This unannounced inspection of Real Life Options 2-4 Bethecar Road took place on 24 July 2018.

Real Life Options 2-4 Bethecar Road is care home. 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.

The service provides accommodation and personal care for up to six adults who have learning disabilities, some of whom may have mental health needs, sensory impairments and/or physical disabilities. The accommodation is a terraced house located in Harrow close to a range of local shops and other community facilities. People have access to safe outdoor space. They have their own bedroom and share the lounge, kitchen and other communal areas. There were four people using the service at the time of the inspection.

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 using the service were supported to live as ordinary a life as any citizen.

There was a registered manager in post at the service. A registered manager is a person who has registered with the 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.

There were systems in place to help keep people safe and protect them from the risk of harm but we found shortfalls in arrangements for safe access to the home by wheelchair users. Risk assessments and risk management plans to minimise potential risks to people were not always in place.

Staff received relevant training to carry out their roles, but refresher training was not always completed and staff had not received training or learning about a person’s medical condition.

Checks were carried out to monitor the quality and safety of the service, but these did not identify shortfalls that we found, or indicate that action was taken to make improvements and develop the service.

Staff knew people well and had a caring and supportive approach to their work. Staff understood the importance of treating people with dignity, protecting people's privacy and respecting their differences. We saw and heard many positive interactions between people using the service and staff. People told us the staff were kind to them.

People's care plans included details about people’s individual preferences and information staff required to provide people with the care and support they needed in the way that they wanted. Care plans were reviewed regularly and updated when people's needs changed. They contained guidance on how to keep people safe whilst maximising their independence.

Medicines were stored and managed safely. People received their medicines as prescribed.

People received the support they needed to access community and hospital healthcare services to ensure that their healthcare needs were met.

People's nutritional needs were met and people were involved in meal planning and preparation. The service encouraged healthy eating and regular exercise. People had the opportunity to take part in a range of activities that met their individual preferences.

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. Staff gained people's consent before providing them with assistance with personal care.

Appropriate recruitment procedures were in place so that only suitable staff were employed to provide people with the care and support that they needed. Staffing levels and skill mix provided peop

This unannounced inspection of Real Life Options – 2-4 Bethecar Road took place on the 14th April 2016. At our last inspection on 21 August 2014 the service met the regulations inspected.

Real Life Options – 2-4 Bethecar is registered to provide accommodation and personal care for six people. The home provides care and support for people who have a learning disability, some of whom have mental health needs. The home is owned and managed by Real Life Options who provide a similar service in two other care homes in North West London and a range of services in other areas. On the day of our visit there were four people living in the home. Public transport and a range of shops are located within walking distance.

The service currently does not have a registered manager. However, a manager was in post managing this service and two other registered locations. He has managed the services for several months first as acting manager and recently as permanent manager, and has commenced the initial process of applying to register with us. 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.

People were treated with respect and staff engaged with people in a friendly and courteous manner. Throughout our visit we observed caring and supportive relationships between staff and people using the service. People told us staff were kind to them. Staff respected people’s privacy and dignity.

There were procedures for safeguarding people. Staff knew how to safeguard the people they supported and cared for. Arrangements were in place to make sure sufficient numbers of skilled staff were deployed at all times. People’s individual needs and risks were identified and managed as part of their plan of care and support to minimise the likelihood of harm.

Care plans reflected people’s current needs. They contained the information staff needed to provide people with the care and support they wanted and required. People were supported to choose and take part in a range of activities of their choice.

People were encouraged and supported to make decisions for themselves whenever possible and their independence was upheld and promoted. People were provided with the support they needed to maintain links with their family and friends.

People were supported to maintain good health. They had access to appropriate healthcare services that monitored their health and provided people with appropriate support, treatment and specialist advice when needed. People chose what they wanted to eat and people were involved in the preparation of their own meals.

Staff were appropriately recruited and supported to provide people with individualised care and support. Staff received a range of training to enable them to be skilled and competent to carry out their roles and responsibilities. Further training in some specific areas was in the process being arranged. Staff told us they enjoyed working in the home and received the support and training they needed to carry out their roles and responsibilities.

Staff understood the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They knew about the systems in place for making decisions in people’s best interest when they were unable to make one or more decisions about their care and/or other aspects of their lives.

People had opportunities to feedback about the service. There were systems in place to regularly assess, monitor and improve the quality of the services provided for people.

We considered all the evidence we had gathered under the outcomes we inspected. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

We met and spoke with five people who were staying in the home and spoke with three relatives and four members of staff, including the deputy manager. The registered manager was not on site at the time of our inspection.

Is the service safe?

We found people had been involved in making decisions about their care and treatment. The care plans were person-centred and reflected people’s wishes and preferences as to how they wanted their care to be delivered.

Staff had the skills and experience to care for people with learning disability and had knowledge of each person's behaviour patterns and assisted them appropriately, while ensuring their care needs were met. Medicines had been handled, stored and administered appropriately.

The provider had an effective recruitment and selection process in place. This had ensured people were safely cared for and were supported by skilled and experienced staff.

People were cared for in a clean and comfortable environment, which was well maintained and secure.

Equipment had been appropriately checked and serviced, including the fire equipment. Each person who used the service had a personal evacuation plan, which had been regularly reviewed and updated as their needs had changed.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which apply to care homes. Staff had received training on the Mental Capacity Act 2005 (MCA) and DoLS and had an understanding of when an application under DoLS should be made and how to submit one to be authorised by the local authority. There had been no DoLS applications since the last inspection.

Is the service effective?

People’s personal, healthcare and social needs had been closely monitored and provided for. Their needs had been reviewed regularly and risk assessments had been carried out where appropriate. The service had worked closely with the local authority, other healthcare professionals and the relatives to ensure people received appropriate care and treatment.

One person’s relative said, “The staff are doing a fantastic job. My (relative) has been living here for several years now and we are very happy (our relative) is well cared for.”

We observed staff interacted well with people and were patient and respectful. The staff we spoke with had a good knowledge of people's needs, daily routine and behaviour patterns. This had ensured people received appropriate care, support and treatment.

Staff said people had been encouraged and supported to lead independent lives. A member of staff said, “People are encouraged to have an independent lifestyle.” Staff had received appropriate training to enable them to meet people’s personal, health and social care needs.

Is the service caring?

All five people who used the service had a learning disability and communicated with us with limited words. We observed their facial expressions, sounds and gestures which indicated they were happy and content with the staff and the care they received.

We observed people being treated with respect and dignity and being encouraged to get involved in making decisions. A relative said, “The staff are always very polite and respectful.” Another relative said, “My (relative) is very happy living here. Our (relative) comes home to us every weekend. The staff are wonderful and they support our (relative) very well.”

One member of staff stated, “This is their home and we try to make it as homely as possible.” We were shown the notice board with people’s own photographs and pictures of outings and activities they had taken part in. The pictures were chosen and arranged in the way they preferred. This showed people’s wishes and preferences had been respected and staff had been caring.

Is the service responsive?

People had access to a choice of community activities and holidays organised by staff. The weekly activity records were detailed and reflected each person’s preferences and lifestyle.

The care records showed people’s needs had been assessed and regularly reviewed. This enabled staff to provide appropriate care and treatment. A relative said, “We were invited to a meeting about three months ago to discuss our (relative’s) care needs. Staff take notice of what we say and respond satisfactorily.” We all work together like a big family to help our (relative), you know. Yes, we are very happy with the care.”

Is the service well-led?

Staff had a good understanding of the provider’s ethos in providing a care service. They were clear about their roles and responsibilities and staff had been consulted before any changes were implemented.

Staff told us the service had improved under the new manager and they had been given support through regular supervision and staff meetings and issues had been discussed to improve the service.

People and relatives had been listened to and suggestions had been taken on board to improve the menu and the activities. Relatives confirmed surveys had been conducted regularly to assess how satisfied people were with the service and improvements had been made as a result. One person’s relative said, “We would talk to the staff or the manager if we had any concerns, but we are very satisfied with the way staff care for our (relative), so we have not needed to make a complaint.”

Another relative commented, “Communication between the staff and us is very good. They keep us informed if there is anything needing to be discussed or if there have been any changes in our (relative’s) condition.”

The provider had an effective monitoring system in place to ensure people lived in a safe environment where staff provided safe and appropriate care and treatment.

During the inspection we spoke with all the people who used the service, three care workers, and the acting manager. Most people who used the service could express their views to us. However, some people provided one word answers, gestured, nodded or shook their head in response to the questions that we asked. People who used the service indicated or told us that they were satisfied with the service and happy living in the home.

Each person who used the service had a plan of care that had been regularly reviewed and included information and guidance about the individual support and care that the person needed. People were supported to be involved in decisions about their lives and best interest decisions were made when people were unable to consent about matters to do with their care and treatment.

Numbers and skill mix of staff were flexible to ensure people’s varied needs were met by the service. Staff knew people well and were aware of their roles and responsibilities in meeting the needs of the people who they supported. People who used the service approached staff without hesitation and staff interacted with people in a sensitive and positive manner. People accessed their bedrooms and the communal areas of the home freely.

People’s health, safety and welfare were protected as they received the advice and treatment that they needed from a range of healthcare and social care professionals.

Records were up to date and kept securely.

We carried out an unannounced inspection to check if the provider had complied with two compliance actions that we had made at the time of our previous inspection that took place on the 1st December 2012. During that inspection we had found that the planning and delivery of care did not meet the individual needs of each person, which did not ensure their welfare and safety. There were also not effective systems in place to regularly assess and monitor the quality of the services provided to people to ensure the health, welfare and safety of people.

During this follow up inspection we spoke to five people using the service and to two relatives of a person living in the home but on this occasion the focus was on talking to staff and checking records to make a judgement as to whether the provider had met the compliance actions Outcome 4 Care and welfare of people who use services, Regulation 9 (HSCA 2008 Regulated Activities) Regulations 2010, and Outcome 16 Assessing and monitoring the quality of service provision, Regulation 10 (HSCA 2008 Regulated Activities) Regulations 2010.

At this inspection we found that the provider had taken proper steps to ensure that appropriate information and records were in place so people were protected against the risks of inappropriate or unsafe care and treatment, and to ensure that a quality service was provided to people.

During the inspection we talked with four people using the service, one relative and three members of staff to get their views about the quality of service that was provided in the home. We also spoke with the team coordinator who was in charge of the home.

We saw that staff talked to people and explained things to them so they were involved in their care. People were supported in maintaining independent living skills and to be involved in the local community. People cleaned their rooms, did their own laundry and helped in the kitchen. They also went for trips and holidays according to their wishes and preferences.

We saw care plans and risk assessments were not always in place to address how people needs were being met and how their safety was being maintained. People’s conditions were also not monitored regularly so action could be taken when necessary to ensure their safety and welfare. For example people were not weighed regularly and a person who needed blood tests quarterly to monitor the level of a medicine was not having these regularly.

The service had some initiatives to monitor the quality of the services provided but these were not always effective to ensure that people were not placed at risk of unsafe or inappropriate care. For example checks were not adequate to ensure that care plans and all safety certificates were in place as required.

Mr. Michael Piekarczyk is listed as a registered manager but he is no longer in post at this location.

We observed that people looked well cared for and were on the whole appropriately dressed. The home had the necessary equipment to transfer and move people with mobility impairments to ensure their safety and that of staff.

People told us that staff are “good” and support them in their daily lives. They reported they can choose the things that they want to do and that staff take their choices into consideration. We observed that people were asked about their choices and were encouraged to make decisions about day to day issues.

People said that they are able to see the doctor when they are not well and that staff accompany them and make arrangements for them to attend doctors’ or hospital appointments. They told us that they like the meals that are provided for them and are able to make suggestions for the meals that are prepared in the home. We observed that people were served well presented meals and drinks that were enjoyed.

People reported that they like their rooms are able to bring their personal items in their rooms. One person showed us pictures of their relatives and their favourite football team.

People said that they were engaged in different activities and are able to go out if they wished to and if staff are informed. They said that they are able to keep in contact with their relatives. We observed that people were supported by staff to visit their family, to maintain family links.