This inspection took place on 5 February 2019 and was unannounced. M Power Limited – 22a Bromley Road provides accommodation, personal care and support for up to 11 people. People using the service had a history of living with a learning disability and mental health needs. 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 this inspection there were six people living at the service.

At the previous inspection on 3 January 2018 we found that the service did not meet the standards we inspected. People did not always have effective risk assessments and management plans in place to mitigate potential risks. People were not supported to consent to care and the premises were not well maintained. In addition, staff did not follow infection control processes which increased the potential risk of infection.

There was a registered manager. This registered manager was new to the service and was employed in October 2018. 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.

At this inspection we found that the registered manager had taken some action to improve the service.

Risk assessments and management plans were updated to provide staff with detailed information to manage risks associated with people’s needs.

Staff had access to and used personal protective equipment including the use of gloves and aprons to reduce the risk of infection. There was a programme of redecoration and maintenance of the premises. However, we found new concerns related to activities for people, the quality of some care records and people were not always supported to practice their religious beliefs.

There was an individual activity programme in place. People who were independent in the community accessed services and social events that interested them. There were no activities arranged in the home for everyone to take part in if they wished to do so.

Care records were not always accurate and did not always accurately reflect people’s needs. There were systems in place for monitoring the quality of care. Staff completed regular audits of the service and developed a business plan to address any concerns in the management of the service. However, the audits had failed to identify the shortfalls we found during this inspection.

There was a system in place to identify people at risk of harm and abuse. Staff followed this guidance to protect people from abuse and to report safeguarding allegations promptly.

The recruitment procedures in place ensured that suitably experienced staff were employed to work with people. Pre-employment checks were completed and returned as part of the recruitment process before staff were employed. Enough staff were employed to care for people safely. The staff rotas showed the deployment of staff was at an appropriate level to effectively support people.

Accidents and incidents that occurred at the service were monitored. The registered manager shared concerns with staff to learn from them and to manage the occurrence.

Each member of staff was supported with an induction, training, supervision and an appraisal.

People had enough to eat and drink. People and staff developed a menu. Staff and people were involved in the preparation and cooking of meals for all people living at the service.

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 supported to give their consent to receive care and support. They a

This inspection took place on 3 January 2018 and was unannounced.

M Power Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

M Power Limited is registered to provide care and accommodation to up to 11 people. At the time of our inspection seven people were using the service, some of whom had mental health conditions or a learning disability.

The service has recently undergone refurbishment. Bedrooms were single occupancy rooms and located over two floors. The building was not adapted to meet people’s needs and parts of the accommodation are not accessible by wheelchair. The service has a garden. The provider was in the process of making new admissions to the home

There was a 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.

People’s care was not always responsive to their individual needs. Staff did not provide appropriate support to one person who had behaviours that challenged the service and others. This put the safety of the person and that of others at risk. People were not always protected from the risk of isolation and were not always able to access all parts of the accommodation. Staff did not always follow good hygiene practices. The environment and accommodation were clean with the exception of the staff room.

Staff knew how to identify and report abuse. Staff followed the provider’s safeguarding procedures to ensure they protected people from potential abuse. There were sufficient staff deployed to meet people’s needs. Staff underwent appropriate recruitment procedures before they started to provide care.

Risk assessments and management plans were in place. Staff had information about people’s needs and the support they required. Staff obtained consent from people before they delivered care and support. People had access to healthcare services when needed.

The registered manager monitored accidents and incidents to identify any patterns and to minimise recurrences.

Staff received the support they required to undertake their roles through an induction, training and supervision of their practice.

People told us they received sufficient amounts to eat and drink. People told us the food provided did not always meet their cultural preferences. We observed people during their lunchtime meal. The food served was not appetising and the menu lacked imagination. Although there was a menu planner, staff prepared a meal that was not planned for that day. Staff monitored people's nutritional needs and made referrals to healthcare professionals for guidance when needed.

People’s care was provided in a dignified and compassionate manner. Staff respected people’s privacy and dignity. Interactions between staff and people were positive. Staff supported people to have equal access to information and opportunities as full citizens.

Staff supported people to undertake activities of their choosing. People enjoyed links with the local community.

People using the service and their relatives knew how to make a complaint if they were unhappy with care delivery. People’s views about the service were welcomed and their feedback was used to develop the service.

People using the service, their relatives and staff said the registered manager was visible at the service. They raised concerns about the management and staffing changes at the service. Staff were supported in their roles and worked well as a team.

Audits and checks were carried out on the quality of care. Improvements were done when needed. The provider planned

This unannounced inspection took place 20 November 2015. The service provides care and accommodation to nine adults with learning difficulties and mental health problems. At the time of our inspection there were six people living at the home.

The service did not have a registered manager. The manager had submitted their application to be registered as the manager of the home with the Care Quality Commission. 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.

The last inspection of the service was on 24 September 2014. We found the service met all the regulations we looked at.

Medicines were not always administered and managed safely. The service worked effectively with other health and social care professionals including the community mental health team (CMHT). People were supported to attend their health appointments and to maintain their health.

People told us that they felt safe living at the home. They said staff treated them with respect and dignity. Care records confirmed that people had been given the support and care they required to meet their needs. Safeguarding adults from abuse procedures were in place and staff understood how to safeguard the people they supported from the risk of abuse. Staff told us they were supported to do their jobs effectively. There were sufficient numbers of staff on duty to meet people’s needs.

People’s individual care needs had been assessed and their support planned and delivered in accordance to their wishes. People and their relatives were involved in reviewing their support to ensure it was appropriate for their needs. Risks to people were assessed and a management plan put in place to ensure that people were protected from risks associated with their support and care.

People’s choices and decisions were respected. People consented to their care and support before it was delivered. People told us they had the freedom to do whatever they wished without restrictions. The manager understood their responsibility under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They ensured that ‘best interests’ decisions were made for those who lacked the mental capacity to make decisions and to ensure people were not unlawfully deprived of their liberty.

People were provided with a choice of food, and were supported to eat their meals when required.

People were encouraged to follow their interests and develop new skills. There was a range of activities which took place within and outside the home. People were encouraged to be as independent as possible. People were supported to practice their cultural and religious beliefs.

There was a range of systems in place to monitor and assess the quality of service provided. Health and safety checks were carried out regularly to ensure the home was safe.

The service held regular meetings with people to gather their views about the service provided and to consult with them about various matters. People knew how to make a complaint if they were unhappy with the service or the care they received.

This inspection was carried out to follow up on concerns identified at our last inspection on 15 May 2014. During that visit, we found the service to be in breach of regulations relating to staffing levels and how the service supported workers to do their jobs effectively. During this visit on 24 September 2014, we answered the questions: Is the service safe? And is it well-led?

We spoke with three people who used the service. We spoke with staff on duty on the day of our visit. We left our phone number so that people could contact us if they wished. Four staff called us to speak with us.

Is the service safe?

The home was safe. Staffing levels were adequate. The home was covered 24 hours per day and there were on-call arrangements in case additional support was required in an emergency. Staff understood the home’s emergency evacuation procedure.

Is the service well-led?

There was a manager in post who started in July 2014. They were in the process of completing their registration with the Care Quality Commission. Staff were trained to do their jobs effectively. The manager showed us a plan to conduct staff supervision six weekly. All staff had received one-to-one supervision from the manager in August and September. Team meetings were held monthly. This ensured staff had support to meet the needs of people they supported.

This inspection was carried out by an inspector who gathered evidence 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, their relatives, and staff supporting them 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 were trained in their roles to support people safely. There was a safeguarding policy in place and staff understood the types of abuse and how to report it. Risks were assessed for people and actions were taken to address any risk promptly. Staffing levels were adequate and the home was covered 24 hours a day by staff. There was emergency plan in place to manage unforeseen events. Incidents and accidents were recorded and reviewed and lessons learned were discussed with staff. Specialist equipment was provided for people who had mobility problems and staff had received training in using these. The home was clean and in good state of repair.

Is the service effective?

People’s care was planned and delivered in a person centred way. People were involved in their care planning and care plans were written in an easy to read format, thereby making it easy for people to understand their care plan. The provider involved other healthcare professionals in the planning and coordination of people’s care and treatment. We saw evidence of the involvement of a speech and language therapist (SALT) in supporting one person with swallowing difficulties and recommendations were implemented by staff. People were supported to access community and health services as required. People participated in a range of activities within and outside the home.

Is the service caring?

Staff understood the needs of people they supported. People using the service told us that they were treated with dignity and respect. One person said, “Staff are nice and listen to us.” Staff interacted and responded to people in an open and positive manner. The atmosphere was relaxed and staff engaged people in discussions. People’s care plans and daily activities reflected their preferences, interests, and choices.

Is the service responsive?

People were supported to participate in activities within and outside the home. There was an effective joint working between the home and other professionals to ensure the service responded to people’s needs. People were supported to attend educational centres to develop new skills. People told us they knew how to make a complaint if they were unhappy. People’s care plans were reviewed and updated to reflect changes in their needs and circumstances.

Is the service well-led?

The provider worked well with other agencies in meeting the needs of people using the service. Staff were trained in their roles. There were quality assurance systems in place to identify, assess and monitor the quality of service provided. We saw records that actions were taken to address identified shortfalls or recommendations from audits.

Staff were not regularly provided with the support and supervision they needed to do their jobs effectively. There was no record to show that induction was carried out for new staff. One-to-one supervision for staff was not regular in line with the organisation’s policy and procedure. Daily handover took place; however, a structured team meeting was last held in September 2013.

We observed that staff treated people they were supporting with kindness and compassion and were responsive to their needs. One person told us, “I’m happy here and the staff look after me. I go out and I do voluntary work. I like my room and sometimes I do my own cooking.”

Staff ensured people gave their consent to the support offered and people we spoke with confirmed that staff included them in decisions about their daily lives. One person’s relative told us that the service consulted them regularly about the care and support provided and any changes to this.

Up to date, individual care and support plans were in place for people using the service which addressed their care and support needs and protected them from risks.

The service worked in partnership with other providers to ensure people's health, safety and welfare needs were met.

Staff received appropriate induction, professional development, supervision and appraisal.

There was a process for in place for dealing with complaints and this was in an accessible format for people using the service.

We spoke with the local authority commissioners who reported that they had no significant concerns about the service from their own monitoring.

Although people told us they were satisfied with the support they received, we found other evidence that people may not always protected against the risks of receiving inappropriate or unsafe care and support because it was not clear how their needs were analysed and the risks assessed as the basis for deciding staffing levels.

This inspection on 2 August 2012 was to follow up the provider’s non-compliance with outcomes 10, 14 and 16, which was identified by our inspection on 11 April 2012.

Following our April 2012 inspection, the provider sent us a report which said it would be compliant with these outcomes by 30 June 2012.

During both of our visits we saw staff attending to and listening to people in a professional, respectful and considerate way, and people were assisted promptly and appropriately.

As this was a follow up inspection to check on the provider’s actions to achieve compliance following our April 2012 inspection, we did not speak to users of the service at this inspection in August 2012.

However, at our previous inspection on 11 April 2012, the people we spoke with told us that they liked the staff, and that staff usually listened to them and provided them with care and services in the way that they wanted. They also said that they felt safe and knew how to raise any concerns or complaints.

People we spoke to said they liked the staff and that staff usually listened to them and provided them with care and services in the way that they wanted.

People said they felt safe and knew how to raise any concerns or complaints.

During our visit we saw staff attending to and listening to people in a professional, respectful and considerate way, and when people raised health or emotional issues with staff they were listened to and looked after appropriately.