This comprehensive inspection took place on 15 August 2018 and was unannounced.

The last comprehensive inspection took place on 31 January 2018. The service was rated inadequate in the key question, ‘is the service Safe?’ and requires improvement in the key questions, ‘is the service Effective? Responsive? and Well Led?’ We found six breaches of regulations relating to the need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance and staffing. Following the inspection, we asked the provider to complete an action plan to show what they would do and by when they would improve the key questions of ‘Is the service Safe, Effective, Responsive and Well Led?’ to at least good. At this inspection we found the provider had made some improvements but not enough to fully meet the regulations.

Hornbeam House is a residential care home for up to three people with learning disabilities. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection one person was living at the service. 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.

The provider, Eton Care Limited, is a private organisation and currently has two locations in London.

At the time of the inspection, there was not a registered manager in post. However, someone had been appointed to the role of manager and were starting work at Hornbeam in September 2018, at which time they would apply to become the registered manager. 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 found incident and accident forms were not always completed as required. We found body maps with no explanation as to what had occurred to cause an injury and with no corresponding incident forms. The action plan attached to the fire risk assessment for the home was not completed until after the inspection. This meant the risks associated with people’s care and well-being were not always identified so these could be appropriately mitigated.

In addition, safe recruitment procedures were not always followed as robustly as they could have been to ensure staff were suitable to work with people as one staff member was missing a second reference.

Medicines were not always managed safely as the medicines administration records (MAR) were signed for by two staff, although most of the time, staff were lone working which meant someone was incorrectly signing. Medicines competency testing had been completed for all staff, however only two staff were observed administering medicines. This meant the provider was not always following their medicines procedures.

We found that consent to care was not always sought in line with the principles of the Mental Capacity Act (2005) as mental capacity assessments were not decision specific and we saw a relative had signed consent forms when they did not have the legal right to do so. A best interests decision meeting was held after the inspection. We recommended the provider follow the principles of the Mental Capacity Act (2005) to make sure people’s rights are respected.

The person received personalised care that was responsive to their needs and staff involved them and their relatives as appropriat

The inspection took place on 31 January 2018 and was unannounced. This was the first inspection of the service since it had been registered in November 2017.

Hornbeam House is a residential home for up to three people with learning disabilities. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection two people were living at the service.

The provider, Eton Care Limited, is a private organisation and the owner is the nominated individual. Eton Care currently has two locations in London.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

At this inspection we rated the service Requires Improvement in the key questions of Effective, Responsive, Well-Led and overall. It was rated Inadequate in Safe and Good in Caring.

During the inspection on 31 January 2018 we found the provider did not always have systems to keep people safe and mitigate risks. Policies and procedures were not clear about the action staff needed to take. Safeguarding records did not have details of the investigation, outcomes or analysis. Incidents and accidents were recorded on ABC (Antecedent-Behaviour-Consequence) charts but were not logged at a single point or analysed. There were no records for fire safety checks completed or personal emergency evacuation plans (PEEPs) to help protect people in the event of a fire. Medicines audits and medicines competency assessments were not completed. This meant the risks to people’s wellbeing and safety had not always been assessed and the risks minimised.

The provider did not always comply with the Mental Capacity Act 2005 (MCA) principles but care workers were responsive to people’s individual needs and preferences. However there was no indication that people’s end of life wishes had been considered as part of the care planning.

The complaints policy and procedures were not up to date. These and the complaints form were not provided in a format that met people’s communication needs.

The registered manager was currently recruiting but at the time of the inspection, there were no permanent care workers. As care workers were agency staff the registered manager did not undertake supervisions or appraisals but had introduced an induction checklist and work book. Care workers undertook training with their agency and felt they had the skills and support to carry out their role competently.

The care plans were written in a person centred manner with clear guidelines and easy read pictures but we did not see any pre-admission assessment records. There was also a lack of written evidence to record that support plans were developed and reviewed with people and their families.

Care workers we spoke with knew how to respond to safeguarding concerns and incidents and accidents. The provider had checks in place to ensure care workers were suitable to work with the people using the service.

There were detailed risk assessments to address some of the risks people faced and risk management plans to mitigate identified risks.

People's dietary and health needs had been assessed and recorded and were monitored to make sure these were met.

The home’s environment met the needs of the people using the service. It was clean and care workers knew about infection control procedures to help prevent infections.

People indicated they were happy at the service and care workers knew peoples’ likes and dislikes and what their routines were. Families were welcome to visit.

Care workers felt the registered manager wa