The inspection took place on 25 July 2017 and was unannounced. Sense Hyde close flats is a care home that provides accommodation and personal care for up to 20 people. The service is split into four flats and supports people with a range of needs including people with a learning and sensory disability and autism. At the time of our inspection there were 17 people living there.

The registration conditions of this service require for there to be a registered manager in post, and there was one 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.

At our last inspection in November 2015 we rated the service requires improvement and found improvements were needed in risk assessments and staff supervision. We found at this inspection improvements had been made and staff were now being supervised regularly and the service was no longer in breach of regulations in the area of staffing.

Risk assessments were robust and tailored for each individual and incorporated into detailed care plans about how each person could be supported safely. We saw improvements in how risk assessments captured the risks people faced and were managed. Medicines were managed safely and the premises were clean, hygienic and set up with meeting people’s sensory needs in mind.

Staff had good understanding of safeguarding and how to protect people from abuse and the challenges they faced out in the wider community. Staff knew how to report any concerns and there was a clear procedure in place for staff to follow and report any issues to senior staff or the registered manager. We saw an example of where a person had sustained an injury and the service had learned from it how better to support the person and identified a training need for some staff members around recording of incidents. This showed the service had reflected on the incident and learned from it.

The service was in keeping with the principles of the Mental Capacity Act 2005 (MCA) and we saw that staff tried to gain consent throughout the day by offering choice and letting people know what was on offer. Deprivation of Liberty Safeguards had been applied for where appropriate.

Staff had attended training in courses that helped them to support people with sensory needs and said they found training helpful. Supervisions were taking place regularly in line with the provider’s policy to ensure staff felt supported and were equipped to effectively do their jobs.

The food on offer was healthy and there was a range of options. People were offered drinks throughout the day.

Staff were caring and kind and had a good insight into how people liked to be cared for and consistently treated them with dignity and respect. We saw involvement from relatives in care planning and where discussions for end of life wishes had been approached.

Care plans and care provided were person centred. Preferences and likes and dislikes were clearly captured and needs were reviewed regularly. Assessments were in depth and had been contributed to by some family members and health and social care professionals. People had days that were filled with a range of activities that were meaningful to them. Activities had been assessed for each person and recorded in detail how staff were to support people.

The registered manager was visible in the service and relatives, people and staff knew who they were. Care staff said the registered manager was approachable and supportive and had seen improvements in how the home was run. Audits to check the quality of care and day to day running of the home were robust and completed by the registered manager and the provider.

We carried out an unannounced inspection of this service on the 19 November 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements for breaches of Regulations 12 and Regulation18 of the Health and Social Care Act (Regulated Activities) Regulation 2014 in respect of risk assessment and staff training.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. 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 Hyde Close Flats on our website at www.cqc.org.uk

Hyde Close Flats provides accommodation with personal care for up to 20 people who have physical and complex learning disabilities and sensory impairment. At the time of our inspection there were 14 people living at the home. The service is situated in High Barnet, in a residential area, close to shops and other local amenities. The service consists of four flats, three with five bedrooms and a bedsit for one person.

At the time of our inspection the service had a registered manager in post. 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 last inspection in March/April 2015 we found the provider had made several improvements to the service. However, we found breaches relating to staff training and understanding in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and risk assessments were required for people at risk of self-harm. Staff training in areas such as Mental Capacity Act 2005 (MCA) and Deprivation of Liberty safeguards (DoLS) had not taken place for most staff for more than five years. Staff had limited knowledge of the MCA and DoLS and the impact of this on the people they cared for. We made recommendations about the management of and learning from incidents and Health Action Plans (HAPs).

We asked the provider to take action to make improvements. We received an action plan from the provider stating that these actions would be completed by end of July 2015. We saw that most of these actions had been completed.

During this inspection we found that the provider had made some improvements as outlined in their action plan. We saw that a number of changes had been made in response to DoLS. The main door entry system had been replaced with an automatic door system, enabling peoples’ independence when entering and leaving the building, unit doors were no longer kept locked and people were encouraged to freely walk around the home with staff support. Health action plans and hospital passports were in place for everyone living at the home and most staff had received refresher training in the MCA and DoLS.

We made recommendations about assessing adults at risk of self-harm and assessing fire risk.

Some staff had not received supervision for seven months. Staff told us that this was due to some of the changes required to improve the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see at the back of this report what action we asked the provider to take.

At our inspection on 31 May 2013 we found the service non-compliant in areas relating to quality assurance and records. Care plans and risk assessments had not been updated following a review by the local authority and the service’s quality assurance system was not effective in ensuring that quality audits took place. During this visit we found that the provider had made some improvements. Records relating to people who use the service and staff were up to date. We reviewed records for ten staff and found that all had received recent supervision, this was confirmed by staff we spoke with. However, the registered manager is aware of the need for improvement in areas such as, streamlining the format used for recording supervision notes. Support plans and risk assessments had been updated and files had been organised into different sections, such as, support plan including guidelines for staff supporting people, for example people with behaviour that challenges the service.

There were systems in place for monitoring the quality of the service. Random document checks on records were carried out by the operations manager and monthly inspections by the registered manager were due to commence on 30 July 2013.

During our inspection on 8 November 2012 we found non-compliance with care and welfare of people who use services and records. The provider submitted an action plan to address areas of non-compliance. At our inspection on 30 May 2013 we found that, although there had been some improvement to records, most care plans and risk assessments had not been updated in line with the action plan and the service’ policies and procedures. “staff really engage well with people,” said one care manager. We contacted a number of relatives, but managed to speak with two. One relative told us, “care givers (care staff) are fabulous.” Another said staff were, “very caring, really good.”

We observed some good interactions between staff and people living at the home. Staff received the necessary training relevant to their role. Although staff told us they felt supported by the manager, most staff had not received regular supervision in line the service policy and procedure.

There were systems in place for monitoring the quality of the service, however this was not effective in ensuring care plans and risk assessments were updated and staff supervision was consistent. The registered manager told us that person centred planning meetings had been held for most people using the service and was aware of the need for further improvements. Following our visit the registered manager provided us with an action plan addressing the areas of concern.

We are considering what further regulatory action is needed to ensure that the provider becomes compliant with the regulations.

At the time of our inspection there were 19 people in residence. We spent most of our time visiting the individual flats and observing the people using the service. We were unable to speak with people who use the service, because they had complex needs which meant they were not able to give us verbal feedback. However, we were able to observe staff interactions and support to learn more about people's experiences of living at Hyde Close. We contacted several relatives but were unable to speak to anyone. We were able to speak with two stakeholders who felt that people were treated with dignity and respect and supported to make choices about their care and treatment.

We saw staff interacting with people in a caring and sensitive manner and saw that staff used different ways to communicate with people to involve them in their care and treatment. However, not all care plans were regularly reviewed and up to date, which meant that people were not always protected from the risk of unsafe or inappropriate care and treatment.

Records held for people using the service were not accurate and up to date. Staff records were not available on the day of our inspection and could not be promptly located.

People who use the service had communication difficulties. We observed them in the seating and dining areas. We noted that staff use different means in order to involve people in their care and treatment. It was evident from the setting of the home and the facilities provided that people's experiences have been taken into account in the delivery of the service.

We observed people to be comfortable during our visit. A person who uses the service went out with staff and returned to the home after having lunch in a nearby cafe'. This indicated to us people access facilities in the community.

We noted from observations that people using the service were relaxed and felt satisfied with their interaction with staff. We saw staff treating people with respect and dignity. People were able to access communal areas and were encouraged to be as independent as possible.

We saw complimentary letters and cards from relatives which stated their satisfaction with the care provided and told us the opportunity they had with regard to their involvement in people's care plan reviews meetings. A letter written by a family reads: "We have been fully involved, and always invited to (a person's) review".

We carried out an unannounced inspection on the 20 March 2015, 25 March 2015 and 27 April 2015.

Hyde Close Flats provides accommodation with personal care to up to 20 people who have physical and complex learning disabilities and sensory impairment. At the time of our inspection there were 15 people living at the home. The service is situated in High Barnet, in a residential area, close to shops and other local amenities. The service consists of four flats, three with five bedrooms and a bedsit for one person.

At the time of our inspection the previous registered manager had left the service in November 2014 and the current manager was in the process of becoming the new registered manager in post. 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 last inspection in May 2014 we found several breaches relating to standards of care and welfare, assessing and monitoring the quality of service provision, cleanliness and infection control, management of medicines, safety, availability and suitability of premises, consent to care and treatment, complaints and records. We asked the provider to take action to make improvements. We received an action plan from the provider stating that these actions would be completed by end of January 2015. We saw that most of these actions had been completed.

Since our last visit in May we found that the provider had made improvements as outlined in their action plan. We saw that the environment was clean and safe for people living at the home. Staff had started to review the person centred plans (PCP) for people living at the home. This involved other healthcare professionals and relatives. We made recommendations for the service to consider Department of Health (DH) guidance on Health Action Plans and Hospital Passports.

People living at the home had complex needs and could not verbally tell us their experiences of the home. We observed how care was being delivered to people. We saw good interactions between staff and people living at the home. Staff were caring, kind and patient when interacting or assisting people with personal care. Relatives told us that they felt their relative was well cared for. Comments about staff included, “they [staff] are very caring,” and “very kind and good to residents and anyone who visits”.

People were treated with dignity and respect and their privacy maintained. We saw that staff spoke in a calm manner and explained what they were doing before supporting people.

People were given choice and their individual needs were being met by the home.

We saw that the provider had a number of auditing systems to monitor the quality of the service. Audits included areas such as cleanliness and infection control, and health and safety of the building.

However, although a number of improvements had been made to the service since our last inspection in May 2014, further improvements were required. We found care records for people using the service were not always updated and risk assessments were required for people at risk of self-harm. Staff training in areas such as Mental Capacity Act 2005 (MCA) and Deprivation of Liberty safeguards (DoLS) had not taken place for most staff for more than five years. Staff had limited knowledge of the MCA and DoLS and the impact of this on the people they cared for. There was no centralised system for recording incidents and we were unable to identify any learning which may have taken place following an incident. We made a recommendation about the management of incidents.

You can see at the back of this report what action we asked the provider to take.