This comprehensive inspection took place on 22 December 2017 and was unannounced. The last inspection took place in May 2017and the service was rated ‘requires improvement’ in Safe, Effective, Well Led and overall. Caring and Responsive were rated ‘good’. We found breaches of Regulations relating to safe care and treatment, safeguarding service users from abuse, staffing and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when they would make the necessary improvements to meet the regulations. During this inspection, we found that improvements had been made.

Santa Care is a ‘care home’ for up to four adults with learning disabilities or mental health needs. 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. At the time of the inspection, three people were using the service. Two of the three people living in the home used British Sign Language (BSL) to communicate which staff had also been trained to use.

The home is one of three owned by the provider who is also 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 on 22 December 2017, we saw the provider had made improvements to how they monitored the service. However, we saw a number of gaps in the records of people using the service and in staff records. This included not all reviews being up to date, care plans not addressing people’s wishes for end of life care and not all staff training was up to date. This meant the service could not ensure a consistent quality of care.

The provider had procedures in place to protect people from abuse. Care workers we spoke with knew how to respond to safeguarding concerns. People had risk assessments and management plans in place to minimise risks. There had been no incidents and accidents since the last inspection but the provider had a procedure in place to mitigate the risk of reoccurrence of incidents if they did occur.

Care workers followed procedures for the management of people’s medicines and underwent medicines training and competency testing. Weekly medicines audits indicated that people were receiving their medicines safely as prescribed.

Care workers had completed training in infection control and used protective equipment as required.

Care workers had an induction and up to date relevant training to develop the necessary skills to support people using the service. Safe recruitment procedures were followed to ensure care workers were suitable to work with people using the service.

People were supported to have maximum choice and control of their lives and 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.

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

People were involved in their care plans and making day to day decisions so the care was reflective of their preferences and wishes.

There was a complaints procedure in place and the service had not had any complaints since the last inspection. The deputy manager was available and people using the service and staff told us they were approachable and supportive.

The service had a number of systems in place to monitor, manage and improve service delivery so a quality service was provided to people.

The inspection took place on 25 May 2017 and was unannounced. The last inspection took place on 9 June 2015 and was rated as ‘Good’.

Santa Care is a home for up to four adults with learning disabilities or mental health needs. Two of the three people living in the home used British Sign Language (BSL) to communicate which staff had been trained in to various levels of competency to use.

The home is one of three owned by the person who is also 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 observed that not all risk assessments were robust and up to date.

Ongoing medicines competency testing was not undertaken, the service did not have a PRN (as required) medicines policy and were not recording the temperature of the medicines cupboard.

We recommended the service use analysis of incidents and accidents to contribute to safe and effective service delivery.

The service did not always follow the principles of the Mental Capacity Act (MCA) 2005.

There were no written records of supervisions or appraisals so we could not be confident staff were receiving the support they needed to deliver care as required by the people using the service.

The service had some systems in place to monitor how the service was run to ensure people’s needs were being met and they were being kept safe, however there were no medicines or service user file audits.

The service had safeguarding and whistle blowing policies and staff knew how to respond to safeguarding concerns.

Safe recruitment procedures were followed and there was sufficient staff to meet people’s needs.

People were involved in menu planning and cooking and had access to the kitchen.

People were supported to maintain good health and access healthcare professionals.

People using the service told us staff were kind and caring and could communicate with them.

Care plans were person centred and reviewed in a timely manner.

The service had a complaints procedure and people we spoke with said they would raise any concerns with the deputy manager.

We found breaches of regulations in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing. You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 9 June 2015 and was unannounced. The previous inspection of the service had been on 29 November 2013 where no breaches of Requirements were made.

Santa Care is a care home for up to four adults who have a learning disability and mental health needs. Three of the four people who were living at the home at the time of our inspection had a hearing impairment . These people used BSL to communicate and the majority of the staff could also communicate using BSL. One person spoke Gujurati as a first language. Some of the staff also spoke Gujurati. The home was owned and managed by Santa Bapoo, an individual who owned two other care homes in North West London. The owner also managed the service. There is no requirement for a separate registered manager.

There were appropriate procedures for safeguarding people and the staff were aware of these.

The risks people experienced had been assessed and there were plans in place to minimise the likelihood of harm.

There were enough staff employed to keep people safe and meet their needs.

People were given the support they needed with their medicines.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLs). DoLS provides a process to make sure that providers only deprive people of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. The provider was aware of their responsibilities and had acted in accordance with the legal requirements.

People were supported to stay healthy and to see other health care professionals when needed.

People were supported to have a varied and nutritious diet.

People had good relationships with the staff. They thought the staff were kind and caring.

People’s privacy and dignity was respected.

People’s needs had been assessed and care plans informed the staff how they should support people.

People took part in a range of different activities which they chose.

There was an appropriate complaints procedure and people knew how to make a complaint.

There was a positive culture at the home where people living there and staff felt able to contribute their ideas. They felt valued and listened to.

There were systems for monitoring the quality of the service.

We spoke with the deputy manager, one other member of staff and two people who were using the service. We observed positive interactions between staff and the people using the service and people told us they were happy. The deputy manager told us that all staff had a working knowledge of British Sign Language (BSL) to enable them to communicate with people using the service and meet their needs effectively.

People were supported to access activities and visit family and friends in the community. We saw that people's needs had been assessed and each person had a care plan that informed staff about the action they should take to meet these needs. Identified risks had been assessed and plans were in place to support staff in minimising these.

The service was well maintained and checks were taking place at regular intervals to ensure that the premises remained safe and suitable for the people using the service.

There were enough staff on duty at the time of our inspection who had the skills and knowledge to meet people's needs effectively.

Systems were in place to enable people to make a complaint if they were unhappy about the service. People told us they knew how to make a complaint but had not had to do so.

During the inspection we spoke with one person using the service. We were also supported by an Expert by Experience who engaged with two people using the service in British Sign Language (BSL) to get feedback about their experiences of using the service. An expert by experience is a person who has personal experiences of using care services.

People were supported in promoting their independence and community involvement. They told us they were given opportunities to express their choices and to make decisions in their daily lives. We observed that staff were aware of people’s preferences and routines so they could support people appropriately. For example they knew at what time people preferred to eat and what time they went to bed or got up.

The home was suitable for people with a learning disability and there were some facilities for deaf people. We however, found that the environment had not been fully assessed to look at adaptations and equipment to promote the independence of deaf people. For example there was not an alerting device when visitors to the home rang the door bell.

People said they were well supported by staff. The home employed three deaf members of staff who knew BSL and the manager said three hearing members of staff have varying knowledge of BSL. The manager told us she would ensure that people were always supported by staff who knew BSL so deaf people did not experience difficulties in expressing their needs if staff working on a shift were not able to communicate with them.

People confirmed that they completed satisfaction questionnaires to give feedback about the quality of services. The provider had a system to assess the feedback provided in the satisfaction questionnaires and to take action where required to address areas where improvement had been identified.

People who use the service said that staff asked them about their choices and involved them in decisions about their care and support. We observed that people were asked about the meals that were prepared in the home and the activities that they engaged in. Those people who have a sensory impairment said that staff manage to communicate with them. We noted that staff either wrote down what they wanted to say or they used basic sign language to communicate with people.

We observed that people appeared relaxed and comfortable in the home. They were able to move freely within the home and go to their rooms whenever they wanted to. They all had care plans in place to address their needs including their spiritual, cultural, social and recreational needs. People said that they could read their care plans if they wanted to.

People said that the home had enough staff to care and support them. We noted that member of staff knew people using the service well and were familiar with people’s needs.

People told us that they are sometimes asked about their views of the service. We noted that the service generally sought feedback from people using the service and other stakeholders to get their views on the quality of the service.

There was a complaints procedure that was accessible to people using the service. They told us that they would talk to staff or the manager if they had any concerns.