We inspected Anvil Close on 20 and 26 March 2018, the first day of the inspection was announced, the provider knew we would be returning for the second day.

At the last inspection, the service was rated Requires Improvement.

At this inspection, the service was rated Good.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Responsive to at least good. At the last inspection, there was a breach of legal requirements in relation to person-centred care.

At this inspection, the provider had made improvements to meet the relevant requirements.

Anvil Close is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Anvil Close is a residential service providing care for up to 12 adults with a range of learning difficulties. There are two flats on the ground floor and two flats on the top floor each with three bedrooms. People with more complex needs live in the ground floor flats. There were nine people using the service at the time of the inspection. 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.

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.

At the last inspection, we found that care plans were not always up to date and therefore did not accurately reflect people's individual needs. Accurate records were not always kept in relation to medicine administration records and stock levels of medicines. Staff did not always receive regular supervision to support them in their role. At this inspection, we found there had been improvements in all of these areas.

People were supported to take part in activities in the community and maintain their interest in hobbies. The majority of people went to day centres during the week. The people that were at the service at the time of the inspection looked happy and content. They were supported appropriately by staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Relatives of people using the service told us their family members were safe and they had no concerns about their wellbeing. They told us they were kept informed about any changes to the care and support their family members received and were able to visit them at any time. People and their relatives were given information about how to raise concerns and they told us they were confident their concerns would be heard and responded to.

Staff told us they felt supported by the management team and were happy with the training and supervision they received. There were robust recruitment procedures in place and new employees received an induction which included an introduction to the values of the service. Records showed that care workers received regular training in a number of relevant topics and regular supervision.

Up to date and accurate records were maintained. These included records of when people had been supported with their medicines, risk assessments and care plans. Care plans were person-centred and included guidance on the most effective ways to communicate

This inspection took place on 25 and 27 January 2017 and was unannounced. At our previous inspection on 10 and 15 September 2015 we found the provider was meeting the regulations we inspected.

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.

Anvil Close provides care for up to 12 adults with a range of learning disabilities. There are two flats on the ground floor and two flats on the top floor each with three bedrooms. At the time of the inspection, there were 11 people using the service.

We were only able to have limited conversation with people using the service as most people using the service had limited verbal communication. However, relatives we spoke with felt that their family members were happy living at the service and had no concerns. We observed care workers interacting with people in a friendly manner. They were also familiar with people’s individual communication needs and were clear about how they sought consent from them in relation to everyday tasks.

Relatives that we spoke with told us they were confident that their family members were happy and settled living at the service. They said that staff were in regular contact with them and kept them informed about any changes to their care or health needs. They also said they would not hesitate to raise any concerns, either formally or informally if they had any.

Staff were recruited after undergoing appropriate recruitment checks and thereafter received training in a number of areas which helped them to carry out their roles. However, we found that their medicines training was not always renewed annually to ensure that they remained competent to administer people’s medicines safely. We also found that not all the care workers received regular supervision to support them in their role.

There were records in place in relation to people’s health and nutrition. These included records of upcoming health appointments, details of people’s previous contact with health professionals, health passports and prescribed food and fluid plans.

Risks to people were identified and steps that staff had to take to mitigate any risks were also identified. Appropriate environmental risk assessments and checks such as fire, electrical and gas safety were carried out.

Some records relating to medicines for one person, such as medicine administration records (MAR) and stock checks of medicines were not completed correctly.

We also found that not all of the care plans were updated. This had been identified as an area of improvement during a previous inspection.

Regular audits were undertaken in relation to a number of areas. We found that these were effective in identifying the areas of improvement that were identified during this inspection. There were action plans in place to make improvements to the service.

We found a breach of the regulations in relation to person-centred care. You can see what action we have told the provider to take at the back of the full version of this report.

During our visit we were unable to speak to any of the people using the service as they were out taking part in activities during the day. We spoke to the relatives of some of the people using the service by telephone following our visit.

We saw that the issues previously identified relating to the fire door system, central heating and general maintenance had now been repaired. The communal areas of each flat had been redecorated and the damaged furniture in one of the lounges had been replaced.

The relatives we spoke with confirmed that they were involved in the development and review of the care plans for the people using the service. We saw that the care plans were up to date and a new detailed care plan format was being introduced.

The relatives we spoke with said "I am very happy with the care provided" and "The home provides very high class care". They also said that they were happy with the cleanliness of the rooms and communal areas.

During our visit we spoke with two members of staff and the manager. We were unable to speak with the people who use the service about their care so we contacted the relatives of two people to ask their views on the support provided.

Both relatives we spoke with commented that the staff provided a good standard of care and their relatives who were using the service were both happy and settled. During our visit we saw the staff speak with the people who use the service is a positive and encouraging way and treated them with dignity.

A relative and two members of staff we spoke with all confirmed that there had been a problem with the central heating system which had left the home feeling cold.

The members of staff felt that they had enough training to do their job and were given support from the senior staff.

A relative we spoke with said "I can't speak more highly about them".

On this occasion we did not meet with people who use the service, as we visited the service to check compliance with Outcome 12 of the Essential Standards of Quality and Safety, regarding the recruitment of staff.

However, at our last visit to the service, in June 2011, the people told us that they liked living at the home, and that they could make choices about their daily lives, what they wanted to do and what they wanted to eat. We also found that people got the right support to meet their needs and develop independence in their lives. People also liked that the environment was calm and relaxed.

People told us that they like living at the home, and that they can make choices about their daily lives, what they want to do and what they want to eat. People get the right support to meet their needs and develop independence in their lives. People like the fact that the environment is calm and relaxed.

We carried out an unannounced comprehensive inspection of this service on 13 and 15 January 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to management of medicines and the care and welfare of people who use services.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements in relation to the breaches found. 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 Anvil Close on our website at www.cqc.org.uk

The home provides care and accommodation for up to 12 people with learning disabilities. It is located in Streatham. It is divided into four flats, each with three bedrooms. There are two flats on the ground floor and two on the top floor. People with more complex support needs live on the ground floor and more independent people live on the top floor.

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.

At our previous inspection we found that medicines management was not safe and people’s individual needs were not always met.

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

Staff had attended refresher training in medicines management. Stock checks of medicines were being carried out and medicine administration record charts were completed correctly. A regional manager carried out audits which were used to minimise the risk from unsafe medicines practice.

Flats had been redecorated to make them more presentable and work was continuing to ensure activity rooms in flats were fit for purpose and utilised in a way that met the needs of people. Link worker meetings had been re-introduced which allowed staff to set and monitor goals for people using the service.