During our last comprehensive inspection of this service which took place on 28, 29 May and 1 June 2015 we found breaches of the regulations relating to person-centred care and good governance. This was because people were not being provided with and supported to participate in a range of meaningful activities. The provider was also failing to provide opportunities to support people, their relatives and staff members to express their views openly and, so far as appropriate and reasonably practicable, accommodate those views.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a comprehensive inspection on the 16 March 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

The service had a new registered manager in post at the time of our visit. 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 registered manager was accessible and approachable and staff felt able to speak with her and provide suggestions and feedback on the running of the service.

Initial assessments were completed by senior staff members to ensure that the service was able to identify and meet people’s support needs before they moved into the service.

People received individualised support that met their needs. The provider had systems in place to ensure that people were protected from risks associated with their support, and care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences.

Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. Medicines were administered safely and records were kept of this.

Care plans were written in plain English and easy to understand. Care plans contained information in relation to people’s preferences about their life choices, health needs, meals, activities and other information related to their care. Care plans were developed in consultation with people and their family members. Where people were unable to contribute to the care planning process, staff worked with people’s representatives and sought advice from relevant health and social care professionals to assess, monitor and review the care needed.

Risk assessments were completed when people first started to use the service and reviewed in line with the provider’s policies and procedures. People’s risk assessments covered a range of issues including guidance around accessing the community, personal care, moving and positioning. For those with complex health and well-being care needs, more detailed guidance was in place from the appropriate health and social care professionals.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and DoLS, and to report upon our findings. DoLS are in place to protect people where they do not have the capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. Where people were not able to communicate their likes and/or dislikes, staff sought advice and guidance from appropriate healthcare professionals and consulted family members.

Staff had received training in mental health legislation which had covered aspects of the MCA and DoLS. Senior staff understood when a DoLS application should be made and how to submit one.

Staff were familiar with the provider’s safeguarding and whistleblowing policies and procedures and able to describe the actions they would take to keep people safe.

People were supported to

A single inspector carried out this inspection. The focus of the inspection was to answer 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 people using the service and their relatives/friends told us, the records we looked at and what staff we spoke with also told us.

If you would like to see the evidence that supports our summary then please read the full report.

Is the service safe?

Flat A 291 Harrow Road is a registered care home for people with learning disabilities. There were four residents living at the home at the time of our visit. We looked at two care records and saw that these contained a variety of risk assessments which included those in relation to the environment, personal care and fire safety.

The service had a safeguarding policy and procedure in place. All staff we spoke with were aware of their responsibilities to report any concerns they had about potential safeguarding issues and were able to describe potential signs of abuse.

Appropriate checks were undertaken before staff began work. All staff were required to undergo a Disclosure and Barring Service check (previously a Criminal Records Bureau check) before commencing employment.

There were arrangements in place to deal with foreseeable emergencies. All staff had received first aid training which was repeated annually. There was a policy in place for dealing with accidents and incidents and we were told that a senior staff member was always on call in case of an emergency. We spoke with six members of care staff and each person correctly explained the policy for handling an accident or incident.

Is the service effective?

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We asked staff how they obtained consent from people using the service on a daily basis. We were given detailed examples of the routines of each person as well as the general likes and dislikes of people.

CQC monitors the operation of the Deprivation of Liberty safeguards which applies to care homes. Staff were aware of the policies and procedures relating to the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and understood when an application should be made and how to submit one. No applications had been submitted at the time of our visit.

Is the service caring?

We carried out observations using the Short Observational Framework for Inspection (SOFI) and observed positive interactions between staff and people using the service.

There were a range of activities available for people who used the service. This included music sessions, baking and going out into the community.

Is the service responsive?

Staff told us that they organised resident’s meetings where issues such as the range of activities, food choices, the home environment, staffing and well-being were addressed.

Is the service well-led?

The service had a registered manager in post. Staff we spoke with told us that the manager was approachable and cared and listened to them.

Staff meetings took place every month and a separate residents meetings took place once a month. We saw that an annual audit took place every year and monthly compliance audits were also conducted.

We used a number of different methods to help us understand the experiences of people using the service because they had complex needs which meant they were not able to tell us their experiences. We also observed the practices of staff when interacting with the people who live there. Staff interactions were well paced. We looked at the provider’s 2012- 2013 feedback survey. This was a survey of all its services, including those at 291 Harrow Road. People were satisfied with the care and treatment they had received and were happy living in their accommodation.

People were assessed regularly by staff to ensure that all their care needs were being met. This included assessing their nutritional status on a monthly basis.

All people's risk assessments and care plans were up to date.

The service had procedures in place to prevent abuse from happening and provided annual training to staff in safeguarding vulnerable adults.

People were cared for in a clean, hygienic environment by staff that had been trained, supervised and supported to undertake their duties appropriately. Staff had received training in infection control and there was a policy and procedure in place.

People were cared for in safe, accessible surroundings which promoted peoples’ wellbeing. However, some areas of the home were in need of repainting.

There was a complaints policy in place and people were given information on how to make a complaint.

This inspection took place on 28, 29 May and 1 June 2015. The visit was announced. Flat A, 291 Harrow Road consists of four separate bedrooms, a communal lounge and a kitchen area. The service provides accommodation for people with learning disabilities. There were four people living in the flat at the time of our visit.

The service had a registered manager in post at the time of our visit. 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, on 7 July 2015 we received an email from the provider informing us that the registered manager had resigned from her post with immediate effect. We are awaiting formal notification regarding this matter.

During this visit we noted that staff were not always being managed and supported effectively. We also observed low levels of interaction and engagement between staff and people using the service.

The service received referrals from social workers based in Westminster. Initial assessments were carried out by senior staff members to ensure that the service was able to identify and meet people’s support needs before they moved into the service on a permanent basis.

Care plans were developed in consultation with people and their family members. Where people were unable to contribute to the care planning process, staff worked with people’s representatives and sought the advice of health and social care professionals to assess the care needed.

People’s risk assessments were completed and these covered a range of issues including guidance around accessing the community, personal care, moving and positioning.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and DoLS, and to report upon our findings. DoLS are in place to protect people where they do not have the capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others.

Staff had received training in mental health legislation which had covered aspects of the MCA and DoLS. Senior staff understood when a DoLS application should be made and how to submit one.

Staff were familiar with the provider’s safeguarding policies and procedures and able to describe the actions they would take to keep people safe.

Staff supported people to attend health appointments and had received training in first aid awareness. There were protocols in place to respond to any medical emergencies or significant changes in a person’s well-being. These included contacting people’s GPs, social workers and family members for additional advice and assistance.

People attended music sessions, went for walks, ate out in restaurants and visited museums.

Staff were aware of people’s specific dietary needs and preferences and offered people choices at mealtimes. Where people were not able to communicate their likes and/or dislikes, staff sought advice and guidance from appropriate healthcare professionals and family members.

There were arrangements in place to assess and monitor the quality and effectiveness of the service. This included house meetings, medicines administration auditing and quarterly service audits.

We found breaches of the regulations relating to person-centred care and good governance. You can see what action we told the provider to take at the back of the full version of this report.