This inspection took place on 4 December 2018 and was unannounced. Harrow Council - Bedford House provides accommodation in two units for a maximum of 20 people who have learning and physical disabilities. The service is set out in two units, one unit provides care and support to people with learning and physical disabilities, which is called the Bedford unit and comprises of 11 bedrooms and the other to people with autism, which is called the Roxborough unit and comprises of 8 bedrooms.

At our last inspection on 16 May 2016 the service was rated Good.

Since the service's last inspection, they had undergone renovation work and had changed one unit. This unit previously provided respite care and had been renovated to provide care to people with autism. Relatives we spoke with told us that these changes had gone well and people had settled well.

There was a registered manager in post at the time of our 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.

People in care homes receive accommodation and nursing or personal care as a 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.

During the inspection we observed care support staff treated people with respect, kindness and compassion. Positive caring relationships had developed between people who used the service and care support staff and people appeared at ease in the presence of care support staff. Relatives we spoke with told us that people were treated with respect and they were well looked after at the service.

There were appropriate systems in place to keep people safe. Staff had received training on how to identify abuse and understood their responsibilities in relation to safeguarding people, including reporting concerns relating to people's safety and well-being. Risks to people had been assessed, updated and regularly reviewed to ensure people were safe and risks to people in relation to treatment or care were minimised.

Appropriate arrangements were in place in relation to the recording, disposal and administration of medicines at the home. We found that medicines were managed safely in the service.

We found that there were enough staff to meet people’s individual care needs. On the day of the inspection we observed that staff did not appear to be rushed and were able to complete their tasks. We discussed staffing levels with the registered manager and he explained that there was flexibility in respect of staffing and staffing levels were regularly reviewed depending on people's needs and occupancy levels.

On the day of the inspection we found the premises were clean and tidy. Relatives we spoke with told us that the service was clean and they raised no concerns in respect of this. There was a record of essential inspections and maintenance carried out. The service had an infection control policy and measures were in place for infection control.

Staff demonstrated that they had the knowledge and skills they needed to perform their roles. Staff confirmed that they received regular supervision sessions and appraisals to discuss their individual progress and development. Staff spoke positively about the training they had received and we saw evidence that staff had completed training which included safeguarding, medicine administration, first aid awareness and health and safety,

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented as well as their likes and dislikes. Care plans were reviewed

At our last inspection of Harrow Council - Bedford House on 16 May 2016 we found that there was a breach of legal regulation. This was because the provider did not have effective arrangements for the management of medicines.

We undertook this announced focused inspection on the 23 March 2017 to check whether the provider had taken action and were now meeting legal requirements.

This report only covers our findings in relation to the safety topic area. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Harrow Council - Bedford House on our website at www.cqc.org.uk.

At our last inspection in May 2016 we rated the service good in the four topic areas; effective, caring, responsive and well-led. The service was rated requires improvement in the topic area safe. The overall rating was good and the overall rating continues to be good after this inspection.

Harrow Council - Bedford House provides accommodation for a maximum of 20 people who have learning and physical disabilities. At the time of our inspection, there were 11 people using the service.

There was a registered manager in place. 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.

At this focused inspection on the 23 March 2017, we found the legal requirements had been met. The provider had taken action to address our concerns about the way medicines were being managed.

We found appropriate arrangements were in place in respect of the administration and storage of medicines. Care workers had received medicines training and policies and procedures were in place. We looked at a sample of Medicines Administration Records (MARs) and found that all these were completed fully. We found the service had an effective medicines audit in place.

This inspection took place on 16 May 2016 and was unannounced. Harrow Council - Bedford House provides accommodation in two units for a maximum of 20 people who have learning and physical disabilities. The residential unit provides long-term care and support for eleven people. The respite unit provides overnight stays, weekend stays and day 'tea visits' for up to nine people. At the time of our inspection, there were eleven people living in the service and four people on the respite unit.

The provider met all the standards we inspected against at our last inspection on 25 April 2014.

There was a registered manager in post at the time of our 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.

During the inspection we observed people were treated with kindness and compassion. It was evident that positive caring relationships had developed between people who used the service and care support staff. People who used the service and relatives spoke positively about staff and the care provided at the home.

We checked the arrangements in place in respect of medicines. We found four unexplained gaps in one person’s medicine administration charts (MAR) and it was therefore not evident if this person had received their prescribed medicine. Further, one of the medicines cupboards did not meet legal requirements. It was wooden and not a designated medicines cupboard. In addition, we noted that a closed sharps box was left on top of this cupboard and was therefore not stored correctly. We found a breach of regulations in respect of this.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Risk assessments had been carried out and staff were aware of potential risks to people and how to protect people from harm.

There were enough staff to meet people’s individual care needs and this was confirmed by staff we spoke with. On the day of the inspection we observed that staff did not appear to be rushed and were able to complete their tasks. The team leader explained that there was flexibility in respect of staffing and staffing levels were regularly reviewed depending on people's needs and occupancy levels.

We found the premises were clean and tidy. There was a record of essential inspections and maintenance carried out. The service had an infection control policy and measures were in place for infection control.

Staff demonstrated that they had the knowledge and skills they needed to perform their roles. Staff confirmed that they received regular supervision sessions and appraisals to discuss their individual progress and development. Staff spoke positively about the training they had received and we saw evidence that staff had completed training which included safeguarding, medicine administration, health and safety, first aid and moving and handling.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented as well as their likes and dislikes. Care plans were reviewed monthly and were updated when people’s needs changed.

Staff we spoke with had a basic understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people’s care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored an

Bedford House was inspected by one inspector on 15th September 2014. During the inspection we were able to communicate with four people who used the service and two family members. We were also able to speak with four staff members, the home manager and the respite manager. We visited to ask five questions; Is the service safe, effective, caring, responsive and well led?

Is the service safe?

People told us that they enjoyed living at the home and that they felt comfortable, safe and well cared for. One person said, "It's very good here. I’ve got a lovely room and I love the staff.”

We checked health and safety records and spoke with the manager and found health, safety and maintenance in the home were managed effectively. We noted staff were able to engage effectively with people who were non-verbal to ascertain their needs and keep them safe.

Is the service effective?

During our inspection we observed staff were able to meet people’s needs. People we spoke with told us staff were always available when they required them. They said that staff were courteous and professional. We saw in people’s care support plans how staff identified people’s wishes and aspirations and how staff individualised care support plans accordingly.

Is the service caring?

People told us staff were polite and treated them with respect. We observed staff engaged positively with the people they supported and communicated effectively with them. People said staff knew their needs well and that they provided the care they needed in the way they preferred. One relative told us, "They know how people like things done" and another said, "The staff are first class. I can't fault them."

Is the service responsive?

People told us their views were listened to and any concerns they raised had always been dealt with satisfactorily. One person said, "I've always been able to talk to someone if I've had a problem. We found measures were in place to allow opportunities for people to have their say about how the home was run. For example a residents' sensory garden had been established after people had raised it as an issue during a people’s meeting.

Is the service well-led?

The senior managers undertook a range of monitoring and audits in regard to the quality of services provided. Staff were informed of outcomes from such processes and information was disseminated to people and their representatives.

During this inspection we spoke with staff at all levels of responsibility about the support they received to do their jobs. All the staff we spoke with told us they had access to good support and appropriate training. They said that they had regular opportunities to discuss their professional development and training needs. We noted there was a robust induction procedure. Staff we spoke with stated they had felt ready to work with people who used the service as soon as they had completed their respective induction. They also told us the management were always available to assist and advise.

We spoke with three people who used the service, four people's relatives and four members of staff including the registered manager.

All the people and relatives we spoke with told us that they were involved in people's care and that their choices were respected. Although people's records were not always clear that people had consented to the care they received, the service took appropriate steps to ensure people consented to the care they received.

People who used the service and relatives told us that they were happy with the care provided. We were satisfied that the service provided care that met people's needs.

None of the people or relatives we spoke with had any concerns regarding the way care was provided. The service had appropriate arrangements in place to safeguard vulnerable adults from abuse.

All the staff we spoke with felt they were supported by their colleagues and managers. They told us they received effective professional development. Staff received appropriate support and professional development including training that enabled them to meet the needs of people who used the service.

People who used the service and their relatives told us they were able to feedback their views about the service and that this was taken into account. The service had appropriate measures to monitor the quality of the service to ensure it could provide care safely.

We met with the manager, respite manager and four staff working at the service. We also talked with one person who uses the service and four relatives.

We saw staff interacting with people in a professional and sensitive way. People were given choices and one person told us how they spent their time. They said they went to the cinema and a day centre and could spend time in their bedroom watching television or sit in the lounge to be with other people.

The care plans were detailed and provided a good picture of the individual, their needs and how these were to be met. Staff said they were aware of people’s needs and we saw a member of staff following a person’s care plan and respecting their preferences.

There were no restrictions on people moving around the service and rooms were accessible for people who used wheelchairs. Those relatives we asked said the décor of the service had improved and they had no concerns about the maintenance of the building.

There were sufficient numbers of staff working in the service.

We saw the pictorial complaints procedure for people. People were not able to read but could be supported by staff or their representatives to make a complaint. One person who uses the service said they would talk with staff if they were unhappy about something. Relatives said they would talk with staff if they had a concern and felt that they would be listened to. The manager told us he had not received any complaints.

People who use the service express their views in various ways, such as talking, making sounds and using gestures. Therefore direct feedback from people who use the service was limited. People told us they were happy living in the service and liked their bedrooms and the garden.

We saw throughout the visit we carried out that people were given choices for example what to eat and what activities to take part in. Some staff had worked in the service for many years and demonstrated an understanding of how people communicate their likes and dislikes.

Staff told us that people have the opportunity to go out as much as possible and that staff support people to visit different community places using various forms of transport such as using public transport, taxi’s and the mini bus that the service owns.

Feedback from relatives was positive with comments that the service was flexible and clean. Relatives told us that people using the respite service always stayed in the same bedroom to provide some consistency and familiarity to their respite stay. Relatives also said they would talk to staff if they had a concern or complaint and that staff were approachable.

Care professionals said the service kept them informed of any “substantial changes” to a person’s condition and they confirmed they were usually invited to reviews that were held about a person.

Advocates told us that the staff were “excellent” in communicating with them and that staff “try to improve lives of people living at the service”.