This inspection took place on 10 October 2016 and was unannounced. At our last inspection in November 2015 the service was not meeting the standards in relation to the safe management of medicines and the proper assessment of the risks to the health and safety of people using the service. At this inspection we found that the service was now meeting these standards.

Burghley Road is a residential care home for up to 24 adults with a history of alcohol dependence. The home is in Kentish Town in Camden. There were 19 people staying at the home at the time of our visit.

There was a manager for the service, but as they had only recently taken up the post, they were not yet registered with the Care Quality Commission. We were informed that they were currently applying to be registered.

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 told us they felt safe at the home and safe with the staff who supported them. They told us that staff were kind and respectful and they were satisfied with the numbers of staff on duty at the home.

The management and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks should be reduced.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment in the first instance. The service was following the appropriate procedures regarding Deprivation of Liberty Safeguards (DoLS) but this was not relevant to the people being supported at the home.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians and any changes to people’s needs were responded to appropriately and quickly.

People told us staff listened to them and respected their choices and decisions.

People using the service and staff were positive about the management of the home.

People confirmed that they were asked about the quality of the service and had made comments about this. Quality assurance systems were in place in order that suggested improvements could be actioned and monitored.

The service had a number of quality and safety audits which were designed to ensure a safe environment was maintained.

This unannounced inspection took place on 10 November 2015. Our previous inspection took place on 9 May 2014 and we found all of the regulations we inspected were met.

Burghley Road is a residential care home for up to 24 adults with a history of alcohol dependence situated in Kentish Town in Camden. There were 22 people staying at the home at the time of our visit.

There was a registered manager was in place at the time of our visit. 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 this inspection we found that risk assessments were not always updated appropriately after there had been an incident of threats and violence at the service.

People were permitted to smoke in their bedrooms but a risk assessment had not been completed for each person.

There were issues with regard to the disposal of medicines. We saw how bottles of prescribed eye drop medicines were not used in the correct date order.

You can see what action we told the provider to take at the back of the full version of the report.

There were not always adequate formal or informal activities to engage and occupy people. Pathways to move people on appropriately after detox had not been established.

We have made a recommendation about improving engagement with people by offering more formal and informal activities. Also the service should explore ways to work with other agencies to appropriately support people after detox to move on to more suitable accommodation and continue their alcohol reduction.

We made a recommendation in relation to people refusing care and treatment as well as refusing to sign consent forms. This should be clearly recorded on peoples records to evidence the fact. 

There were no call bells or panic alarms located in the corridors, communal areas or medicine room. This meant that staff were unable to call for assistance in an emergency situation.

We have made a recommendation about introducing an emergency communication system to summon assistance if required.

Staff had a good understanding of safeguarding issues and the types of abuse that may occur. They were also able to tell us how to report and record concerns and use the whistle blowing procedures if required.

Safe recruitment procedures were in place that ensured staff were suitable to work with people as staff had undergone the required checks before starting to work at the service.

Staff completed an induction programme and mandatory training in areas such as safeguarding, health and safety and medicines.

Records showed that staff had received one to one supervision monthly unless they were on holiday or absent from work. There was also evidence of regular annual appraisals.

People currently staying at the home were not subject to a Deprivation of Liberty Safeguards (DoLS) authorisation to deprive them of their liberty to receive care and treatment. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005.

Staff showed dignity and respect as well as demonstrating an understanding of people’s individual needs. They had a good understanding of equality and diversity issues and were able to tell us how they ensured people’s cultures, beliefs and the way they wished to live their lives were recognised and supported.

Staff knew how to support people to make a formal complaint and they told us that most issues were resolved effectively before they got to a formal stage.

There was effective communication between all staff members including the managers. Staff received daily verbal handover and we saw evidence of regular staff meetings that also covered more strategic issues such as policy briefings, staffing issues an updates.

Audits and quality monitoring visit took place regularly. Quarterly audits of support plans, including risk assessments and reviews were undertaken. A traffic light system was used as quality grading to prompt action and ensure compliance.

This inspection was a carried out as a responsive follow up to a recent serious occurrence at the service.

You can see our judgements on the front page of this report.

At this inspection we sought to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them, a visitor and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff we spoke with demonstrated awareness of the different types of possible abuse and all were confident about reporting concerns should they need to.

Is the service effective?

We viewed the records of five people using the service and saw each person’s records contained an assessment of needs completed with the person as well as an assessment by the referring local authority.

Is the service responsive?

Most of the comments people made were complimentary although the provider may wish to note that someone told us “90% of the time I am treated with respect”, another person said “some staff knock on my door all of the time, others only some of the time”.

Is the service well-led?

We were informed by the manager that a recent survey of people using the service had been completed.

This report is a follow up to our reports published in April and September 2013. We had inspected this provider on 5 and 10 April 2013, when we noted some issues which had a minor and moderate impact on people using the service. We followed up with another visit on 24 July 2013 when we judged that the provider had not taken sufficient steps to ensure that people experience care and support that met their needs. In addition the provider did not ensure that people who use the service were always protected against the risks associated with medicines. We set compliance actions requiring the provider to take steps to comply with Regulations 9 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We made a further visit on 28 November 2013 when we judged that the provider had now taken sufficient action to ensure that people experience care and support that met their needs. The provider had also improved medication management and we noted that people were protected against the risks associated with medicines.

In this report the name of Mr. Bauer appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

This report is a follow up to our report published in April 2013. We had inspected this provider on 5 and 10 April 2013, when we noted some issues which had a moderate and minor impact on people using the service. These related to standards regarding respecting and involving people, their care and welfare, management of medicines, and monitoring the quality of the service. We set compliance actions requiring the provider to take steps to comply with Regulations 9, 10, 13, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We made a further visit on 24 July 2013 when we found that the provider had taken sufficient action to ensure dignity and independence of the people.

We also found that the provider had a working system in place to regularly assess and monitor the quality of service that people received.

Whilst there had been some significant improvements in care provided to people who use the service and medication management there were still some outstanding concerns. We judged that the provider had not taken sufficient steps to ensure that people experience care and support that met their needs. People were not always protected against the risks associated with medicines.

We inspected the home on the 28th November 2012, when we looked at records of people living at the home, staff files and other records relating to the service. We spoke with the acting manager and their deputy and interviewed three care workers. We observed care being provided and spoke with six people using the service.

Most people we spoke with were happy with the care being provided. One person said of the home “it’s good,” but that there was “not much going on.” We did not see any structured activities taking place. The need for more activities to be provided at the home had recently been noted by one of the local authorities commissioning the care. Because of this, the provider was actively working with people at the home to identify and introduce more activities which the people would enjoy and benefit from.

People said that at times there was not enough staff to meet their needs. Staff members we interviewed also expressed concerns over staffing levels and the impact this had on the care being provided.

The atmosphere at the home was quite calm and relaxed. We saw that staff members were friendly and confident in their interaction with people and the support they provided.

People told us that they felt treated with respect and were able to choose how they spent their time. We saw that people could express their wishes and have their needs met. They said that they usually knew what was happening in the service.

People said that they liked the food on offer, the choices and the quality. They told us that they felt safe and protected by service. They said that they were well cared for.

People told us that they felt treated with respect and were able to choose how they spent their time. We saw that people could express their wishes and have their needs met. They said that they usually knew what was happening in the service.

People said that they liked the food on offer, the choices and the quality. They told us that they felt safe and protected by service. They said that they were well cared for.

People using the service told us that staff were supportive, one person said that “they are helpful, 88% of them". Another person confirmed that "most of them are OK" and that they were “very helpful.”

People using the service told us that staff had not always acted on what they promised. This related to the purchase of some equipment and the redecoration of one of the rooms.

During our visit we observed some poor interaction between staff and people who use the service. Staff did not always talk about people in a respectful way and there were minimal opportunities for positive interactions between people who use the service and care workers.

People told us that their care needs were met and we saw that care plans were up to date. We noted that risk assessments were not sufficiently detailed. The provider had developed improvement plans to allow people greater involvement in suggesting and participating in activities, but the plans had not been fully implemented.

We raised concerns regarding administration of medication as we noted discrepancies in records and the medication stock kept at the home.

Since our previous visit the provider had made some improvements relating to staffing levels and additional staff were employed to ensure people’s care needs were met.

The provider did not have effective systems in place to assess and monitor quality of the service.