We undertook an unannounced inspection on 13 June 2017 of Abilities Short Breaks - Respite & Residential. Abilities Short Breaks - Respite & Residential is a small care home registered to provide accommodation for persons who require personal care for a maximum of four people with learning disabilities. The home is owned and managed by Abilities Development Limited who provide a similar service in one other care home in North West London.

At the time of the inspection, the service was providing care and supporting four people.

There was 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 on 7 April 2016, the service did not meet Regulations 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the premises were not secure and properly maintained and complete and contemporaneous records were not maintained in relation to the care and treatment provided to people using the service. This meant the quality rating we awarded was requires improvement.

After the inspection, we received an action plan from the service telling us what action they would take to meet legal requirements.

At this inspection the registered manager was able to demonstrate that measures had been put in place since the last inspection to respond to the issues identified. The premises had been maintained. Care plans had been updated. and clearly detailed the support people needed and received with all areas of their care. Care plans were reviewed and were updated when people's needs changed.

Relatives told us that they were confident that people were safe in the home.

Systems and processes were in place to help protect people from the risk of harm. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

Bedrooms had been personalised with people's belongings to assist people to feel at home.

Staff had been carefully recruited and provided with induction and training to enable them to support people effectively. They had the necessary support, supervision and appraisals from management.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had made necessary applications for DoLS as it was recognised that there were areas of the person’s care in which the person’s liberties were being deprived. Records showed that the relevant authorisations had been granted and were in place.

There were suitable arrangements for the provision of food to ensure that people's dietary needs were met.

Staff were informed of changes occurring within the home through daily handovers and staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

There was a management structure in place with a team of care workers, manager and registered manager. Staff spoke positively about working at the home. There were systems in place to monitor and improve the quality of the service.

Abilities Short Breaks - Respite & Residential is a small care home registered to provide accommodation for persons who require nursing or personal care for a maximum of four people. The home is owned and managed by Abilities Development Limited who provide a similar service in one other care home in North West London.

There was 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.

This inspection took place on the 7 and 11 April 2016 and was unannounced. At the last inspection on the 27 April 2015 we found the registered manager was not meeting four regulations in relation to investigating any possible incidents of abuse, management of medicines, reviews of people’s care and no quality assurance system in place to monitor the quality of the service being provided to people who use the service.

Following the inspection the registered manager sent us an action plan telling us how they were going to address the concerns identified. During this inspection we found that the registered manager had taken sufficient action to meet the breaches. Reviews of people’s care had been conducted, there were processes in place for the safe management of medicines and investigating any possible incidents of abuse and there were some processes to measure the quality of service being provided.

However further breaches of regulations were found in relation to complete and clear records not being kept in relation to people’s needs and the premises not being properly maintained.

At the last inspection, the home consisted of people living there on a permanent basis alongside people who came to the home for respite purposes. During this inspection, we observed the set up of the home had changed and there were now four people living at the home permanently and no respite service.

This provided a more settled and comfortable environment for people using the service. People had their own rooms and set routines for their daily life. One relative told us there was “Homely” feel to the home.

At the last inspection, we found there was a lack of leadership in the home. During this inspection, we found there was a deputy manager at the home who worked alongside the registered manager. Staffing levels appeared to be more settled as there was a management structure in place which was the registered manager, deputy manager and a team of core permanent care workers.

There were processes in place for the proper and safe management of medicines.

There were safeguarding and whistleblowing policies and procedures in place and training records showed staff undertook training in how to safeguard adults. Staff we spoke with were able to identify different types of abuse and were able to describe what action to take if they suspected abuse.

There were effective recruitment and selection procedures in place to ensure people were safe and not at risk of being supported by people who were unsuitable.

Some risks to people were assessed and guidance was in place for staff to follow to minimise the risk to people being harmed.

Records showed and staff told us they received regular training and received regular supervision and appraisals. However there were no spot checks in place to effectively assess the competency of staff to ensure they were able to provide people with the appropriate care and support they needed.

There were some arrangements in place to obtain, and act in accordance with the consent of people using the service. Care plans contained some information about people’s mental state, levels of comprehension and the support needed for a person in areas where they may lack the capacity to give consent. Appropriate Deprivation of Liberty Safe

We undertook an unannounced inspection on 27 April 2015 of Abilities Short Breaks – Respite and Residential.

At our last inspection on 22 January 2014, the service did not meet Regulation 15 - Safety and suitability of premises. We conducted a follow up inspection on the 29 July 2014 and found the service met the regulation.

Abilities Short Breaks – Respite and Residential is registered for a maximum of four people who have learning disabilities. At the time of the inspection there were two people using the service. The home also provides regular respite for five additional people for four to five days a month.

There was 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.

During our inspection, observation and feedback from relatives demonstrated there were some positive aspects to the service including kind care workers and a registered manager who relatives felt was approachable and would always get back to them if they needed to speak with her.

However it was evident that the service was not well managed and there were no effective processes to ensure people were safe and to monitor the quality of care being provided for people using the service.

The management structure currently in the home was a registered manager, three permanent care workers and four agency staff. The registered manager told us it had been a challenging time for her as she was in process of recruiting a deputy manager for the home. Two managers had been recruited and neither were found to be suitable for the role.

People’s safety was compromised in the way some medicines were managed and administered. We found shortfalls in the recording and auditing of medicines.

People were not protected from avoidable harm or abuse. There was a system in place for recording incidents however we noted that some incidents had not been followed up or further investigated and the local safeguarding team had not been notified.

When speaking with staff, they were familiar with people’s needs and their key risks. However feedback from staff and relatives told us there were issues with consistency of staff and care being provided to people as agency staff were routinely hired.

Care workers had a good understanding about people’s respect and dignity and were aware of the importance of treating people with respect and dignity. During the inspection, we noticed the upstairs bathroom did not have a shower curtain so people’s privacy and their dignity were not respected.

Staff received regular relevant training and received support from the registered manager. Appropriate checks were carried out when staff were recruited.

People were able to visit family and friends or receive visitors and were supported and encouraged with maintaining relationships with family members. Relatives told us they were in regular touch with the registered manager and care workers and could informally discuss any issues. However feedback from relatives and records showed there had been no formal reviews of peoples care.

During the inspection, we noted and discussed with the registered manager the décor of the home as it contained basic furnishing and there was a need for improvement. Relatives also told us they raised the issue of the décor of the home as they felt it was not homely.

There were no robust and effective quality assurance and governance systems in place to monitor the quality of the service being provided to people who use the service and to manage risk effectively. We found medication errors had not been detected, incidents has not been followed up, people’s weight had not been monitored and reviews of care had not taken place.

We found four breaches 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 this report.

During our previous inspection of 22 January 2014, we found that the provider did not have suitable arrangements to ensure that service users and others having access to premises where a regulated activity is carried out are fully protected against the risks associated with unsafe or unsuitable premises. (Regulation 15(1)).

We carried out an inspection on the 29 July 2014 to check whether improvements had been made. We found the manager had taken steps to provide care in an environment that was adequately maintained.

There were two people living in the home. We spoke with one person who used the service and a relative of a person who used the service. The person who used the service indicated by smiling and nodding that they were happy to be in the home. We spoke with a relative by phone. They informed us that people had been treated with respect and dignity. This relative said “I am satisfied. My relative is very happy there”.

We observed that staff were pleasant and spoke in a respectful manner towards people who used the service. The home had a policy on ensuring equality and valuing diversity and ensuring that the human rights of people were protected. Staff were aware that all people who used the service should be treated with respect and dignity.

People who used the service had been assessed and staff were aware of the likes and dislikes of people. Care plans and risk assessments had been prepared with the involvement of people or their representatives.

The premises were clean and there was a record of maintenance and inspections carried out. However, some deficiencies were noted in the safety arrangements.

There was evidence that staff employed had been carefully recruited. The recruitment records contained references, criminal record disclosures and other essential documentation. The home had a policy and procedure for safeguarding adults. Staff could provide examples of what constituted abuse and knew how to respond to allegations or incidents of abuse. Complaints made had been promptly responded to.