service had health action plans in place. Records we reviewed showed that people were supported to attend health appointments where necessary. Systems were also in place to ensure that people's nutritional needs were monitored and met.

We observed positive interactions between staff and people who used the service. People told us the staff who supported them were kind and caring and enabled them to maintain their independence as much as possible.

Staff demonstrated a commitment to providing care which would improve the quality of life of the people they were supporting.

All the people we spoke with told us they would feel able to raise any concerns with the managers in the service and were confident they would be listened to.

The service was based on a set of values which were well understood by staff. There were a number of quality monitoring systems in place. Both staff and people who used the service were encouraged to comment on the service provided and to identify where any improvements could be made.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. We spoke with three people who used the service and two family members. We spoke with the registered manager, the deputy manager and with two care workers. We also spoke to a safeguarding manager and two social workers from the local authority. We looked at five care records and four staff records.

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

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. A local authority social worker told us “my client is absolutely safe there.” All staff had received safeguarding training and in discussion demonstrated a good understanding of the signs of abuse. Staff had access to and were familiar with the safeguarding policy of the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The local authority had initiated an interim DoLS application. Policies and procedures were in place to provide staff with guidance about legal requirements. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff they understood people’s care and support needs. A family member told us how “I am sure that staff will support my relative with whatever is best for them.” A local authority social worker told us “my client is in the best position that they have ever been.” We saw in their records staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers were patient and gave encouragement when supporting people. A family member told us how, "staff are doing an amazing job.” A care worker told us “we try to make it as much of a home environment as possible.” One family member told us “staff are so kind and really want to help, I live far away and yet they take my relative to see me from time to time.”

Is the service responsive?

We saw on records how people’s needs had been assessed before they moved into the home. A local authority social worker told us how “any information requested has been responded to quickly.” Records confirmed people’s preferences, interests, and diverse needs had been recorded and care and support had been provided which met their wishes. People had been supported to maintain relationships with their relatives. The registered manager told us “we discuss any potential new admission with those who live here. We want to get them involved as it is their home.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they were asked for their verbal feedback on the service. A family member told us how “staff know what they are doing; they have coped really well with my relative.” Staff told us they were clear about their roles and responsibilities. They also told us management support was very good and there was a manager on call 24 hours a day.

People who used the service told us they were happy with the support they received from staff. A relative told us, “they have treated my relative well all the time l have been there”. One person told us, “staff support me with washing” and another said, “I like staff. I get on with staff”. We saw that there was a good rapport between staff and people. Their interactions were respectful and positive and it was clear people were happy.

People told us staff supported them, to make decisions about their care, and to develop the skills needed to lead a more independent life. We saw people were supported to go for shopping and with other household chores.

The provider had effective recruitment and selection procedures in place, which ensured people’s health and welfare needs were met by staff who were fit and appropriately qualified.

The care we observed met people's needs. Person centred plans and risk assessments were based around their needs and preferences.

People took their medicines at the times they needed them, and in a safe way.

During the inspection we met the four people living in the home. They all have complex needs which meant they were not able to tell us about their experiences. In order for us to understand their experiences we used the Short Observational Framework for Inspection (SOFI) to observe how they spent their time during our inspection. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We saw that staff treated people with respect and dignity. Staff were around to ensure that people were safe and received support that met their needs. People were encouraged to make choices regarding their food and drinks.

We noted that staff were pleasant to people, unhurried and gave people as much time as they needed when assisting them with their meals. This ensured people using the service were treated with respect and their rights upheld. The atmosphere in the home was very calm and this indicated that the people living in the service were settled.

People using the service told us that they were involved in their care and treatment. One person told us that staff would tell them what they were planning to do and asked them if they wanted to take part in activities or personal care.

People told us that they took part in weekly meetings during which they discussed holidays planned, outings, food, their health and wellbeing.

People using the service told us that they were involved in the planning of their care and that they had contributed to the plan of care. One person told us, that she met with her key worker to discuss her care plan. A comment made by one of the people using the service. "I spoke to (mentioning the name of staff) about my folder and we discussed if I am still happy with the care".

We spoke with people and asked them if they felt safe at 120 Harrowdene Road. None of the people spoken with raised any concerns and told us that staff were looking after them well and ensured that they were safe.

People using the service told us that staff helped them to take their medication. All people spoken with told us that they were not able to self-medicate and made the following comments, "Staff give me my tablets, I would forget taking my tablets".

People using the service spoke very positively about all carers, in particular about the registered provider/manager.