This was an unannounced inspection that took place on 30 June and 3 July 2017.

The service provides supported living care for up to three people with learning disabilities and is located in the Twickenham area.

The service had a 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 and associated Regulations about how the service is run.

In May 2015, our inspection found that the service required improvement in the area safe regarding a small proportion of the medicine records that were incomplete for creams administered. All the other key questions were rated good with an overall good rating. At this inspection the service was rated overall good and good for all the key questions.

People we spoke with told us that the staff provided good support for them when they needed it. They had close bonds with the people who lived next door which was a care home for people with learning disabilities that shared the same staff and was part of the same organisation. They had access to activities they had chosen and did them as a group or individually including with people from the learning disability care home. This depended upon their preference and the type and nature of the activities.

During our visit people came and went as they pleased and the service provided a warm and inclusive atmosphere.

The staff were familiar with people using the service and the field of work that they as staff were engaged in. Their work skills and training enabled them to meet people’s needs and provide support in a professional, friendly and supportive way. They were professional in their approach and accessible to people using the service and their relatives. Staff said the training they received was good and enabled them to do their jobs.

People had support plans, that were up to date and underpinned by risk assessments and other documents that contained clearly recorded, fully completed, and regularly reviewed information. This enabled staff to perform their duties. Staff records were also up to date.

People were supported and advised to have healthy, balanced diets that also met their likes and preferences whilst protecting them from nutrition and hydration associated risks. People were encouraged to discuss health needs with staff and had access to community based health professionals, when required.

The registered manager was approachable, responsive, encouraged feedback from people and monitored and assessed the quality of the service provided.

This was an unannounced inspection that took place on 13 May 2015.

The service provides supported living care for three people with learning disabilities and is located in the Twickenham area.

The service had a 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 and associated Regulations about how the service is run.

In April 2014, our follow up inspection found that the service met the regulations we inspected against. At this inspection the service met the regulations.

There was one improvement area. A small proportion of the medicine records were incomplete for creams administered. The other records we looked at were up to date and well kept.

We recommend that the service refers to current medicine administration and recording guidance.

People said they enjoyed living at 89 Heathfield North and that the staff provided good support for them when needed. They chose the activities they wanted to do and when they wanted to do them. They did activities as a group and independently depending on type, nature and choice.

During our visit the home provided an inclusive and warm family atmosphere. People were laughing and smiling a lot which reflected that they were enjoying themselves.

The care plans, risk assessments and other documents contained clearly recorded, fully completed, and regularly reviewed information. This enabled staff to perform their duties.

The staff were very knowledgeable about the people they worked with and field they worked in, including bank staff on duty. They had appropriate skills, training and were focussed on providing individualised care and support in a professional, friendly and supportive way. They were trained and understood how to de-escalate challenging behaviour which they were required to do during our visit. They were professional in their approach and accessible to people using the service and their relatives. Staff said they had access to good training, support and career advancement.

People were protected from nutrition and hydration associated risks with balanced diets that also met their likes, dislikes and preferences. They said they liked the choice and quality of food available. People were encouraged to discuss health needs with staff and had access to community based health professionals, when required. Staff knew when people were experiencing discomfort and made them comfortable.

The manager was approachable, responsive, encouraged feedback from people and monitored and assessed the quality of the service provided.

Our inspection team was made up of an inspector who answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

During our visit we saw that people were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust, staff understood how to safeguard the people they supported and had received training. Details of specific areas or circumstances under which people may be particularly vulnerable were written down in the care plans we saw.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helps the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

The staff rotas took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met.

No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. One person said that they had been involved in writing their care plan and it met their current needs. The care plans had been signed by people using the service. People told us "I'm going to the park", "I'm going to have my lunch now" and "I've been to work today".

The layout of the service enabled people to move around freely and safely and the premises met the needs of people with physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People commented, “The staff are my friends”. A relative said, “In the main very good and friendly, the atmosphere is happy and I am confident in the staff although they can be under pressure sometimes”.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed. The home is also part of the Richmond Council 'Quality assessment framework'.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. During our visit people were coming from and going to a number of different activities either individually or as a group. The home has access to transport, which helps to keep people involved with their local community.

People knew how to make a complaint if they were unhappy. Two people said that they had never needed to make a complaint as any problems were generally sorted out on the spot or during house meetings . We looked at how complaints were investigated. People could therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

There was a new management structure in place that was pro-active, listened to people's needs and opinions and acted upon them. They were introducing a number of new initiatives and had employed consultants to introduce practice improvements in areas they felt required it. The service worked well with other agencies and services to make sure people received their care in a joined up way and was part of the Richmond Council 'Quality assessment framework'.

The registered manager was away from work and suitable covering interim measures were in place. Appropriate notifications to the Care Quality Commission had been made.

During our visit people using the service told us they liked living where they were, chose what they did, when they did it and got support if it was needed. They did not tell us about the asessment and admission process.

They liked the staff, way they were treated and felt safe living at the home. They did not comment on staff numbers or the complaints procedure. "Happy birthday from me I designed this card for you". "I like living here we're like a family". "I enjoy working it keeps me busy".

We saw that there was a thorough assessment and admissions procedure that was fully documented although no one new had used the service for some time.

There were up to date support plans in place that were regularly reviewed and up dated that were underpinned by risk assessments.

There were also thorough safeguarding and complaints procedures that staff had been trained in.

We also found there were enough staff on duty during our visit and on the rota to meet people's needs.

At our previous inspection we made a compliance action that some walls in the communal lounge and sun lounge areas within the home required redecoration and a sink area draining board made safe. During our responsive visit we found that the work had been carried out to a satisfactory level. People using the service told did not comment on the work carried out.

During our visit people told us they liked living where they were, chose what they did, when they did it and got support if it was needed. They liked the staff, way they were treated and felt safe living at the home.

They told us there were enough staff. They did not tell us about the quality assurance system in place. They did tell us they were asked what they thought about the service they got and that staff were very good. One person told us "I like spending time with my friends and my parents". "I get upset if staff take over things I can do". "I am proud to have a paid job".

The people who live at the home told us that there were happy there. They appeared relaxed and comfortable. They told us that they liked the staff. We saw that the staff treated people with respect and kindness.