The inspection took place on 24 January 2019 and was unannounced.

Edwin Therapeutic Unit 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. The service was registered to provide care for up to three young people with learning disabilities, autism spectrum disorder, mental health issues and eating disorders. There was one person living at the service as another person had transferred to another service the week before 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 in post who was present during inspection. 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 on 30 November 2017, the overall rating of the service was ‘Requires Improvement. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not supported to maintain and develop their independence nor to meet their assessed needs and goals.

We required the provider to take action to make improvements. The provider sent us an action plan detailing how they planned to address the breaches of Regulations and said that this would be completed by the 31 March 2018.

We also made recommendations about the helping people to maintain a balanced diet and to make sure staff skills were kept up to date with best practice.

At this inspection, we found the service had improved. The registered manager had led a cultural shift in the staff team so that they were clear about the aims of the service. These were to support people to maintain and develop life skills. People were encouraged to work towards achieving their goals, to take steps towards independence and be responsible for their meals.

The frequency of staff training in key areas had changed to help ensure they knew how to support people’s individual needs.

Staff knew what steps to take to safeguard people from situations in which they may be at risk of experiencing abuse. Risks to people's safety had been assessed, monitored and managed to make sure people were protected from harm. There were enough care staff to provide people with the care they needed. Checks had been completed before new care staff had been appointed. Suitable provision had been made to prevent and control infection. Lessons had been learned when things had gone wrong. There were policies and procedures for the management of medicines and staff had received training in how to give and record people’s medicines.

People were helped to access healthcare services. Staff understood how to support people to make informed choices and decisions. 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.

Staff communicated with people in a kind manner and treated them with dignity and respect. Positive and valued relationships had developed between people and staff. People were supported to pursue their hobbies and interest. People had access to advocates when necessary.

People were asked for their views about the service and there were opportunities for them to raise any concerns or complaints so they could be acted on. The quality of t

The inspection took place on 30 November 2016 and was announced.

Edwin Therapeutic Unit 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. The service was registered to provide care for up to three people with learning disabilities, autism spectrum disorder, mental health issues and eating disorders. There was one person living at the service at the time of the inspection.

There had not been a registered manager at the service since 23 July 2015. The manager of the service had applied and was being assessed as to their suitability for the role. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected in March 2017. Seven breaches of Regulation were found with regards to the provider failing to : Regulation 9, ensure care plans were personalised; Regulation 11, follow the principles of the Mental Capacity Act 2015; Regulation 12, safely manage risks to people; Regulation 13, make referrals to local authority safeguarding; Regulation 16, to record and respond to complaints; ensure quality auditing systems were in place and have sufficient managerial oversight of the service; and Regulation 18 (HSCA) provide adequate staff to meet people’s assessed needs; Regulation 18 (Registration Regulations) notify CQC of events and incidents without delay. The service was placed in special measures.

After the inspection the provider sent us a plan of action setting out how they planned to address the breaches of Regulation. They told us the identified breaches had been met before the date of our inspection visit on 30 November 2017.

We also made recommendations about the way medicines were audited and providing nutritious and healthy meals.

At this inspection, we found improvements. However, we also found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Quality assurance processes had identified shortfalls in the service and most had been addressed. However, the service was not meeting its aim to support people to become more independent and develop life skills. Instead, people had become reliant on the staff support provided. Improvements had been made to care plans so they were personalised but people had not been supported to meet their assessed needs and individual goals.

People had their health and nutritional needs assessed but we have made a recommendation in relation to supporting people to have a balanced diet.

New staff received a structured induction and were provided with a programme of training in areas essential to their role. We have made a recommendation about the planned frequency of the training programme to ensure staff are competent and up to date with their practice.

Improvements had been made in assessing potential risks and guidance was in place and available to staff to make sure people were protected from harm.

People were supported by staff who were trained to recognise the signs of abuse and the provider had reported concerns about people's safety to the relevant authorities.

Staff understanding of the principles of the Mental Capacity Act 2005 had improved through training and discussion.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager had submitted DoLS applications to ensure that people were not deprived of their liberty unlawfully.

The systems in place for the management of medicines had b

We undertook an unannounced inspection of Edwin Therapeutic Unit on 8 March 2017. This inspection was done in response to information of concern we received from the local authority. Edwin Therapeutic Unit is a care home registered to provide accommodation and personal care for a maximum of three people who have learning disabilities, autism spectrum disorder, mental health issues and behaviours that challenge. It specialises in supporting people to manage high levels of behaviours that challenge. People required a range of support in relation to their support needs. At the time of the inspection there was one person living in the service, although we reviewed some documents relating to other people who had moved from the service prior to our site visit.

The service was based in central Gravesend close to the town centre and its shops and amenities. The service was in a quiet residential street and consisted of three bedrooms over two floors, an office, a communal lounge, a kitchen and two bathrooms. There was a small garden accessed by people in the rear of the property.

The service did not have a 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. We spoke to the registered provider about this and were told that another manager would be taking over management of the service with another service as a dual registration.

The provider did not have effective systems in place to protect people against abuse and harm. The provider had up to date policies and procedures but did not give staff correct guidance on how to report abuse in line with the Health and Social Care Act 2014 or the local authority’s safeguarding adults policy, protocol or guidelines.

Risks were not consistently assessed and managed to keep people safe from avoidable harm. Some risks assessments were out of date and staff did not have access to one person’s risk plan for managing their behaviours that challenge.

Assessed staffing levels had not consistently been adhered to. Some incident reports showed that where three staff should have been on shift there were on occasions only two or one staff member supporting three people who were funded to receive one to one support.

The principles of the Mental Capacity Act 2005 were not consistently being adhered to. Where people were assessed as not having the capacity to make a certain decision a best interest meeting was being held; however, only one person was recorded as being involved in the decision.

Food safety checks had been carried out regularly. There was a menu for people to choose food from and have input to. People had enough to eat and drink, and received support from staff where a need had been identified. However, there was a lack of fresh fruit and vegetables being recorded as being eaten by people and Staff did not consistently support people to eat healthily.

Care plans were not personalised and did not contain enough information on how to motivate people to engage with their support programme. One person had recommendations made by a psychologist but these had not been included in the person’s care documents.

Complaints were not consistently used as a measure to improve the service delivered to people. Not all complaints were being recorded which meant that the service could not learn, and make improvements, from people’s experience.

The registered provider did not always keep up to date with current legislation and national guidance. Advice given to care workers around safeguarding vulnerable people was not in line with the local safeguarding policy or legislation. The registered provider did not have appropriate knowledge of the Health and Social Care Act 2008 and CQC Registration R

We inspected this service on 14 June 2016. The inspection was announced. The provider was given one working days’ notice because the location provides a care service to a small number of people and we needed to be sure that someone would be available at the location to see us.

The Edwin Therapeutic Unit is registered to provide accommodation for young people who need a high level of therapeutic care and supervision due to learning disabilities, autism, mental health needs or behaviour that challenges themselves or others. The location is registered to provide personal care for a maximum of three people. At the time of our inspection, only one person lived at the service but another person was moving in that week.

At the time of our inspection the unit manager had been in post since the previous registered manager had left in August 2015. The unit manager had applied to the Care Quality Commission 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.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, the unit manager had applied for DoLS authorisations for some people living at the service, with the support and advice of the local authority DoLS team. The unit manager and staff understood their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments and decisions made in people’s best interest were recorded.

People told us they felt safe. Staff had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and measures put in place to manage any hazards identified. The premises were maintained and checked to help ensure people’s safety. However, the fire risk assessment was due to be reviewed. We have made a recommendation about this.

People received their medicines safely and when they needed them. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely.

There were enough staff with the right skills and knowledge to meet people’s needs. Staff received the appropriate training to fulfil their role and provide the appropriate support. Staff were supported by the unit manager and the provider who they saw on a regular basis. Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support.

People were treated with kindness and respect. People’s needs had been assessed to identify the care they required. People’s care plans were person centred and gave staff the information and guidance they required to give people the right support. People were encouraged and supported to be as independent as possible. Detailed guidance was available for staff to follow to support people who displayed any behaviour which caused a risk to themselves or others.

People had access to the food that they enjoyed and were able to access drinks when they wanted to. People’s nutrition and hydration needs had been assessed and recorded. Staff supported people to meet any specific dietary needs. People were supported to remain as healthy as possible with the support of healthcare professionals.

People were supported to participate in a range of activities they enjoyed within the unit and in the local community. People were supported to complete educational courses to develop their skills and confidence.

Processes were in place to monitor and improve the quality of the service being provided to people.

When we last inspected in September 2014, we found that where people did not have the capacity to consent, the provider did not always act in accordance with legal requirements. This was because the registered manager had not received essential training in the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Some of the care workers we spoke with were unable to demonstrate appropriate knowledge about DoLS. We also found that the service's policies on restraint, mental capacity assessments and the procedures relevant to DoLS were unavailable. Records of meetings that took place in people's best interest following assessments of their mental capacity were unavailable.

We asked the provider to provide an action plan that outlined how improvements could be made within a set time frame. We have received the action plan and this follow-up inspection was scheduled to check that improvements have been carried out.

During this follow-up inspection, we found that remedial actions had been taken and that the provider had achieved compliance with the Regulation 18 of the Health and Social Care Act 2008.

At the time of our follow-up inspection, only one person was living in the unit. We spoke with the registered manager, the acting deputy manager and one member of care staff. We looked at the set of records for the person who used the service, staff training records, three of the service's policies and procedures.

During this inspection, the inspector focused on answering our five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes the records we looked at and what the staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people who used the service were protected from the risk of abuse because the registered manager, the deputy manager and other members of care staff were trained in the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

The provider ensured that staff's need for training and the development of their skills were taken in consideration. Training in the principles of the MCA and DoLS had been provided and refresher courses were scheduled.

Is the service caring?

We found that people were supported by staff who were mindful of people's needs. A member of staff told us, "We care for our residents and the more we learn about how to care for them the better".

Is the service responsive?

People's views were considered and represented by an independent mental health advocate when necessary.

Is the service well-led?

The provider and registered manager ensured that remedial actions to achieve compliance with the regulations had been carried out. They told us, "We have scheduled a team meeting in February 2015 where staff will have the opportunity to discuss possible scenarios (about MCA and DoLS) and put their knowledge in practice, and we have discussed this during supervision".

At the time of our inspection, only one person was living in the unit. We spoke with the registered manager, the acting deputy manager and three members of care staff. We spoke with the person who used the service and their local authority case manager. We looked at the set of records for the person who used the service, staff training records, the service's policies and procedures.

During this inspection, the inspector focused on answering our 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 we observed, the records we looked at and what people using the service and the staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people who used the service were protected from the risk of abuse because all staff were trained in the safeguarding of vulnerable adults and the management of challenging behaviour. However we found that training on the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards (DoLS) was not effective. We found risk assessments with clear action plans were in place to ensure people remained safe.

Is the service effective?

The person who used the service told us they were satisfied with the quality of care that had been delivered. We looked at their assessment of needs and support plan and we checked that the delivery of care was in line with their care plans and assessed needs. Stimulating activities were chosen by the people who used the service. The person who used the service commented, "I don't get bored here". Additional training was available to staff if people had specific needs.

Is the service caring?

We found that people who used the service were supported by kind and attentive staff. A member of staff told us, "The young people we look after are very vulnerable. They need patience, understanding, support and above all stability”. The person who used the service told us, "I am very happy here" and "The staff are nice".

Is the service responsive?

People's needs had been assessed before care and support began and their support plans were reviewed regularly to reflect any change in their needs. We saw that people's care plans included their history, wishes and preferences. People were involved with reviews of their care plans. People's views were sought about the quality of care that they received and their views were taken into account. The person who used the service told us, "I get choices and I am the one to choose” and " If I am not happy I tell them (staff) straight away and they know and they change things”.

Is the service well-led?

We found that the registered manager operated an effective system of quality assurance to identify how to improve the service. People who lived in the service were regularly consulted about their level of satisfaction. The manager told us, "This is such a small service, we have residents meetings every day and continuously check their satisfaction". We saw the service operated an open door policy and staff were encouraged to express their views. A member of staff told us, "The manager, the acting deputy manager and the owner are very approachable, we communicate very well and as it is such a small place we are a little like a family".

As part of our inspection we spoke with the two people who used the service about the care and support they received. We also spoke with the relative of one of the people who used the service.

People told us they "Liked" living at Edwin Therapeutic Unit. Comments included "I like it here" and "It's okay, i just wished there was more to do sometimes". Another person said "it's not like home, but I understand why I have to be here". One relative said "I have no complaints so far although I would like to be kept more up-to-date with things that happen".

We reviewed the care records for both of the people who used the service. We found that the care plan for a person who was new to the service was not readily available as it was still being developed by the Provider. We also found that risk assessments were not always robust enough as they lacked appropriate information to guide staff on how to reduce areas of risk.

We found that the service had completed the appropriate checks in order to maintain a safe and suitable environment for people. We also saw that there were systems in place to monitor the quality and effectiveness of the care that people received.