At our last comprehensive inspection in November 2017 the service was rated ‘Requires Improvement’. At that inspection we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to the need for consent, safe care and treatment, staff support and good governance.

At this inspection we found that the registered provider had addressed these breaches. At this inspection the service was rated ‘Good’.

Hail - Burghley 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 home accommodates a maximum of four people in one terrace house. At the time of our inspection there were three people living at 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 identified, with the input from the person where possible and were recorded in people’s care plans. 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. Medicines were being audited regularly so any errors could be picked up quickly and action taken.

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 people required.

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, were 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

This unannounced inspection took place on 15 and 16 November 2017 and was undertaken by one inspector.

At our last inspection in June 2015 the service was rated ‘Good’. At this inspection we found that the rating had changed to ‘Requires Improvement’.

Hail - Burghley Road is a ‘care home’ for people who have a learning disability. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates a maximum of four people in one terrace house. At the time of our inspection there were four people living at the home.

There was a new manager in post but they had not yet registered with the Care Quality Commission. 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.

Risks to people’s safety in relation to the environment were not always being addressed in a timely manner. The systems used to monitor people’s safety were not always effective and this was putting people at unnecessary risk.

Staff understood the principles of the Mental Capacity Act (MCA 2005) but the associated Deprivation of Liberty Safeguards (DoLS) were not fully understood. The staff made sure that people were accompanied when they went outside the home because they would not be safe to leave the home on their own. However, this meant that people were being deprived of their liberty without lawful safeguards being put in place.

People were not always having a detailed and accurate assessment of their needs undertaken which meant that not all their needs were being met.

Staff were not always being supported to carry out their roles and responsibilities effectively because they were not receiving regular supervision, appraisals or appropriate training.

Information about how to make complaints was not available in formats that were accessible to people who used the service. We have made a recommendation about making the complaints procedure accessible to everyone.

People and their relatives told us they were well treated by the staff, felt safe with them and trusted them.

Staff knew how to recognise and report abuse and they understood their responsibilities in keeping people safe. Staff understood that people were at risk of discrimination and knew that people must be treated with respect. Staff understood that there were laws to protect people from discrimination.

The service was following appropriate recruitment procedures to make sure that only suitable staff were employed.

Staff had completed training in the management of medicines and people were receiving their medicines appropriately.

People who used the service and their relatives were positive about the staff and told us they had confidence in their abilities.

Staff offered choices to people as they were supporting them and tried hard to involve people in making decisions about their care.

Relatives told us the staff kept them up to date about any changes in people’s needs and they felt involved in their relative’s care.

The management and staff were quick to respond to any changes in people’s needs and care plans reflected people’s current needs and preferences.

Staff were positive about the new manager and told us they appreciated the clear guidance and support they received.

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

This inspection took place on 2 June 2015 and was unannounced. Hail – Burghley Road is a care home for up to four people with learning and physical disabilities. The home is owned by Quadrant Housing Trust and operated by Haringey Association for Independent Living (HAIL).

There was no registered manager in post at the service, as the previous manager had left in December 2014. The provider had taken steps to recruit a new manager, but had not yet been successful. An acting manager was in place who was due to register as the manager for the home. 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 July 2013, and it was found to be meeting all the regulations inspected.

During this inspection we found that there was room for improvement in the planning of activities for people living at the home, although this was partly as a result of people changing their minds about what they wanted to do. There were some gaps in monitoring records which might cause a delay in detecting significant changes to people’s health.

There were appropriate systems in place for recording people’s consent, or best interest decisions made on their behalf to ensure that their rights were protected. There was an accessible complaints procedure in place for the home, although it had not been used recently.

People were content and well supported in the home. They had good relationships with staff members who knew them well, and understood their needs. They and their health care professionals spoke positively about the service. People and their family members where relevant, had been included in planning the care provided and they had individual plans detailing the support they needed.

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. People were treated with respect and compassion. They were supported to attend routine health checks and their health needs were monitored within the home. The home was well stocked with fresh foods, and people’s nutritional needs were met effectively.

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 areas for improvement were identified and addressed.

We spent time with all three people who live at the home. 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). We also looked at all three people’s care and support records in detail and spoke with four staff members. 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 supported to live in a clean environment 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 carried out this inspection to follow up on compliance actions made at the previous inspection visit.

The inspection was carried out by two inspectors. We spent time with or spoke with three people who lived at the home. They had complex needs which meant that some of them were not well able to tell us their experiences.

Since the previous inspection the manager of the home had left employment with the provider organisation, and we were told that a new manager had been recruited. The new manager was due to begin working at the home in the week following the current inspection.

People appeared to be well supported within the home. They indicated that they were provided with the care that they needed, and had formed good and supportive relationships with staff members.

Improvements were noted in the home’s safeguarding procedures to ensure that people were protected from abuse. Medication administration procedures had been improved to ensure that people were administered their prescribed medicines safely. Some improvements had been made with regard to staff support, although the interim manager was aware that there was room for further development in this area. There were improvements in the quality assurance procedures for the home, to assess and monitor the quality of service that people received.

We met and spoke with all four people who lived at the home. 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 appeared to be well supported within the home. They indicated that they were provided with the care that they needed, were given choices, and had formed good and supportive relationships with staff members. People were supported to engage in a range of activities in accordance with their preferences.

There were insufficiently robust procedures in place to monitor people’s finances effectively, and ensure that their medication needs were met.

Improvements were noted to the home environment and staff advised that they had received training in supporting people with dementia. However there was insufficient monitoring of staff training needs, and provision of staff support, supervision and appraisals.

Overall we found insufficient monitoring of the quality of records, care and support provided for people living at the home.

People were generally positive about the home, indicating that they were provided with the care that they need, were given choices, and had formed good and supportive relationships with staff and management. The most recently admitted person had complex needs, and had found it difficult to settle in the home.

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.

However some improvements are needed to particular areas of the environment and safeguarding procedures. Staff had not had training in dementia care, and were not receiving regular supervision. There are also insufficiently rigorous quality control procedures in place for the home.