291 Harrow Road consists of three separate flats each accommodating four people. The service provides accommodation for people with learning disabilities. We inspected Flat B. At the time of our inspection, four people were living at the service.

At the last inspection, the service was rated "Good". At this inspection, we found the service remained "Good".

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.

People were protected from the risk of potential abuse and avoidable harm. Staff knew how to identify abuse and to report any concerns about people’s welfare. Risks to people’s health and well-being were identified and managed. Staff underwent appropriate pre-employment and verification checks to ensure their suitability and fitness to provide care at the service. There were enough numbers of sufficiently skilled and experienced staff deployed to provide care to people.

People received the support they required to take their prescribed medicines. Staff followed safe medicines management processes. The premises were well maintained and safe for people living at the service.

Staff received regular training, supervision and annual appraisal to enable them to undertake their roles. Staff understood and supported people in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People had sufficient food to eat and drink and enjoyed the meals provided at the service. People received appropriate support to maintain their health and well-being. Staff supported people to access healthcare services when needed.

People’s care was provided in a respectful and caring manner. Staff maintained people’s privacy and dignity. Staff had developed positive relationships with people using the service and their relatives.

People were involved in care planning and staff provided support as planned. Staff supported people to live an independent life as possible and encouraged them to participate in a range of activities. The registered manager sought people’s views about the service and acted on the feedback.

People received care in line with the provider’s vision and values. Staff were supported in their roles and were committed to supporting people to develop their full potential. The registered manager was visible at the service and was commended by health and social care professionals and staff in relation to her leadership and management of the service.

External agencies were involved in improving the quality of care provided to people. Consistent checks were carried out to improve the quality of care.

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 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 B 291 Harrow Road is a registered care home for people with learning disabilities. There were four people 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 three members of 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 spoke with two members of staff about 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 and Deprivation of Liberty Safeguards 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 spoke with two family members on the day of our visit. Both made positive comments about the care given to their relatives. 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 an art group, going out to the park and pampering sessions for example massage.

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 operated an open door policy.

Staff meetings took place every month and a separate residents meeting 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 and 29 May 2015 and was announced. Flat B, 291 Harrow Road consists of 4 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 manager in post who was in the process of registering 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 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 meet people’s specific needs before they moved into the accommodation provided.

Care plans were developed in consultation with people and their family members. This ensured people’s support needs could be identified and met before moving into the service on a permanent basis.

People’s risk assessments were completed and these covered a range of issues including guidance around accessing the community and personal safety. People using the service and their relatives expressed positive views about the service and the staff.

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. There were protocols in place to respond to any medical emergencies or significant changes in a person’s well-being.

People’s independence was promoted and staff actively encouraged people to participate in activities.

Staff were required to support people to complete shopping tasks, design menu plans and prepare meals. Staff were aware of people’s specific dietary needs and preferences and offered people choices at mealtimes.

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