We inspected HMT Care – 48 Albany Drive on 13 February 2018 and the inspection was unannounced.

HMT Care – 48 Albany Drive is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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.

H M T Care - 48 Albany Drive provides a specialist service for people diagnosed with neuro-disabilities, specifically Huntington's Disease. There were seven people living at the service at the time of inspection. The service is a large Victorian detached house in a residential area of Herne Bay. The service was set out over three floors. On the first two floors there were communal areas and people's bedrooms. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. On the third floor was the company office. There was a passenger lift for people who could not use the stairs.

At the last comprehensive inspection in February 2017 the overall rating for the service was Requires Improvement. One breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 was identified. The provider failed to deploy enough staff to meet people’s needs.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key question Safe to at least Good.

At this inspection improvements had been made and the breach in regulation met. No further breaches were identified.

A registered manager worked at the service each day. A registered manager is a person who has registered with 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.

People told us and indicated they felt safe living at the service. People were protected from the risks of abuse, discrimination and avoidable harm by staff who were trained and knowledgeable in their roles. Accidents and incidents were recorded and reviewed and action was taken to refer people to the relevant health care professionals when needed. People’s medicines were administered safely and given on time.

People and their relatives said there were enough staff to support them when they needed anything. Staff had been recruited safely and were coached and mentored by the provider and registered manager. The provider and registered manager worked closely with the Huntington’s Disease Association to keep up to date with best practice.

The building and grounds were clean and well maintained. People’s rooms were personalised with their own pictures, photographs and ornaments to help them feel at home. People had access to communal areas and the garden.

People were supported to eat healthily. Staff liaised with health care professionals, such as dieticians and speech and language therapists and followed any advice given to help them stay as healthy as possible.

People were supported to have maximum control of their lives and were supported in the least restrictive way possible; the policies and systems in the service supported this practice. People’s physical and mental health needs and their social and cultural preferences were assessed and reviewed. People and their relatives and had been involved in planning and making decisions about their care.

Staff supported people to move into and out of the service, working with local authorities and health care professionals to make sure that any move was co-ordinated well. People had developed strong relationships with the provider, registered manager and staff. Staff were kind, patient and caring and people and their relatives had no complaints about the quality of service delivered

The inspection took place on 7 February 2017 and was unannounced. The inspection was carried out by two inspectors.

H M T Care - 48 Albany Drive provides a specialist service for people diagnosed with neuro-disabilities, specifically Huntington's Disease. There were six people living at the service at the time of inspection. They had complex communication and mobility needs.

The service is a large Victorian detached house in a residential area of Herne Bay. Some people had lived at the service for a long time and were becoming increasingly frail. Due to the deterioration in their condition the amount of personal care and support they needed had increased.

The service was set out over three floors. On the first two floors there were communal areas and people's bedrooms. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. On the third floor was the company office. There was a passenger lift for people who could not use the stairs.

There was a registered manager working at the service and they were supported by an assistant manager. They were also the registered manager of another service close by. 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.

On the day of the visit the registered manager was there for part of the inspection. The assistant manager, staff and the provider supported us throughout the inspection. The registered manager had been in charge at the service for a long time. They knew people and staff well.

The assistant manager spent more time at this service managing it on a day to day basis and the registered manager spoke with the assistant manager daily and came to the service when needed but spent more of their managerial time at the provider's other service.

At the last inspection in January 2016 we found breaches of regulations. At this inspection some improvements had been made but further improvements in some areas, were needed.

At the previous inspection there had been a breach of regulations related to managing risks to people. Staff did not have clear guidance about what to do in the event of someone choking or what signs to look for if people’s skin was at risk of becoming sore. Improvements had been made and staff had guidance about supporting people if they should choke and what to look for if people’s skin was at risk of becoming sore.

When we last inspected the service there had been a breach of regulations related to staff not receiving the supervision they needed. At this inspection improvements had been made, staff had received regular one to one supervision meetings and annual appraisals. Informal meetings with staff had not always been documented and this was an area for improvement.

At the last inspection there had been a breach in regulations related to people not receiving person centred care and treatment and care plans not being reviewed or updated. At this inspection improvements had been made, people’s care plans were reviewed and updated more regularly. The care plans gave details of what was important to people and how they liked to be supported.

At the previous inspection there was a breach of regulation relating to quality assurance audits not identifying shortfalls in the service. Systems to identify and assess risks to the health and safety or welfare of people were not detailed and the provider had failed to ensure that records were accurate.

At this inspection some improvements had been made, regular audits had been completed and covered a range of areas. Records were completed and information was accurate and provided enough detail to identify issues and any actions taken. However not all of the shortfalls we f

This inspection took place on13 January 2016, was unannounced and was carried out by two inspectors.

H M T Care - 48 Albany Drive provides a specialist service for people diagnosed with neuro-disabilities, specifically Huntington's Disease. There were seven people living at the service at the time of inspection. They had complex communication and mobility needs.

The service is a large Victorian detached house in a residential area of Herne Bay. Some people had lived at the service for a long time and were becoming increasingly frail. Due to the deterioration in their condition the amount of personal care and support they needed had increased.

The service was set out over three floors. On the first two floors there were communal areas and people’s bedrooms. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. On the third floor was the company office. There was a passenger lift for people who could not use the stairs.

There was a registered manager working at the service and they were supported by a deputy manager. They were also the registered manager of another service close by. 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. On the day of the visit the registered manager was not available. The deputy manager, staff and the provider supported us throughout the inspection.

The registered manager had been in charge at the service for a long time. They knew people and staff well. The deputy manager spent more time at this service managing it on a day to day basis and the registered manager supported her two days a week but spent more of their managerial time at the provider’s other service.

The deputy manager and staff did not fully understand how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. They did consider people’s abilities to give consent to complex decisions but there were some areas of people’s treatment when their ability to consent had not been fully considered. This was an area for improvement. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLs applications had been made to the relevant supervisory body in line with guidance.

The care and support needs of each person were different and each person’s care plan was personal to them. Parts of the care plans recorded the information needed to make sure staff had guidance and information to care and support people in the safest way. People indicated they were satisfied with the care and support they received. However, some parts of the care plans did not record all the information needed to make sure staff had guidance and information to care and support people in the way that suited them best and kept them safe. Potential risks to people were identified but full guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the interventions they needed to keep them as safe as possible.

Staff were caring and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. Staff were kind and caring when they were supporting people. Some people were unable to communicate using speech so staff anticipated or interpreted what they wanted and responded quickly. The way that people co

There were six people using the service and we met, spent time with or spoke with most of them. People indicated that they were happy with the service.

People’s hobbies and interests were supported and people had support to keep in touch with their family and friends. People’s needs were assessed and detailed in care plans that provided staff with clear guidance. Staff understood people’s needs especially relating to Huntington’s Disease.

People maintained good physical and mental health because the service worked closely with health and social care professionals. The home was safe, well maintained and suited people’s needs. Each bedroom was single were personalised with people’s own photographs and pictures.

Staff were supported and supervised and there was enough skilled and experienced staff to meet peoples’ needs. Staff worked together as a team with each shift planned in advance so that staff knew their roles and responsibilities. Staff engaged with people in a calm, respectful and reassuring manner.

Most people who use the service were unable to communicate and tell us what they thought of the quality of the care due to their communication difficulties. One person who used the service was able to tell us about the service. This person told us, "I am looked after well and I can go out when I want to". However, through observation during the site visit we were able to observe staff supporting people who use the service in a respectful way and that staff took time to explain where possible the options available and supported them to make choices.

We found that people who had communication difficulties were able to express their wishes with support of staff, involvement of relatives and outside agencies. Staff understood their roles and responsibilities and all pre- employment checks were completed before starting work.

People who use the service were unable to communicate and tell us what they thought of the quality of the care due to their communication difficulties. Through observation however during the site visit we were able to observe staff supporting people who use the service in a respectful way and that staff took time to explain where possible the options available and supported them to make choices