This unannounced inspection took place on 9 October 2018 and was carried out by two inspectors. At our last comprehensive inspection in August 2017 the service was rated ‘Requires Improvement’. At that inspection we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Registration Regulations 2009. These breaches were in relation to staff recruitment, safe care and treatment, consent, person-centred care and good governance. At this inspection we found that the registered provider had addressed these breaches. At this inspection the service was rated as ‘Good’.

DRS Annexe Care Home is registered to provide accommodation and personal care for up to 12 people with mental health needs and learning disabilities. People in care homes receive accommodation and 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. At the time of our inspection there were 12 men living in the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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 and associated Regulations about how the service is run.

The home had a relaxed atmosphere and people told us they were well treated by the staff and felt safe with them. We saw the way that staff interacted with people had a positive effect on their well-being.

Staff understood their responsibilities to keep people safe from potential abuse, bullying or discrimination. Staff knew what to look out for that might indicate a person was being abused.

Risks had been recorded in people’s care plans and ways to reduce these risks had been explored and were being followed appropriately.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were positive about working at the home and told us they appreciated the support and encouragement they received from the management.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff understood the principles of the Mental Capacity Act (MCA 2005) and knew that they must offer as much choice to people as possible in making day to day decisions about their care.

People were included in making choices about what they wanted to eat and staff understood and followed people’s nutritional plans in respect of any cultural requirements or healthcare needs.

Both people who used the service and the staff who supported them had regular opportunities to comment on service provision and made suggestions regarding quality improvements. Staff told us that the management listened to them and acted on their suggestions and wishes.

All parts of the home, including the kitchen, was clean and no malodours were detected.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences. Staff and management made sure no one was disadvantaged because of their age, gender, sexual orientation, disability or culture. Staff understood the importance of upholding and respecting people’s diversity. Staff challenged discriminatory practice.

Everyone had an

This inspection took place on 22 August 2017 and was unannounced. At our last inspection in October 2015 the service was rated ‘Good’. At this inspection the rating of this service changed to ‘Requires improvement’.

DRS Annexe Care Home is a registered to provide accommodation and personal care for up to eighteen people with mental health needs and learning disabilities. At the time of this inspection there were 18 people living at the home.

There was a registered manager in post but they were not present on the day of the 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.

Recruitment procedures were not always being operated effectively to ensure that suitable people were being employed at the service.

Systems used by the provider to assess, monitor and improve the quality and safety of the service were not always effective. These systems had not identified potential problems with the quality of care planning, the safety of medicines management or the safety of the premises.

Medicines were not always being managed safely.

People enjoyed the food provided and were offered choices of what they wanted to eat. However, safe food hygiene practices where not being followed and staff were not always following the advice of healthcare professionals regarding nutritional supplements.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. However, it was not always clear from records that people had or were able to give their consent to care and treatment.

People’s care plans did not always contain sufficient detail in order to make sure people’s preferences in relation to their care and chosen activities were being met.

People told us they liked the staff at the home and friendly and supportive relationships had developed between staff and people using the service.

Individual risks to peoples’ safety had been identified and staff were aware of the actions they needed to take to mitigate these risks.

People had access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff were aware that the people they supported needed help to stay safe and they understood their responsibilities to keep people safe from potential abuse and discrimination.

Staff were positive about working at the home and told us they appreciated the support and encouragement they received with their learning and development.

People using the service and their relatives told us they could raise any concerns they had with the staff and management of the home.

People using the service, their relatives and other stakeholders were asked about the quality of the service and had made comments about this.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to staff recruitment, safe care and treatment, consent, person-centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.

We inspected this service on 13 October 2015. The inspection was unannounced. DRS Annexe Care Home is a residential home providing care for up to eighteen people with mental health needs and learning disabilities. Some of the people who live at the home have a dual diagnosis related to mental health needs and use of illegal drugs. There is no alcohol or drug use on the premises and this is strictly enforced by the provider. The home is situated in the Bruce Grove area of Tottenham.

At the time of our inspection there were eighteen people living at the service, seventeen men and one woman. One person was subject to a community treatment order.

The service is located in three adjoined terraced houses, on two floors with access to an outside area at the back.

We previously inspected the service on 9 May 2013 and the service was found to be meeting the regulations.

DRS Annexe had a registered manager at the service. 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 the time of the inspection the registered manager had been promoted within the organisation so the day to day running of the service was being managed by a DRS Home Care Manager.

During the inspection there was a calm and pleasant atmosphere. People using the service informed us that they were satisfied with the care and services provided. We observed good quality interactions between staff and people using the service, and this was confirmed by our discussions with relatives and people who lived at the service.

Staff were fully aware of people’s needs and these were carefully documented in care plans. Staff responded quickly to changes in people’s needs if they were physically or mentally unwell.

Care plans were individualised and reflected people’s choices, likes and dislikes, and arrangements were in place to ensure that these were responded to.

Care plans provided detailed information on people’s health needs which were closely monitored. People were supported to maintain good health through regular access to healthcare professionals, such as mental health professionals and GPs. Risk assessments had been carried out and these contained guidance for staff on protecting people.

Staff told us they felt supported. Staff knew how to recognise and report any concerns or allegations of abuse and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated. Regular supervision took place with staff.

There were enough staff to meet people’s needs. This was evidenced by rotas and by talking to people living at the service.

Staff had been carefully recruited. Appropriate references and Disclosure and Barring Service checks were undertaken before staff began work to ensure that staff were safe to work with people.

People had their medicines managed safely. People received their medicines as prescribed and on time. Storage and management of medicines was well managed with specifically trained staff dispensing medicines.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely. Staff understood the need to gain consent from people using the service before providing care. DoLS applications had been made for a number of people living at the service.

The service was well managed. The premises were clean and in a good state of repair. Regular audits took place in relation to infection control and management of people’s money. There was evidence of regular servicing of essential facilities such as gas, electricity and fire equipment. Fire drills took place on a regular basis.

The building was in need of redecoration in some areas and a minor repair was required to an area of flooring. The provider could evidence plans for redecoration and repair to the flooring.

We spoke with six people who live at the home. They were generally positive about their experiences. They told us they liked the home. The following are examples of some of the comments we received:

“I have no concerns.”

“[I am] good today.”

“I like it here and I’m not just saying that.”

“Yeah, it is good. The staff are nice.”

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

There was an effective complaints system available.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

When we visited we spoke with five people who were using the service, three members of staff and looked at five people’s care files. The people who were using the service spoke mainly in a positive manner about the home and their experiences there. When we asked people about the home one person told us “it is more good than bad” and another person told us it was “very good”. Someone else told us that their “previous home (had) many problems but don’t have that now. I like this place”.

There was evidence that people’s views and experiences were taken into account in the way the service was provided. People using the service told us they were able to express their views of the service and we saw evidence of their involvement in their care. Some people using the service suggested they might like to have more culturally specific food.

People experienced care, treatment and support that met their needs and protected their rights. There was evidence people using the service had their individual needs assessed and the care was delivered in a manner that met these.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff had access to appropriate training and were supported in their roles.

The registered person had not ensured that confidential records were kept securely. When we visited we found old files containing personally identifiable information being stored in a communal area.