We inspected this home on 18 October 2016. This was an unannounced Inspection. The home was registered to provide residential care and accommodation for up to 13 people who live with mental health needs, autism or a learning disability. At the time of our inspection there were 12 people living at the home, and one person was having some trial visits before deciding if they wished to move to Apna House permanently.

We last inspected this service in October 2015 when we found the registered provider was in breach of two legal regulations, Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider was not ensuring restrictions placed upon people were referred to the appropriate supervisory body. They were also in breach of Regulation 18 of the Health and Social Care Act 2008 Registration Regulations 2014 because notifications that the registered provider was required to send to the commission by law were not being submitted. This inspection identified that improvements had been made and these breaches were now fully met.

A registered manager was in post and was present throughout 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.

We met and spoke with 10 of the people using this service. Either from gestures or discussions with people or through our observations, people indicated for the majority of the time they felt safe. People told us how they had made some changes to their lifestyle and behaviour to minimise the impact of other people's unsettled behaviour on them. We observed people looking relaxed and comfortable around staff and within the home. Staff understood their roles and responsibilities to protect people from the risk of potential harm. Staff were aware of the registered provider’s processes for reporting any concerns. There were enough staff to support people safely and recruitment checks were in place to help ensure staff that were employed were safe to work with people.

Staff had been trained to support people effectively. This included learning about the specific needs and conditions people lived with. Staff told us that they received regular supervision and felt supported. More senior staff were always on-call for them to seek advice and guidance.

People had access to a variety of food and drink which they enjoyed. People were supported when necessary to access a range of health care professionals.

Staff had a basic knowledge of their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be unable to make their own decisions. Further opportunities to develop the knowledge and confidence of staff had been planned. We observed staff working consistently in line with people's care plans when restrictions or safeguards had been agreed for people. Staff were observed seeking people’s consent before providing any care and support.

People were relaxed in the company of staff and we observed many positive, compassionate interactions between people and the staff who were supporting them. People had been given opportunities to learn new skills and were encouraged to remain as independent as possible. We observed staff ensuring people’s privacy and dignity was maintained.

People had opportunities to express their individual culture and faith.

People knew how to raise complaints. Where complaints had been raised the registered manager had taken prompt and appropriate action. There were a wide range of systems and opportunities for people to provide feedback about all aspects of the service.

There was a registered manager in post who was

We received some concerns about the home relating to people not being cared for properly, poor management and concerns about the safety of the home. We brought forward our inspection of the service. This inspection took place on 26 October 2015 and was unannounced. At the last inspection on 06 May 2014, the provider was meeting the regulations we looked at.

Apna House is a care home which is registered to provide care to up to 13 people. The home specialises in the care of men who have mental health needs and a learning disabilities. On the day of our inspection there were nine people living at the home.

The home is required to have 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. A new manager had recently been appointed and was in the process of registering as the manager.

The provider had not always recognised when the care being offered had put restrictions on people’s ability to make choices, and move around freely. Restricting people’s freedom to move around without the necessary authorisation meant that the provider was not meeting the requirements of the Deprivation of Liberty Safeguards; therefore people’s human rights were not protected. You can see what action we told the provider to take at the back of the full version of this report.

The provider had not always fulfilled their legal responsibility of notifying us of events or occurrences that had taken place in the service. This is so that we can where needed take follow up action. You can see what action we told the provider to take at the back of the full version of this report.

Staff understood the different types of abuse. The manager had ensured that the safeguarding systems in place were strengthened so that the procedures were consistently followed.

Risks to people had not always been well managed. Systems were in the process of being improved so that learning from incidents takes place, to ensure people’s wellbeing and safety.

People were supported by adequate numbers of staff on duty.

People were supported to receive their medication as prescribed. Medicines were safely managed. Staff who administered medicines had received training in this.

Staff received the training and support needed and were supported by the manager so they could carry out their role effectively.

Staff were kind and compassionate in the way they supported people. People were supported to pursue interest and hobbies that were of interest to them.  

People had access to food and drinks and were supported to have food that they enjoyed.

The provider had management systems in place to assess and monitor the quality of the service provided to people. However, they were not always effective at identifying where improvements were needed. The newly appointed manager had taken steps to ensure that the required improvements were made so that people were provided with a safe and effective care service.     

On the day of our unannounced inspection, we found that eleven people were living at this care home. We subsequently spoke to five people who lived there, four members of staff and the manager of the home. We found that some people were not able to give us their views on the service because of their complex needs and health conditions. We visited on a weekday when all eleven people were at home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We found that there were good arrangements for making sure that the home and the people who lived there were safe. Care was provided in an environment that was safe, accessible, clean and adequately maintained. People’s health and welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

We checked people’s care plans and found them to be detailed, relevant and up to date. This meant that people were receiving safe and appropriate care.

We spoke to several people who lived at the home. People told us they felt safe at Apna House. Comments included, “Everything is fine thanks, staff are really good and I’m comfortable with my bedroom.”

We saw that the home had appropriate safeguarding procedures in place. These were detailed and fit for purpose. We checked staff training records and saw that staff had received recent training in safeguarding vulnerable adults. We spoke to staff and they demonstrated that they understood their role in safeguarding the people they supported and knew what action to take should it be necessary to do so.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes. We found that one person living at the home was subject to a restriction by this legislation. We spoke to the manager and staff about the Deprivation of Liberty Safeguards (DOLS) and found that they understood their responsibilities in relation to the law.

We concluded that people were safe at Apna House and were protected from harm and inappropriate care.

Is the service effective?

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. We saw that people had regular access to a range of health and social care professionals which included general practitioners, dentists, chiropodists and opticians.

We found that most of the care staff had worked at this care home for many years and knew the people they supported very well. Care staff told us that they were well trained, competent and able to meet the needs of the people who used the service.

Training records showed that staff had received appropriate training in a number of relevant topics, including: health and safety, food hygiene, dealing with diabetes, epilepsy awareness, safeguarding vulnerable adults and nutrition.

People told us that they were happy with the care they received and the care staff who supported them.

We concluded that care staff had the appropriate skills and knowledge to ensure that people received safe, effective and appropriate care and support.

Is the service caring?

People were supported by kind and attentive staff. It was apparent to us during our observations and time spent talking to people, that staff were attentive, patient and caring with the people they were supporting. Staff treated people with respect and dignity. People commented, “No complaints, the staff are very good” and “I can’t really fault the staff, they are very helpful.”

We spoke to relatives of people who lived at the home. They were complimentary about the standards of care being delivered and the competence of staff delivering care and support. Comments included, “My relative is happy there, I have regular contact and I think overall care is good” and “The home seems very good, we have no complaints.”

Is the service responsive?

There were good arrangements for making sure that people could express their views about the service. We saw records including a customer satisfaction survey (questionnaires) which showed that people had been consulted about their preferences in terms of activities, meals, the home environment and improving the service. This meant that people were supported in promoting their independence and had regular opportunities to discuss and influence matters that were important to them.

We found that care staff had regular meetings with the manager of the home where they were able to discuss their training and development needs, welfare and any concerns they might have about the people they were caring for.

We found that Apna House had a comprehensive complaints policy. We noted that a version of this policy had been prepared in another relevant language as well as in English. An ‘easy to read’ version of the policy had also been made available for people who lived at the home and their relatives. This meant that the provider had published a complaints policy in a format that met people’s needs.

We concluded that people who live at Apna House were involved in their care and listened to in a way that responded to their needs and concerns.

Is the service well-led?

A check of records showed that the provider had an effective system to regularly assess and monitor the quality of service that people received.

We found that the home was visited regularly by the provider's quality assurance team. Their reports showed that they looked at health and safety matters, maintenance issues, staffing (including training) and people's well-being as part of their visit to the home. We saw that their reports were shared with the manager who acted upon the comments and recommendations made.

We concluded that there was effective leadership at Apna House and that people received care and support in a safe environment and were treated with respect, care and consideration.

On the day of our unannounced visit nine people were living at Apna House. We subsequently spoke to five people who lived there, three of their friends and relatives, the manager and three members of care staff.

People were complimentary about the care staff who supported them and their living environment. Comments included: “I really enjoy the food here” and “The staff are very nice here and helpful.”

People’s privacy, dignity and independence was respected and people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. From our observations it was apparent that care staff were attentive, polite and sought consent before providing care and support.

People’s needs were assessed but care and support was not always planned and delivered in line with individual care plans. We noted that in some cases where specific health conditions had been identified, there were not always appropriate risk assessments in place to manage these.

People who lived at the home were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that care was provided in an environment that was safe, accessible and adequately maintained and that the provider had an effective system to regularly assess and monitor the quality of service that people received.

Apna House is registered to provide accommodation and personal care for up to 13 people as well as a personal care service to people living in their own home. The personal care service was not in operation at the time of our inspection visit. We have just looked at the care provided directly at Apna House during this inspection.

We met and spoke with 10 of the 12 people living at Apna House. People gave mainly positive feedback about the service they receive, and their comments included, "There are enough staff here. I go out when I want, it is fine", and "It's nice here. They look after me. I go out if I want to. I feel safe here." Some people told us they did not like the service, and did not feel safe. We have followed this up with the local authority.

Most people told us they were supported by staff they like, and who treat them kindly. We found that people's health needs were known and being well met by staff at Apna House.

We found that enough staff were on duty to enable people to do the things they liked, but some people told us they often had to wait for the staff support they needed.

We did not find that the systems in place to check on the safety and quality of the service were always adequate. We found that identified shortfalls were not always acted upon. We found examples of times this had impacted on people's safety and welfare.

During this visit, we talked to people living at the home, and asked staff about people’s needs. We also looked at people’s care plans. An expert by experience joined us on this visit. Experts by experience are people who have experience of using services; either first hand or as a family carer and so have a better understanding of how the needs of people could be met. The expert by experience who joined us on this visit was able to interpret what the people who lived at the home were saying. This helped us get a clearer picture of what it is like to use the service.

The expert by experience spoke with 12 people living at the home during our visit. People we met during the visit appeared happy and settled. Our observations of people who lived at the home and staff interactions throughout the day were positive. The languages spoken in the home were mainly Urdu and Punjabi. The people we met spoke positively about life at the home. We found that the home promoted people's rights and choices and supported people’s independence. Staff spoke to different people in different ways according to their ability to communicate and in their language of preference. Staff treated and spoke to people with respect.