The inspection took place on the 9 and 10 May 2017 and the first day of the inspection was unannounced. We told the registered manager that we would be coming back the following day. At our previous inspection on 21 July 2014 we found the provider was in breach of one regulation relating to the safety and suitability of the premises and the service was rated ‘Requires Improvement’.

Clarence Road provides residential care and support for up to 15 adults with mental health needs across three floors of the building. At the time of our inspection 15 people were living in the service, but one person was receiving in-patient support whilst in hospital.

There was a registered manager in post at the time of our inspection. 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.

People’s risks were managed and care plans contained appropriate and detailed risk management plans with input from health and social care professionals, which were updated regularly when people’s needs changed. Staff worked closely with people and met them regularly to ensure they were aware of their needs.

The service had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service. Sufficient numbers of staff were employed to keep people safe and meet their needs.

People who required support with their medicines received them safely from staff who had shadowed senior staff and completed training in the safe handling and administration of medicines. Staff completed appropriate records when they administered medicines and these were checked by staff and audited monthly to minimise medicines errors.

People and their relatives told us they felt safe using the service and staff had a good understanding of how to protect people from abuse. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns. Staff were confident that any concerns would be investigated and dealt with.

Improvements in the environment and furniture had been made since the last inspection.

New staff completed an induction programme and a six month probation period. Staff members also took part in a training programme to support them in meeting people’s needs effectively. New staff shadowed more experienced staff before they started to carry out care tasks independently and received regular supervision from management. They told us they felt supported and were happy with their input during the supervision they received.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were aware of the importance of asking people for consent and the need to have best interests meetings in relation to decisions where people did not have the capacity to consent. The provider was aware when people had restrictions placed upon them and notified the local authority responsible for assessment and authorising applications.

People had regular access to healthcare services and staff discussed people’s appointments during handover meetings and were aware when they were due. Staff worked closely with other health and social care professionals, such as the community mental health team, district nurses and psychiatrists. We saw evidence of this in communication records and people’s care plans.

Staff were aware of people’s dietary needs and food preferences and people were involved in decisions about the food they wanted to eat.

We observed positive interactions between people and staff, including the registered manager, throughout the inspection. People and their relatives told us staff were kind and

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 CQC which looks at the overall quality of the service. At the last inspection in June 2013 the provider was compliant with the regulations we checked. This was an unannounced inspection.

This service provides residential care and support in Hackney for 15 adults with mental health needs. The premises provide en-suite single rooms and a communal lounge. There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The premises were in a state of disrepair in some areas and needed refurbishment. The furniture did not take into account or meet people’s needs.

Whilst people were encouraged to be independent and engaged in a number of activities, the provider could not always demonstrate that people’s individual wishes were taken into account in the planning and delivery of their daytime activities.

The service was safe. The provider took appropriate action to protect people by reporting allegations of abuse to appropriate authorities, including the Care Quality Commission (CQC) and local safeguarding team. Staff had received training and knew how to recognise and report signs of abuse. Risks to people’s health and safety were assessed and taken into account in planning and providing their care. Staff supported people to receive their medicines safely.

The provider had arranged for people to have mental capacity assessments when they lacked capacity to make certain decisions about their care. They also sought advice from a professional regarding some of the practices at the home and whether they were considered to be restrictive to people using the service.

Staff had undertaken relevant training to help them carry out their roles effectively and received support from their line managers. Staff were knowledgeable about people’s needs and how to meet them. People were supported to have adequate nutrition and hydration. Their meals took into account their preferences, religious, cultural needs and special dietary requirements.

People’s needs were assessed prior to their admission and all had personalised care plans detailing their needs and how to meet them. People worked towards and made progress with their goals over time, however staff did not always encourage people to expand their experiences to improve their level of independence in broader areas and improved their quality of life.  People had access to healthcare services and received ongoing healthcare support. Clarence Road staff worked in partnership with health and social care professionals to plan, meet and review the mental health needs of people who used the service. Actions taken by Clarence Road staff and effective joint working with other professionals helped to reduce the number of incidents in the home and hospital admissions.

People who used the service had a good relationship with staff, who had a kind and caring attitude towards them. People knew how to make a complaint and were able to raise issues or concerns in their meetings. There were no formal complaints made in the last year.

There were a range of internal quality audits within the home to check the quality and safety of the service. The service was well led by the manager and staff valued the support they received. However organisational changes were proposed and staff were concerned about any possible impact on them and the service. The manager ensured they kept up to date with information about best practice to ensure they could identify and delivery quality care. 

We found one breach 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 the report.

The service was providing care to fifteen people with enduring mental health needs. We spoke with four people during the inspection. People using the service were pleased with their care. One person said, "it's like being part of being a big family. The staff are wonderful."

The service assessed people's individual needs and preferences to ensure their care was appropriate. People told us they were involved in their care planning and were offered choices. People said their wishes were respected including if they changed their mind. Staff told us that all the people using the service had the capacity to make their own decisions about their day to day care. Staff were able to explain how they obtained people's consent.

People were generally positive about the food in the home. One person said, "we have lovely food." Another person said, "it's sometimes good and sometimes not." We found that the home provided well balanced and healthy meals. People were involved in planning the daily menus. The staff monitored people's weight and any nutritional needs.

People using the service and staff members told us there were sufficient members of staff on duty at the home. We saw that staff did not seem rushed and were able to engage people in a relaxed and sensitive way.

The provider had a complaints policy and encouraged people to raise concerns with staff. People told us they knew how to make a complaint. One person said, "I can say something any time I want."

There were 15 people living at the home. We spoke with five people and a relative of one person who was unable to speak English.

The people we spoke with were very positive about the home and the staff. One person said: "I know everybody". Another person said "It's brilliant here. Everything is good." People felt they were getting the right support for their needs at Clarence Road. One person said: "I want to stay forever."

We observed that staff members were respectful and we saw positive interactions between staff members and people using the service. We saw that people felt comfortable coming to the office to chat to the acting manager.

All the people we spoke with said they felt safe at the home. One person told us that occasionally there were problems between people using the service but staff intervened early to resolve any problems.

All the people we spoke with said they could make suggestions about the service and felt able to raise any concerns.