This announced inspection took place on 18 and 19 October 2017. 1-3 Emerton Close provides accommodation for people who require nursing or personal care for up to 10 adults who have a range of needs including learning disabilities. 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 were 10 people across three separate units, each of which have separate adapted facilities at the time of our inspection.

At our previous inspection on 23 and 25 November 2016 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. We found some aspects of the arrangements for the safe management of medicines for people using the service were not robust. The provider had not taken timely action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. Some aspects of the quality assurance systems were not effective. Following that inspection the provider sent us an action plan showing how they planned to make improvements.

At this inspection we found that the provider had made improvements. Relatives commented positively about staff and the service. Staff felt supported by the acting manager. The service had worked effectively in partnership with health and social care professionals. Visiting health and social care professional spoke positively about the service and the staff. The service had made improvements in the systems used by the provider to assess and monitor the quality of the care people received. These included regular residents meeting, staff meetings, area manager’s audits and acting manager’s checks. As a result of these checks the service made improvements.

Although the provider had made improvements since the November 2016 inspection, at this inspection we identified some further improvement was required in specific areas of medicines recording and audits. Whilst there were safeguards in place Medicines administration record (MAR) were not completed correctly. Some of the PRN (as required) medicine protocols did not have sufficient information included for staff to ensure that they were only given when they were required. The medicines audit carried out in the house had not identified the issues we have found.

In response to the inspection feedback, the area manager told us that they would oversee all the future checks carried out by the acting manager and revalidate them to avoid any errors.

The above issues were a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we have asked the provider to take at the back of the full version of this report.

People had received their medicines as prescribed. We observed a medicines round and found that staff followed safe procedures of administration medicines and completed the medicines administration records (MAR) charts. Staff received medicines management training and their competency was checked. All medicines were stored safely. The liquid medicines were labelled and dated when opened. However, we saw there was an inconsistent approach to medicines recording within the service and this required improvement.

Records showed that appropriate referrals had been made, and authorisations granted by the relevant ‘Supervisory Body’ to ensure people’s freedoms were not unduly restricted. The provider had completed the monitoring forms for the ‘Supervisory Body’ in line with the conditions they had placed on people’s DoLS authorisations.

The service did not have a registered manager in post. The previous registered manager left the service in July 2017. In the interim, the service had the deputy manager

This unannounced comprehensive inspection took place on 23 and 25 November 2015. This is the first inspection of the service since their registration in September 2015 with a new provider, Avenues London.

1-3 Emerton Close provides accommodation for people who require nursing or personal care for up to 10 adults who have a range of needs including learning disabilities. There were 10 people receiving personal care and support at the time of our inspection.

At this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. We found some aspects of the arrangements for the safe management of medicines for people using the service were not robust. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities 2014). However there were some areas of good practice about the management of the medicines.

The provider had not taken timely action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. This was a breach of regulation 13 of the health and Social Care Act 2008 (Regulated Activities 2014). We also saw some areas of good practice in relation to best interest decisions and staff asked for people’s consent, when they had the capacity to consent to their care.

Some aspects of the quality assurance systems were not effective and a recommendation about medicine management by external professionals was found outstanding. This was a breach of regulation 17 of the health and Social Care Act 2008 (Regulated Activities 2014). We saw some areas of good practice about the quality assurance system and process to assess and monitor the quality of the care people received.

You can see what action we have asked the provider to take at the back of the full version of this report.

There was a registered manager in post. 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. However, currently a new service manager was in day to day management of this service and their application for a registered manager was being processed by CQC.

Relatives of people who use the service told us they felt safe and that staff and the service manager treated their loved ones’ well. The service had clear procedures to support staff to recognise and respond to abuse. The service manager and staff completed safeguarding training. Staff completed risk assessments for every person who used the service which were up to date and included detailed guidance for staff to reduce risks. There was an effective system to manage accidents and incidents, and to reduce the likelihood of them happening again. The service had arrangements in place to deal with emergencies. The service carried out comprehensive background checks of staff before they started working and there were enough staff on duty to support to people when required.

Staff assessed people’s nutritional needs and supported them to have a balanced diet. Staff supported people to access the healthcare services they required and monitored their healthcare appointments.

Staff involved relatives of people who used the service in day to day life of their loved ones. Staff considered people’s choices, health and social care needs, and their general wellbeing.

Staff supported people in a way which was kind, respectful and encouraged them to maintain their independence. Staff also protected people’s privacy and dignity, and human rights.

The service supported people to take part in a range of activities in support of their need for social interaction and stimulation. The service had a clear policy and procedure about managing complaints. People knew how to complain