We conducted an announced inspection of 63 Eton Avenue on 31 October 2018. The service is a small home providing care and support for up to three people with learning disabilities, autism and behaviours that may be challenging. There were three people living at the home when we visited.

At our last inspection we rated the home as Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The home 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.

Procedures were in place to ensure that people were safe from harm, Personalised risk assessments for people were up to date. Staff members had received training in safeguarding of adults from abuse and understood their roles and responsibilities in ensuring that people were safe.

People’s medicines were managed safely. They were stored and administered appropriately. Accurate records were made when medicines were given. Staff members had received training in the safe administration of medicines.

People had personalised care plans in place. These were reviewed regularly and updated to reflect any change in needs. One person’s care plan had been developed in an easy read picture assisted format and the home was planning to ensure that all care plans were made accessible in the near future.

People’s care plans and risk assessments included guidance for staff on supporting people’s communication needs. Staff members communicated with people in ways that they understood, using, for example, objects and gestures along with words where appropriate. Behavioural plans were in place which focused on minimising people’s anxieties.

All staff members working at the home had been safely recruited. References and criminal record checks were taken up prior to their appointment. New staff members received an induction to ensure they had the knowledge required to prepare them for their role. All staff members were provided with a range of training sessions which were relevant to their work. This training was regularly refreshed to ensure that staff maintained their skills and knowledge. All staff members had received regular supervision from a manager.

People were supported to eat and drink a healthy range of foods. Support was provided to ensure that their health needs were met and staff at the home liaised regularly with other health and social care professionals.

The home was meeting the requirements of the Mental Capacity Act (2005). People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were offered choices about what they wanted to do. Staff members demonstrated that they understood the importance of enabling people to make their own decisions.

Monthly quality monitoring audits and reviews had taken place and people and relatives had been asked for their feedback about the support provided at the home. A complaints procedure was in place and a family member told us that they knew how to use this.

We carried out a comprehensive inspection at 63 Eton Avenue on 3 March 2016 at which a breach of legal requirements was found. This was because the provider had not ensured that people had assessments in relation to their capacity to make decisions and had not submitted applications to a commissioning local authority requesting Deprivation of Liberty Safeguarding (DoLS) application for people who lived at the home. DoLS is part of the Mental Capacity Act (MCA) 2005 and requires that authorisations are applied for in relation to people who are under continuous supervision and are unsafe to leave the home unaccompanied where they do not have capacity to make safe choices about their care and support. After this inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to this breach

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On 14 March 2017 we undertook a focused inspection to check that the provider had taken action in order to meet legal requirements.

This report only covers our findings in relation to the effective topic area. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 63 Eton Avenue on our website at www.cqc.org.uk.

At our last inspection of 3 March 2016 we rated the service good in the four topic areas safe, caring, responsive and well-led, and good as the overall rating. The service was rated requires improvement in the effective topic area.

63 Eton Avenue is a care home registered for three people with a learning disability situated in North Wembley. At the time of our inspection there were three people living at the home. The people who used the service had significant support needs because of their learning disabilities.

The service has a registered manager. 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 of the Health and Social Care Act and associated Regulations about how the service is run.

At our focused inspection on 14 March 2017, we found that the provider had taken action to ensure that legal requirements were met. We found that applications for DoLS authorisations had been made for people who lived at the home. Care documents included information about people’s capacity to make decisions.

Training for staff members was up to date. We saw that staff members had received training on the Mental Capacity Act 2005 and DoLS.

We conducted an announced inspection of 63 Eton Avenue on 3 March 2016. The service provides care and support for up to three people with learning disabilities, Autism and behaviours that challenge the service. There were two people using the service when we visited.

At our last inspection on 13 December 2013, the service met the regulations inspected.

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.

We did not find appropriate Deprivation of Liberty Safeguards (DoLS) in place for people who used the service. Staff were trained in the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005. However staff did not demonstrate sufficient knowledge and understanding of their responsibilities.

Safeguarding adults from abuse procedures were robust and staff understood how to safeguard the people they supported. The registered manager and staff had received training on safeguarding adults and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

Safe practices for administering and storing medicines were followed. Records were kept when medicine was administered. The registered manager ensured that medicines administration had been audited frequently to ensure people who used the service were administered the correct medicines.

People and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only people who were suitable worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with a range of training to help them carry out their duties. Staff received regular supervision. There were sufficient staff deployed in the service to meet people’s needs.

People were supported to eat and drink and their nutritional needs were monitored. People were supported effectively with their health needs and had access to a range of healthcare professionals. People were involved in making decisions about what kind of support they wanted.

Staff and people who used the service felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was an effective complaints policy and procedure in place.

The service carried out regular audits to monitor the quality of the service and to plan improvements. Where concerns were identified action plans were put in place to rectify these.

We found one breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Our inspection of 8 August 2013 found that people were not protected from the risks of unsafe or inappropriate care and support because accurate and appropriate records were not maintained by the provider. The provider wrote to us and told us that they would retrain staff in medicines management, record keeping and include medicines records in a monthly audit processes.

In this inspection we found people’s records were accurate and fit for purpose. Plans of care contained detailed information relating to their care and treatment.

We spoke with one person who used the service, and observed the care provided to another person who had complex communication needs and was unable to tell us verbally about their experiences. The person we spoke with told us "I like this home, I want to stay. I don't want to go" and "the staff here are nice. They help me do what I want to do".

The care we observed met people's needs. We saw that people were provided with information to be able to make choices about their care and support, and to make decisions about their day-to-day lives, when they could.

We found that the service had appropriate measures in place to manage people's medicines, and that the premises were safe and suitable for the needs of staff, visitors and people who used the service.

We saw that the provider ensured there were enough skilled, qualified and experienced staff to meet people's needs. We found that the provider had not taken steps to ensure that people's personal information and records were accurate, fit for purpose and held securely.

When we visited 63 Eton Avenue we met people who lived there and saw them engage with care workers. We met the deputy manager and one of the care workers. People using the service were from an Asian background and the home provided culturally appropriate food and supported people to engage with their community. People told us that they were 'happy' at the home and we observed appropriate interactions between care workers and people.

We found that people were supported in promoting their independence and community involvement. Their diversity, values and human rights were respected. People seemed to like the staff and they were provided with good care and support. They felt safe and were listened to when they communicated any concern or anxieties.

Medication procedures for the recording and disposal of medicines were not being followed.

We looked at staff training records and spoke to staff. They felt the staffing levels allowed them to spend quality time with people and felt well supported and trained. The provider had systems in place to check the quality of the service.

People who use services spoke positively about the standard of care and support they received. As one person put it, “I like it here.” People told us that staff treated them respectfully, and involved them in decisions about their care and support. We were told that the service has “nice staff”, and that “I am not treated badly here.”

People told us that there was enough to do at the service. They told us about a variety of places that they go to, including recent weekend excursions into London, and about going to a local mosque on Fridays.

We found that suitable arrangements were not in place to ensure that people were always safeguarded against the risk of abuse and had their human rights upheld. This was because incidents of aggressive behaviour by people were not always effectively reviewed. Additionally, some cases of aggression towards other people who use services had not been reported to appropriate external professionals.