This inspection took place on 21 and 24 February 2017, the first day of the inspection was unannounced. We told the provider at the end of the first day of inspection that we would be retuning for a second day.

At our previous inspection on 18 February 2016 and 22 February 2016 breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to safe care and treatment, person-centred care, staffing, notifications and good governance.

We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breaches found.

There was a registered manager at 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.

Abbeyfield - Richard Cusden provides personal care for up to 22 older people, including those who may have dementia. It is located near Streatham and Tooting, South West London. At the time of the inspection there were 21 people using the service.

At our previous inspection we found that risks to people were not always assessed correctly, care plans were not always reflective of people’s current support needs, staff training was not up to date, the provider did not always notify the CQC of notifiable incidents and systems to monitor the quality of service were not effective.

At this inspection, we found that improvements had been made.

The provider carried out risk assessments for people covering a number of areas including risk of pressure sores, risks of falls, moving and handling and infection control. We saw that these accurately reflected the risks and were reviewed every month. Although we found that staff took appropriate action when supporting people who were assessed at risk, we have made a recommendation in relation to guidelines around managing high risks for people.

Care plans covered a number of areas and were reviewed on a monthly basis by people’s key workers. Where people’s needs had changed, care plans and other associated documents were updated.

Improvements had been made in the provision of training to staff. Staff told us there were opportunities for training, and they felt well supported.

The provider was aware of the type of incidents that they were required to notify the Care Quality Commission (CQC) of and we received these in a timely manner.

The provider carried out a range of audits to monitor the quality of service. These included care plan audits, medicines audits, health and safety, kitchen and infection control audits. There were plans to re-introduce a programme of peer monitoring of services from other registered managers. Feedback was also sought from people and staff through surveys and meetings.

People using the service told us they felt safe living at the home. Training records showed that care workers had received safeguarding training. They were familiar with the term safeguarding and who they could report concerns too.

People said staff respected their choices and promoted their freedom. Care workers were aware of the importance of offering people a choice in how they wanted to be supported and to make decisions for themselves wherever possible. Where safeguards were needed to keep people safe and these were deemed to be a restriction on people’s liberty, the correct procedures were followed.

People were supported to take their medicines. Care workers received training and were assessed in medicines management. We observed them supporting people appropriately, records were completed correctly and regular medicines audits took place.

Morale amongst the staff team had improved since the last inspec

This inspection took place on 18 and 22 February 2016. The first day of the inspection was unannounced, the provider knew we would be returning on the second day. This was the first inspection of this service since it registered with the Care Quality Commission (CQC), it was previously registered under a different provider.

Abbeyfield - Richard Cusden provides personal care for up to 22 older people, including those who may have dementia. It is located near Streatham and Tooting, South West London. At the time of the inspection there were 22 people using the service, 16 females and 6 males.

There was a manager at the service; they were in the process of applying to become the 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 using the service told us they were happy living at the home and that they were fond of the care staff and other people at the home. They told us that staff treated them well and they felt safe living there.

Care workers demonstrated to us that they knew about people, their preferences and their behaviours. They were able to recall details about people’s history that was documented in their care plans.

We saw some good examples of a caring attitude between care workers and people using the service, for example care workers spent time speaking to people and if people needed some support they were quick to respond. However, we also saw some instances where the care provided could have been better and where people were not supported as they should have been.

People’s support needs in relation to their medicines and health were being met by the provider. People were registered with a GP and were visited by a district nurse if they needed nursing care. Medicines practice at the home was robust.

People were offered a choice in relation to their meals which was prepared using fresh, good quality ingredients. Although there were concerns raised about the length of time the service was without a permanent chef, we saw evidence that the manager was in the process of recruiting a chef and assistant.

The provider was meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The provider followed guidance where people that who did not have the capacity to understand decisions related to their care and where restricted in their movements and had applied to the relevant authorities to do so legally. However we found that one person’s authorised DoLS had expired.

Staff recruitment at the home was robust and staffing levels were sufficient to meet people’s needs. However, we saw on occasion that staffing levels had not been at the required level in the weeks leading up to the inspection which could potentially have impacted on the care provided.

We found significant gaps in the training provision for staff. There was a lack of training specifically in dementia awareness, MCA/DoLS and care planning.

We found that risks were not identified correctly in all cases, and were therefore not adequately mitigated against. People were at risk of not having their needs met as care plan documentation was not always fully completed or up to date. Some needs assessments had not been fully completed, care plan evaluations did not always accurately reflect peoples changing needs, and outcomes and people’s wishes were not always identified to be followed up.

There was a lack of quality monitoring within the home aside from medicines audits which were thorough.

The home had been taken over by a new provider in December 2014 and there was a long delay before they had notified the CQC of this. There had been some recent safeguarding alerts which CQC had also not been