This unannounced inspection was undertaken on 30 May 2018 and was carried out by one inspector. At our last comprehensive inspection in March 2017 the service was rated ‘Requires Improvement’. At that inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Registration Regulations 2009. These breaches were in relation to good governance, statutory notifications and the requirement to have a registered manager. At this inspection we found that the registered provider had addressed these breaches. At this inspection the service was rated as ‘Good’.

HAIL- Bedford Road is a ‘care home’ for people who have a learning disability. 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. The service accommodates a maximum of six people. At the time of our inspection there were six people living in the home. Most of the people using the service had been living at the homes for many years. Most of the staff team had also been working at the home for some time and everyone knew each other well.

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.

The manager was in the process of registering with the Care Quality Commission but was on annual leave at the time of 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.

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. People using the service were relaxed with staff and the way staff interacted with people had a positive effect on their well-being.

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 appropriately. People were supported to take their medicines as prescribed.

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

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 people had.

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. Although care staff were expected to carry out cleaning tasks, they told us they were able to maintain a clean environment as well as support people safely.

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

This inspection took place on 7 March 2017 and was unannounced. Hail – Bedford Road is a care home for up to six people with learning and physical disabilities.

At the time of the inspection Care Quality Commission records showed there was a registered manager in post, however, staff at the service told us this person had not worked at the service since 2015. There was an acting manager overseeing the day to day running of the service and the provider told us they were recruiting to the post of registered manager at the time of the inspection. A registered manager is a person who has registered with the 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 last inspected this service in September 2015, and it was found to be breaching the regulation which required the provider to send notifications to the Care Quality Commission. A notification is information about important events which the service is required to send us by law.

At this inspection we found one incident which should have been notified to the CQC and had not been notified.

The atmosphere at the service was friendly and warm. A number of people had lived at the service for many years and staff understood people’s needs and methods of communication.

Although training took place we found a number of staff required refresher training in key areas including epilepsy and communication techniques. Staff had received supervision on a regular basis in recent months, but there was a period between 2015 and 2016 in which no supervision took place. Appraisals had not taken place for the majority of staff in 2016.

Although the service was clean throughout we found an out of date meat product in the fridge which was labelled and sealed, which had been overlooked. We also found that due to issues relating to the behaviour of one person, there was no soap in two toilets or toilet paper in one toilet at the scheme.

Risk assessments were in place for the majority of risks identified and care records were up to date for most people living at the service. We could see that people had access to health care and the service had photo prompts of key health professionals on records to assist staff in communicating with people living at the service.

There was a wide range of food at the service and people chose the menu using pictures at the weekly residents’ meeting.

Staff were kind and we saw they had made the garden attractive and interesting particularly for people with a sensory loss or autism.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Staff understood the importance of gaining consent before supporting people and the service had in place the relevant paperwork if they were restricting people’s liberty or making decisions on their behalf in their best interest.

Regular checks were completed for fire safety equipment and fire panels, electrical testing, lighting systems and gas safety. The service was in need of refurbishment in a number of areas, including a downstairs bathroom and the living room flooring which was cracked.

We saw that the provider carried out a health and safety audit on an annual basis. The acting manager checked some areas such as medicines and people’s finances on a regular basis, but there were no quality checks by the provider of care records or supervision and training. Also, in the absence of the acting manager supervision, training and quality auditing of care records was not carried out by the provider.

There was a breach of the regulations in relation to the governance of the service and notifying CQC of important events. We are considering our regulatory response to this latter concern.

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This inspection took place on 30 September 2015 and was unannounced. Hail – Bedford Road is a care home for up to six people with learning and physical disabilities. The home is owned by Circle 33 Housing Association and operated by Haringey Association for Independent Living (HAIL).

There was no registered manager in post at the service, however the acting manager was applying to register with CQC. A registered manager is a person who has registered with the 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 last inspected this service in June 2014, and it was found to be breaching regulations regarding recording people’s consent, staff supervision and quality assurance. We found improvements in these areas during the current inspection.

During this inspection we found that two incidents which should have been notified to the CQC had not been notified.

People were content and well supported in the home. They had good relationships with staff members who knew them well, and understood their needs. People were treated with respect and sensitivity.

The home was well stocked with fresh foods, and people’s nutritional needs and preferences were met effectively. People’s health care needs were met effectively, and monitoring records were maintained to ensure prompt action was taken if there were any significant changes to people’s health.

People had a choice of activities available to them within and outside of the home, and staff were looking at further ways of increasing choices for them. There were systems in place for recording people’s consent, or best interest decisions made on their behalf to ensure that their rights were protected. A complaints procedure was in place for the home, although it had not been used recently. Some care plans needed further updating to ensure that they contained only current information.

The service had an appropriate recruitment system for new staff to assess their suitability, and we found that staff were sensitive to people’s needs and choices, supporting them to develop or maintain their independence skills, and work towards goals of their own choosing, such as planning a holiday.

Staff in the service knew how to recognise and report abuse, and what action to take if they were concerned about somebody’s safety or welfare. Staff spoke positively about the training provided and this ensured that they worked in line with best practice. They received regular supervision and felt supported by the home’s management.

There were systems in place to monitor the safety and quality of the home environment and to ensure that people’s medicines were administered and managed safely. Quality assurance monitoring systems were in place, to ensure that any issues of concern were identified and addressed, although there was room for further improvement of these systems.

At this inspection there was one breach of regulation relating to notifications to the CQC. You can see what action we told the provider to take at the back of the full version of the report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

During the inspection we spoke with two people who used the service and spoke to a relative by phone. We spent time observing staff engagement with people and we spoke with two care workers, and the registered manager. Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

People who used the service told us they felt safe and staff were friendly. We saw staff interact with people who used the service in a respectful manner. The relative of the person who used the service told us they were confident that people were safe. Staff were clear about their roles and responsibilities and felt supported by management staff. The management team had some systems in place to support workers; however, we found staff appraisals had not been completed for a long time.

The home had systems in place to identify assess and manage risks relating to the health, welfare and safety of people who used the service.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to residential homes. Whilst senior staff understood the principle and the process for application was clear we found that the documentation concerning residents with DoLS currently in place was not sufficient and had not been regularly reviewed.

Is the service effective?

Staff told us that there was good communication amongst staff about the service and people's needs, which enabled them to carry out their roles effectively in providing the care and support people needed.

People's care needs had been assessed and care and treatment had been planned and delivered in a way that promoted people's safety and welfare. Risk assessments had been carried out where necessary. Care plans had been regularly reviewed with involvement from people and those who were important to them.

Is the service caring?

We saw that people were supported by kind and attentive staff who approached people in a friendly manner. People who used the service were seen to be happy, laughing and chatting with staff. The relatives we spoke to felt that people seemed to be well cared for and were treated with respect by staff.

Staff were knowledgeable regarding the specific care needs of people and respected the choices that people made. Staff had an understanding of people's cultural and religious needs and where appropriate, arrangements had been made to meet these needs. People's privacy and dignity were respected. People took part in a variety of activities of their choice.

Is the service responsive?

People received individualised care which was responsive to their interests and preferences. People told us they were listened to and felt involved in decisions about their care. People's care and health were monitored closely. Written notes about people's health and care had been completed by staff.

People's health, safety and welfare was being protected as they received the advice and treatment needed from a range of health and social care professionals. Relatives of people who used the service told us if they had any concerns or complaints, they would feel comfortable raising them with staff. However, we found that there had not been any formal survey of relatives or people using the service.

Is the service well-led?

The registered manager had recently left the home and the deputy manager was acting in this role, we were told that the Care Quality Commission had not been informed of this change. Monitoring checks of the quality of the service had been carried out. These included checks of the care provided to people and the quality of their environment. Improvements were made when needed. Staff meetings took place regularly so staff views about the service were taken into account.

We spent time with all six people who use the service. They had complex needs which meant they were not well able to tell us their experiences. Therefore in addition we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We also spoke with four staff members, checked three people’s records and six staff files.

Our observations showed that people were well supported within the home. They were given choices, and had formed good and supportive relationships with staff and management. They were protected from the risk of abuse, and had their medication needs met appropriately.

There were sufficient staff working at the home to meet people’s needs, and they were given appropriate training and supervision. Recording procedures within the home were sufficiently robust to ensure that the home was run effectively in the interests of people living there.

We met and spoke with four of the people who use the service. They had complex needs which meant they were not well able to tell us their experiences. Therefore in addition we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People were positive about the home, indicating that they were provided with the care that they needed, were given choices, and had formed good and supportive relationships with staff and management.

Although people’s individual care needs were being met, the regular review and updating of records needs to be addressed. There is a need for a robust quality assurance procedure to be introduced for the home.

People were positive about the home, indicating that they were provided with the care that they needed, were given choices, and had formed good and supportive relationships with staff and management.

People had access to healthcare professionals when needed, and they received their medication at the prescribed times. They were happy with the food served in the home, and the variety of activities available to them. Their privacy and dignity is respected and they are protected by appropriate safeguarding procedures.

However some improvements are needed in particular areas including ensuring that person centred plans and risk assessments are up to date, more rigorous recording of property held for safekeeping, current safety certificates for the environment, and staff training updates. There are also insufficiently rigorous quality control procedures in place for the home.