This inspection took place on 10 January 2017 and was announced. At our previous inspection on 4 December 2015 we found the provider was meeting the regulations we inspected.

There was a registered manager at the service. 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.

Old Hospital Close (21) provides accommodation for up to five people with learning disabilities. It is located in Balham, close to local amenities and transport links. It shares staff with a sister home based at number 12. At the time of the inspection there were four people using the service.

People using the service told us they were happy and enjoyed living there. They spoke positively about the day centres they attended and said that staff were kind towards them.

People were encouraged to maintain their independence. We observed people making their own breakfast and getting themselves ready to go out on the day of the inspection. We also observed care workers encouraging people to carry out their personal care and to complete daily living tasks such as collecting their laundry for washing.

Relatives that we spoke with told us they were happy with the support their family members received from the service. They told us that they knew the staff and were kept informed if anything happened. People were supported to maintain relationships that were important to them.

Regular meetings were held where people were able to discuss issues that were relevant to them in a group environment, which included activities, menus, staffing and any concerns. People were also able to discuss issues privately through one to one meetings with their key workers who they met on a monthly basis.

People had their health and medicine support needs managed appropriately by the provider. Healthcare professionals such as therapists and psychiatrists were involved in providing additional support if needed.

The provider was complying with the Mental Capacity Act 2005 (MCA) and had submitted applications to legally deprive people of their liberty where it was felt they were not free to leave the service on their own for their own safety.

Care plans were individual to people and based around encouraging their independence and improving their daily living skills. These were reviewed on a monthly basis.

Staff told us they felt supported and enjoyed working at the service. They received regular training which was monitored to ensure it was up to date, which helped them to support people more effectively. They also received regular supervision and were given areas of responsibility which helped them to motivate them to carry out their duties.

The service was well managed. We received positive feedback about the registered manager from relatives and staff. A number of audits were carried out to monitor the quality of service provided to people, some of these were based around the ratings systems used by the Care Quality Commission (CQC).

We carried out an unannounced comprehensive inspection of this service on 18 and 23 June 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to safe care and treatment, premises and equipment, staffing, person-centred care and good governance.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements in relation to the breaches found. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Old Hospital Close (21) on our website at www.cqc.org.uk

Old Hospital Close (21) (formerly called St James' Care Home (21)) provides accommodation for up to five people with learning disabilities. It is located in Balham, close to local amenities and transport links. It shares staff with a sister home based at number 12. At the time of our inspection, there were four people living there, three males and one female. The home is arranged over three floors. People live in single bedrooms, with shared bathroom and kitchen facilities.

There was a registered manager at the service. 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 our previous inspection we found that some areas of the home were in a state of disrepair and needed attention, identified risks to people were not always managed appropriately, staff supervision was not held regularly, support plans and goals for people were not always evaluated in a timely manner, and accurate records were not always maintained.

At this inspection, we found that improvements had been made.

Renovation work had taken place to improve the environment. The general cleanliness of the home had improved. New furniture had been purchased for the lounge. The flooring had been replaced in the communal areas downstairs. People’s bedrooms had also been renovated.

Care plans, including risk assessments had been modified. New risk assessments in the case of an emergency had been introduced. Support plans had been amended so they identified clearer goals for people. Regular key working sessions took place, these included monitoring people’s progress towards their identified goals.

Staff supervisions were taking place on a regular basis and staff told us morale at the service had improved.

Record keeping at the service had improved. Care plans, staff files and other records related to the management of the service had been arranged in logical order making the information easier to find.

This inspection took place on 18 and 23 June 2015. The first day of the inspection was unannounced; the provider knew that we would be returning for a second day. This was the first inspection of the service since its new registration with the CQC.

Old Hospital Close (21) (formerly called St James' Care Home (21)) provides accommodation for up to five people with learning disabilities. It is located in Balham, close to local amenities and transport links. It shares staff with a sister home based at number 12. At the time of our inspection, there were four people living there, three males and one female. The home is arranged over three floors. People live in single bedrooms, with shared bathroom and kitchen facilities.

There was a registered manager at the service; however she was not managing the service at the time of our inspection. Another manager was in post and they were in the process of registering with the CQC 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 using the service told us that staff were caring and looked after them. They told us about some of the activities they did throughout the day. They said staff helped them with their medicines and they liked the food at the home.

Although risk assessments were reviewed, staff were not always made aware of changes in risk. Where risks to a person’s safety had been identified, control measures were not always in place to minimise the risk. Support plans were not always evaluated so it was difficult to monitor progress people had made towards their identified goals.

Accurate records were not always maintained in respect of care records and also some staff records.

Some areas of the home were in need of care and attention. Some furniture needed to be replaced and more consideration was required to help create an environment more appropriate for people with learning disabilities.

We observed that staff were caring towards people. They supported people to be as independent as possible and treated them respectfully. However, we found that staff felt undervalued and demoralised. They told us they did not feel supported by management and that their views were not always heard. There was a lack of staff supervision at the home, although staff did receive ongoing training.

The manager had been brought into this service by the provider to try and make improvements. He was experienced in managing a similar sized service with the same provider and was clear about the improvements that he needed to make. Given time and support he felt confident he could turn things around.

Staff were happy with the new manager and told us they felt confident in his abilities to help them to work better as a team.

We found breaches of regulations relating to safe care and treatment, premises and equipment, staffing, person centred care and good governance. You can see the action we have asked the provider to take at the back of the full version of this report.

We have made some recommendations about submitting an authorisation under the mental capacity act 2005 to restrict people of their liberty lawfully and around creating an environment appropriate for people with learning disabilities.