About the service: Clock Tower Mews is a residential care home providing accommodation and personal care to eight people with a learning disability and autism.

People’s experience of using this service:

¿ Previous breaches of regulations were now met. This meant people experienced a better quality of care that was safely delivered. However, some work continued to be needed to ensure that people's records were fully person centred. The registered manager had an action plan to address this area.

¿ People were kept safe from harm because assessments identified the risks to their health and well-being. Plans were in place to respond to people’s needs. People were supported by a sufficient number of staff who had been trained to keep people safe f. People’s medicines were now safely managed and administered as the prescriber intended.

¿ Staff were aware of people’s nutritional needs and supported these well. Consent was now obtained in line with legal requirements. The building was purpose built and adapted to meet the physical needs of people.

¿ People continued to be cared for in a dignified manner. People’s confidential information was now stored securely.

¿ People’s relatives were now fully involved in the review and development of people’s care. People were now able to enjoy a range of activities and pursue their individual interests. Concerns and complaints were promptly responded to. People and relatives were confident to raise concerns when necessary.

¿ Governance systems were now in place to monitor the quality of care provided. Leadership was now visible across the service, and staff, health professionals and relatives were all positive about the sustained improvements.

¿Registering the Right Support has values which include choice, promotion of independence and inclusion. This is to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen. The registered manager and staff were meeting the principles of this policy.

Rating at last inspection: Inadequate. The inspection was carried out in March 2018 and the report was published on 1 June 2018.

Why we inspected: This comprehensive inspection was planned based upon the findings from our previous inspection. At that inspection we found five breaches of regulations, rated the service inadequate and placed the service in special measures.

Follow up: The service is no longer in special measures as they have achieved a rating of good. However, we will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

We always ask the following five questions of services.

Is the service safe? Good

This inspection was carried out on 22 and 27 March 2018 and was unannounced. At their last inspection on 27 February 2017, the provider was found to not be meeting the standards we inspected. We rated the service overall as requires improvement. These areas of improvement were in relation to safe care and treatment, keeping people safe from harm and leadership and governance. At this inspection we found that improvements had not been made and there were additional areas that continued to not meet the standards. We found breaches of regulations in relation to providing safe care, supporting staff, obtaining people’s consent, involving people in their care and overall management and governance of the service.

Clock Tower Mews is a ‘Care Home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to eight people. At the time of this inspection there were seven people living there.

The service did not have a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. However a newly appointed manager had submitted an application to CQC to register and at the time of inspection was awaiting this to be assessed.

People were not consistently supported in a safe manner as staff were not aware of how to mitigate some risks to people’s well-being. risk assessments were not completed to support staff with keeping people safe.

Staff knew how to report any risks to people’s safety; however staff were not all able to describe how they would identify when a person was at risk of harm or abuse.

Medicines were not consistently managed safely.

There were sufficient staff available to support people’s needs in a timely manner.

People lived in a clean, hygienic environment although not all staff had received up to date infection control training.

Staff had lacked leadership, development and training over the previous 12 months.

Most people were supported in accordance with the principles of the Mental Capacity Act 2005; however, this was not consistent.

Staff were not consistently aware of people’s nutritional needs, however people were provided with fresh appetising meals they appeared to enjoy.

People were supported by staff in a respectful and kind manner with staff ensuring people’s dignity was maintained. However we found improvements were required in keeping confidential information relating to people secure.

Some people received care in a person centred way but we observed some people who did not. People and their relatives where appropriate, were not always involved in planning their care.

People were provided with limited activities that did little to support their individual hobbies, interests or preferences. There was a complaint’s process which people and their relatives knew how to use. However, people's relatives had not been confident that their concerns would be responded to with the previous management team, although they felt more confident in the new management.

There were systems in place to monitor the quality of the home. However, they had not identified the areas that required improvement that we found on inspection. People, relatives and staff were not all positive about the running of the home.

The overall rating for this service is ‘Inadequate’ and the service therefore is in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again withi

We inspected Clock Tower Mews on 06 October 2016, 13 October 2016 and 11 November 2016 and found the service was meeting the required standards. We rated the service as good.

We undertook a focused inspection on 27 February 2017 in response to concerns raised to us about the safety and management of the care people received. These concerns referred to mismanagement of people’s finances, a lack of staff to meet people’s personal care needs and a lack of respect from staff towards service users. Although at this inspection we found no evidence to support the concerns raised, we did however identify breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to keeping people safe, managing incidents within the home, reporting concerns and governance.

Clock Tower Mews provides accommodation and personal care for up to eight people with learning disability support needs. On the day of our inspection, there were eight people using the service.

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.

Risks to people’s safety and welfare were not consistently responded to mitigate the risk of harm to people. People were not kept safe because incidents that occurred that may place people at risk of harm or abuse were not investigated and responded to. People’s finances were managed well with robust measures in place. There were sufficient numbers of staff available to meet people’s needs who had time to carry out their daily tasks in a calm and unhurried manner. The Registered Manager carried out a robust recruitment process that ensured staff employed were of sufficient good character to work in the home. Medicines were administered and managed safely by staff who had received training.

People’s care records were not completed accurately as required and were also not stored in a safe and secure manner. Notifications that are to be submitted to CQC regarding notifiable events had not consistently occurred. Audits of the quality of service provided although completed were not effective in identifying gaps. Staff and relatives felt the Registered Manager was open, fair and responsive and kept them informed regarding developments within the home.

We undertook an unannounced inspection of Clock Towers Mews on the 6 October 2016, 13 October 2016 and 11 November 2016.

The service provides accommodation and personal care for up to eight people with mental health and learning disability support needs. On the day of our inspection, there were eight people using the service.

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.’

The staff had undertaken risk assessments which were regularly reviewed to minimise potential harm to people using the service.

There were appropriate numbers of staff employed to meet people’s needs and provide a safe and effective service. Staff were aware of people’s rights and choices, and provided people with person centred care. Medicines were administered safely by staff who had received training.

The provider had a robust recruitment process in place which ensured that staff were qualified and suitable to work in the home. Staff had undertaken appropriate training and had received regular supervision and an annual appraisal, which enabled them to meet people’s needs. Staff were well supported to deliver a good service and felt supported by their management team. The provider had effective systems in place to monitor the quality of the service they provided.

People were supported to make decisions for themselves and encouraged to be as independent as possible. People, relatives and /or other professionals were involved in planning the support people required.

People were supported to eat and drink well and to access healthcare services when required. Staff were quick to act on peoples’ changing needs and were responsive to people who required support.

We found that staff asked people for consent prior to providing support or treatment. We spoke with staff who demonstrated an awareness of how to gain consent from people. Staff explained to us how they gained consent where a person lacked capacity to provide this.

People's care was delivered in an individual and personalised way. Each person's plan contained information specific to the individual and guided staff with how they would provide care.

People were protected from the risk of abuse.

We found that staff and management had not always received the professional development, appraisal or supervision that is required.

The provider had an effective system in place to monitor the quality of service provision and protect the health and safety of people in the home.

We used a number of different methods to help us understand the experiences of people using the service, because most of the people using the service had complex needs which meant they were not able to tell us their experiences.

The care plans that we saw included information on how each person communicated. We observed staff talking with people as they assisted them to eat at lunchtime, and taking time to help them express their views.

We saw evidence that each person’s health needs were reviewed, and appropriate referrals were made to healthcare professionals, for example to the dietician and the epilepsy nurse.

We found that there were enough qualified, skilled and experienced staff to meet people’s needs. Staff we spoke with told us that they received training to enable them to meet the needs of people using the service.

The people who live in Clock Tower Mews were unable to communicate with us. We contacted their relatives who told us that they were happy with the care their relative got in the home.

They told us that the staff were wonderful and that the home was welcoming at all times of the day. They said that the manager and the assistant manager were always in the home. They told us that the home was always fresh and clean.

However the evidence we found and information we received from some of the staff at Clock House Mews and from social care professionals from Hertfordshire County Council did not support the relatives opinions of the service.