About the service: CareTech Community Service Limited – 237 Kenton Road is a residential care home registered to accommodate up to 12 people. At the time of this inspection the service was providing personal care to eight people who have a learning disability. Not all people who used the service were able to communicate with us verbally.

The service had been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured that people who used the service were able to live as full a life as possible and achieve the best possible outcomes. The principles reflected the need for people with learning disabilities and/or autism to live meaningful lives that included control, choice, and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

People’s experience of using this service:

• People told us they felt safe living in the home. Staff were aware of their responsibility of safeguarding people from the risk of potential abuse. Staff had access to risk assessments that told them how to promote people's independence and to reduce the risk of harm whilst doing so. Staff were recruited safely and were provided in enough numbers to ensure people's needs were met.

• People were supported by trained staff to take their medicines as prescribed. Systems and practices reduced the risk of cross infection. Where things went wrong, lessons were learned, and action was taken by the registered manager to reduce the risk of this happening again.

• People were cared for by staff who were skilled and supported in their role by the registered manager. People were involved in the assessment of their needs to ensure they received the service the way they liked. Staff supported people to access relevant healthcare services when needed. The environment was suitable for the people who used the service.

• People's consent was obtained before care and support was provided and staff had a good understanding of the Mental Capacity Act 2005.

• People were cared for by staff who were kind, caring and respected their right to privacy and dignity. People were encouraged and supported by staff to be involved in making decisions about their care and treatment.

• People were treated kindly by staff and were assisted to pursue social activities of their choice. People’s concerns were listened to and acted on to ensure they received a safe service. At the time of our inspection visit the provider was not offering a service to people who required end of life care.

• The culture of the home was person-centred and supported people to achieve their goals. People were encouraged to be involved in the running of the home to ensure the service they received met their specific needs. The provider worked in partnership with other relevant agencies to ensure people's care needs were met. The provider's governance was effective in assessing, monitoring and driving improvements therefore, people received an effective and safe service.

Rating at last inspection: The service was rated Good at the last inspection in October 2016.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We undertook an unannounced inspection on 22 and 24 August 2016 of CareTech Community Services Limited - 237 Kenton Road. CareTech Community Services Limited - 237 Kenton Road

is a care home that provides personal care and accommodation for up to twelve people who have

learning disabilities. There were ten people using the service at the time of this inspection.

There was a registered manager in post. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection on 25 and 26 June 2015, we found breaches of legal requirements in relation to Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure there were sufficient numbers of suitable staff deployed to keep people safe and meet their needs. The systems in place were not robust enough to assess, monitor and improve the quality and safety of the services being provided to people.

We received an action plan from the service telling us what action they would take to meet legal requirements in relation to the breaches. 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 and the provider was now meeting regulations. We found there were sufficient numbers of staff to meet people’s needs and spend quality time with people using the service and systems were in place to monitor and improve the quality of the service. The service undertook a range of checks and audits of the quality of the service and took action to improve the service as a result. Feedback about the quality of the service people received was obtained through review meetings and satisfaction surveys. Records showed positive feedback had been provided about the service.

Relatives informed us that they were satisfied with the care and services provided. Relatives also 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 and staff demonstrated that they were aware of these. 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.

We found the premises were clean and tidy. There was a record of essential maintenance carried out at the home. The service had an infection control policy and measures were in place for infection control. 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.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes. Care plans were reviewed monthly and were updated when people's needs changed.

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 w

We carried out an unannounced comprehensive inspection of this service on 25 and 26 June 2015 at which there was a continuation of two breaches of legal requirements. These related to care workers not being supported to have the necessary knowledge and skills they needed to carry out their roles and people not receiving person centred care and being engaged in meaningful activities. We served two warning notices because of the continuing breach.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on the 9 October 2015 to check that they had followed their plan, met the warning notices and to confirm that they now met legal requirements. We inspected the effective and responsive domains only at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Caretech Community Services Limited – 237 Kenton Road’ on our website at www.cqc.org.uk’.

CareTech Community Services Limited - 237 Kenton Road is a care home that provides personal care and accommodation for up to twelve people who have learning disabilities.

The service did not have a registered manager in post. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

A new manager had been appointed but was not registered with the CQC. However, we were told this manager was to leave. The service improvement manager told us that a new manager had been recruited and was due to take up post in November 2015.

At this inspection of 9 October 2015, we found that the provider had followed their action plan, the warning notices had been complied with and legal requirements had been met.

We found that the provider had ensured staff received additional training they needed to support people with complex needs and people with a visual impairment. Staff told us they felt the training was useful and were supported by the management. Additional staff were in place to ensure staff were able to provide the one to one support people needed and to be engaged in meaningful activities. Individual activity planners were in place and were being followed so people had the opportunity to participate in activities of their choice. .

Reasonable adjustments in the home had been made in accordance to people’s specific needs and risk assessments were updated accordingly.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service. 

This was an unannounced inspection that took place on the 17 July 2014. At our last inspection in October 2013 we found that this service met all the national standards looked at.

CareTech Community Services Limited -237 Kenton Road is a care home that provides personal care and accommodation for up to twelve people who have learning disabilities. The home is located in a residential area of Kenton in the London Borough of Brent.

The home had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of the inspection the registered manager was away and the home was being managed by the deputy manager until the registered manager returned in August 2014.

The provider did not always promote people’s well-being by providing them with the opportunity to participate in a variety of activities that had been chosen by them and met their individual varied needs.

Staff were up to date with mandatory training set by the provider, and received regular supervision and support. Most staff had qualifications in health and social care. However, staff had not received appropriate specific training to enable them to gain knowledge and understanding of the meaning of learning disability particularly profound and multiple learning disabilities (PMLD). Staff lacked understanding of how to interact and communicate in a positive and skilled manner with people with PMLD including visual impairment.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. We found that there were no DoLS authorisations in place. The manager knew what constituted restraint and knew that a person’s deprivation of liberty must be legally authorised. The service had plans to review whether any applications needed to be made in response to the recent Supreme Court judgement widening the scope of the DoLS.

We saw that staff were kind and treated people with respect. However, at times during the inspection there was not much meaningful interaction between staff and people who used the service. This was particularly evident during lunchtime and when people were in the garden with staff.

People’s needs were assessed and details of people’s communication needs and the care and support they needed were recorded in each person’s personalised plan of care. Staff we spoke with were aware of the content of people’s care plans. Staff liaised with healthcare and social care professionals to obtain specialist advice so people received the care and treatment that they needed.

There were systems in place to monitor the quality of the service and improvements were made when needed. However, there were areas where it was not apparent that strategies were in place to ensure staff received the appropriate training to enable them to deliver care and meaningful activities to people who had complex needs.

We found a number of breaches of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

During our inspection we spoke with one person who used the service, two relatives, three members of staff and the manager.

Overall, everyone was satisfied with the care provided and said that people were treated with respect and dignity. One person who used the service told us that they were "happy” at the home. One relative told us that staff were “wonderful”. Another relative said "The home goes to great length to support people”.

Care records we looked at indicated that the needs of people had been attended to. The care records contained assessments, care plans and evidence of regular reviews. There was documented evidence that the healthcare needs of people had been attended to and there were records of appointments with healthcare professionals.

We observed that care plans were recorded in pictorial and written format and contained information about people's preferences.

There were appropriate arrangements in place to manage medicines.

Staff we spoke with told us that they enjoyed working at the home and felt supported by their colleagues.

Records we looked at were up to date could be located promptly.

People using the service had varied communication needs. Some people spoke to us, others gestured, nodded or shook their head in response to the questions that we asked about the service they received at the home. People told us that they received the care they needed and wanted and they were positive about the staff that supported them.

People’s care plans included detailed information about the individual support people wanted and needed from staff. People’s independence and skills were promoted and supported by staff. We saw that people using the service were involved in carrying out some household tasks.

People were supported and encouraged to make decisions about their lives. During the inspection people decided what they wanted to eat, and what they wanted to do.

Staff knew about their roles and responsibilities in meeting the needs of people who use the service and they supported people in a friendly and respectful manner.

People’s health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals.

There were enough qualified, skilled and experienced staff to meet people’s needs.

Records were accurate and up to date.

The manager told us that she had commenced the process of registering with us.

During our visit to 237 Kenton Road we spent most of our visit talking to people using the service to gain their views about what it was like living in the home. Some people due to their varied communication needs gestured, nodded or shook their head in response to the questions we asked about the service they received at the home. Due to people’s communication needs we spent a significant part of the visit observing people using the service and theit interaction with staff and with other people.

People told us or indicated they were happy living in the home. They informed us they liked their bedrooms, enjoyed the food and chose what to eat and wear. People confirmed they had the opportunity to participate in activities of their choice, and received the care and support they wanted and needed. They told us or indicated to us that staff listened to them and were approachable. During our visit people showed signs of ‘well being’ and they were seen to be relaxed. We saw people smiling, laughing and approaching staff without hesitation.

Staff spoke of enjoying their job supporting and caring for people at 237 Kenton Road. They told us there was generally good staff teamwork and they felt supported by the manager and senior staff.

This inspection took place on the 25 and 26 June 2015 and was unannounced. At the last inspection on the 17 July 2014 we found the provider was not meeting two regulations in relation to supporting staff and care and welfare in meeting people’s individual needs through the provision of meaningful activities.

Following the inspection the provider sent us an action plan telling us how they were going to address the concerns and that the appropriate measures would be in place by 5 June 2015. During this inspection we found that the provider had taken some action but it was not sufficient as there were still concerns in relation to staff not being supported to enable them to care for people effectively and people not receiving person centred care and being engaged with meaningful activities. Further breaches of regulations were also found in relation to staffing levels and quality assurance systems not being robust enough to effectively assess, monitor and improve the quality and safety of the services being provided to people.

CareTech Community Services Limited - 237 Kenton Road is a care home that provides personal care and accommodation for up to twelve people who have learning disabilities.

The service did not have a registered manager in post. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous registered manager had left the service. A new manager had been appointed who had been in post for three months. The new manager had not yet registered with the CQC.

Relatives spoke positively about the service. They told us “We are very pleased with the way [person] is being cared for, I am very pleased [person] being at this home”, “They are kind and [person] is happy”.

There were insufficient staffing levels to deliver care that met people’s individual needs and ensure their welfare and safety. People’s safety was being compromised as they have complex needs and required one to support with their care. They were being left unsupervised during the day as care workers were busy with other people in the home or involved with household chores.

People using the service experienced a lack of consistency in the care being provided. Care workers told us there had been many staff changes and absences that had affected the service and their duties were shared out between agency, bank and permanent staff. Care workers felt this placed extra pressure on them to ensure people received the support they needed.

Some risks to people were identified and managed so that people were safe and their freedom supported and protected. However there was limited information about the safe practice of moving and handling and there were no specific risk assessments for people who were visually impaired.

Although staff had received some additional training they did not feel they were supported to have the necessary knowledge and skills they needed to support people with complex needs and people with a visual impairment. Staff told us they felt demotivated and felt there was a lack of direction at the home.

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. However, there was no information about the attempts that had been made to support some people who lacked capacity and had limited or no contact with their families, to involve them in the planning of their care and seek independent advocates if necessary.

People were supported to maintain good health and have access to healthcare services and received on going healthcare support. Each person had a Health Action Plan and which outlined people’s medical backgrounds, allergies, current medicines and records of appointments with healthcare professionals such as GPs, dentists, psychiatrists and opticians.

There were comprehensive communication profiles which detailed how people using the service were able to communicate. We observed care workers communicated with people in a way that was understood by them.

All the people using the service were attending day centres and people were taken out into the community. People were supported to maintain relationships with their family members.

We saw people were treated with respect and dignity and kept safe. However people did not receive person centred care. We observed people using the service sitting for periods with no planned activity and little to do. Care workers were not engaging or involving people in a meaningful manner and did not spend any quality time with people. Care workers were more task focused which means care workers were more focused on household chores and tasks relating to their work rather than spending quality time with people, engaging and involving them in meaningful conversation or activities.

The current systems in place were not robust enough to monitor and improve the quality of the service being provided to people using the service. Effective measures had not been put in place which showed the provider had addressed the concerns raised at the last inspection and had made improvements to the quality of care being provided to people.

Relatives spoke positively about the new manager and told us “[Person] is happy with him. He is much kinder. I am very impressed, he is professional. Things seem to under control” and “I have spoken with the new manager and he is a nice person.”

The new manager told us he was looking into areas where the service could be improved and was producing an action plan which he wanted to implement to ensure the quality of service improved and any concerns raised were addressed.

We made four recommendations about reviewing risk assessments, arrangements in which people’s finances are managed, MCA and DoLS practices and arrangements for how people can express their views.

We found four breaches of the new Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.