We undertook this unannounced inspection on 15 January 2018. Care Assist in Harrow (Kings Road) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection. Care Assist in Harrow (Kings Road) is registered to accommodate a maximum of six people. On the day of this inspection there were five people living in the home with mental health needs.

At our last comprehensive inspection on 26 January 2016 the service met the regulations we inspected and was rated Good. At this inspection we found the service remained Good.

People who used the service informed us that they had been treated with respect and dignity. The service had arrangements to protect people from harm and abuse. Care workers were knowledgeable regarding types of abuse and were aware of the procedure to follow when reporting abuse. Risks assessments had been carried out and risk management plans were in place to ensure the safety of people. The service followed safe recruitment practices and sufficient staff were deployed to ensure people’s needs were met. There were suitable arrangements for the administration of medicines and medicines administration record charts (MAR) had been properly completed.

The premises were kept clean and tidy. Infection control measures were in place. There was a record of essential maintenance and inspections by specialist contractors. Fire safety arrangements were in place. These included weekly alarm checks, a fire risk assessment, drills and training. Personal emergency and evacuation plans (PEEPs) were prepared for people to ensure their safety in an emergency.

The service worked with healthcare professionals and ensured that people’s healthcare needs were met. The dietary needs of people had been assessed and arrangements were in place to ensure that people received adequate nutrition.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. We noted that the home had suitable arrangements in place to comply with the Mental Capacity Act 2005 and DoLS.

Care workers worked well as a team and there was effective communication amongst them. They had received a comprehensive induction and training programme. There were arrangements for staff support, supervision and appraisals.

Care workers prepared appropriate and up to date care plans which involved people and their representatives. People were encouraged to be as independent as possible and to engage in various activities.

The service listened to people who used the service and responded appropriately. There were opportunities for people to express their views and experiences regarding the care and management of the home. Complaints made had been recorded and promptly responded to.

Comprehensive checks and audits of the service had been carried out by the registered manager and the deputy manager to ensure that the service provided care of a good quality.

We undertook this unannounced inspection on 26 January 2016. Care Assist in Harrow (Kings Road) is registered to provide personal care and accommodation for a maximum of 6 people with mental health needs. At this inspection there were 6 people living in the home.

At our last inspection on 23 October 2013 the service met all the regulations we looked at.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

People informed us that they were satisfied with the care and services provided. They had been treated with respect and felt safe living in the home. There was a safeguarding adults policy and suitable arrangements for safeguarding people. Staff were caring and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them were assessed and this information was easily accessible to staff. Staff prepared appropriate and up to date care plans which involved people and their representatives. Personal emergency and evacuation plans were prepared for people and these were seen in the care records. People’s healthcare needs were monitored and attended to. Staff worked well with community healthcare professionals to bring about improvements in people’s care. This was confirmed by three social and healthcare professionals who informed us that they were satisfied with the care provided.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Regular residents’ meetings and one to one sessions had been held for people and the minutes were available for inspection. The home had an activities programme but more effort is needed to ensure that people were encouraged to participate in social and therapeutic activities. The registered manager was aware of this and a staff member had been identified to do this.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. People were able to prepare meals which they liked and which met their cultural preferences. The arrangements for the recording, storage, administration and disposal of medicines were

satisfactory. Audit arrangements were in place and people confirmed that they had been given their medication.

Staff had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their manager. There were enough staff to meet people's needs. Staff were knowledgeable and enthusiastic about their work. Teamwork and communication within the home was good.

People and their representatives expressed confidence in the management of the service. The results of the last satisfaction survey and feedback from people indicated that they were satisfied with the care and services provided. Staff were aware of the values and aims of the service and this included treating people with respect and dignity and promoting their independence.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried ou

We found the home to be clean and the staff were pleasant and respectful to people at all times. People were free to come and go as they pleased and were responsible for doing their own food shopping and cooking. People were encouraged and supported to be independent and were involved in discussions regarding their individual care plans.

We saw that the provider had appropriate policies and procedures in place to ensure people's safety and welfare and the staff had also received appropriate training that included safeguarding of vulnerable adults. This ensured they were able to support people and help meet their needs. The provider also had procedures in place for the management of medicines. We looked at audits that had been carried out with regards to medicines and found them to be accurate. Medication records were correctly filled in and there were no discrepancies with the number of medicines accounted for.

The provider had taken steps to monitor the quality of the service it was providing. We found that since the last inspection there had been a change of the manager and improvements to the service had been made. People said in the last satisfaction survey that they had not been involved in aspects of planning their care. However, we saw evidence that people had been involved. The manager stated they would carry out a new survey to reflect the changes and improvements to the service.

People who used the service told us that they were satisfied with the service

Five people told us that they were happy living in the service. One person told us that they wanted to be more independent in their own flat. Another person said that it was better than where they had lived beforehand. A new member of staff told us that they were enjoying their new role, and that they were pleased with their induction training.

We observed staff planning the care for one person without fully involving them or showing them respect.

We spoke with staff who were able to explain their understanding of safeguarding and whistle blowing procedures satisfactorily. People's money was being kept safely and with proper audit trails to evidence this.

We found that medication was being administered inappropriately without a proper prescription or records being kept.

The service had a system for carrying out quality audits on a quarterly basis.

One person who spoke to us was quite positive about the home’s staff and the way in which he is treated.

We were able to meet and talk briefly with two of the three people living in the home. People who live there are independent and go out alone as and when they wish to do so. Some prefer to spend their time in rooms or out of the house, rather than the communal areas. Day services could be available for the people living in the home, but none wish to attend.

Staff were observed speaking respectfully to people, trying to engage them in conversation and involve them in the activities of the service. This included the reviews of their support needs which are currently being carried out. They were helping to promote a calm and relaxed atmosphere.