This unannounced inspection was undertaken on 26 September 2017 and was carried out by one inspector. At our last inspection in September 2015 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

Hail - Granville Road is a care home providing accommodation and support with personal care for six people with learning disabilities. On the day of the inspection there were five people living at the home. There had been no new admissions to the home since our last inspection.

There was a manager in post who was in the process of applying to be 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 2008 and associated Regulations about how the service is run.

Staff understood their responsibilities to keep people safe from potential abuse, bullying or discrimination.

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

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

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 manager.

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 the associated Deprivation of Liberty Safeguards (DoLS). Staff 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 healthcare needs people had.

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.

Everyone had an individual plan of care which was reviewed on a regular basis.

Relatives told us that the management and staff listened to them and acted on their suggestions and wishes.

People were supported to raise any concerns or complaints and relatives were happy to raise any issues with the manager if they needed to.

People were included in monitoring the quality of the service and better ways to include them in this process were being explored. The manager and staff understood that observation was very important to identify people’s well-being where people did not always communicate verbally.

This inspection took place on 8 July 2015 and was unannounced. Hail – Granville Road is a care home for up to six people with learning disabilities and autism. The premises are owned by Circle 33 Housing Association.

There was no registered manager in post at the service, however there was a manager in post who was in the process of amending their registration from being the registered manager of another care home run by the provider. 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 conducted a scheduled inspected of this service on 25 July 2014, following which we served a warning notice regarding an unsuitable environment and three requirements relating to breaches in medicines management, cleanliness and quality assurance. We conducted a follow up visit on 5 February 2015 which confirmed that the requirements of the warning notice had been met. During the current inspection we found that there were some areas in the environment which presented a risk to people living at the home, including unrestricted windows.

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 and their family members and other representatives where relevant, had been included in planning the care provided and they had individual person centred plans detailing the support they needed.

People were treated with respect and compassion. 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. There was an accessible complaints procedure in place for the home, and it was being used appropriately.

The service had an appropriate recruitment system for new staff to assess their suitability. 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 attending concerts or planning a holiday. People engaged in a variety of activities within and outside of the home, with staff support as needed.

People 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 and people’s finances were managed appropriately. Quality assurance monitoring systems were in place, to ensure that areas for improvement were identified and addressed.

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.

No concerns had been raised and the service met the regulations we inspect against at their last inspection on the 11 July 2013.

This inspection was unannounced.

The service had a registered manager in place. 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.

HAIL (Haringey Association for Independent Living) - Granville Road provides accommodation and support with personal care for up to six people with learning disabilities and autism. People had their own room with a sink and shared communal facilities.

People’s safety was being compromised in a number of areas. This included how the service was managing maintenance of the premises, the suitability of equipment used by people living at the service, cleaning the service to an adequate standard and ensuring medicines were kept safely. We saw that the provider and the registered manager were not ensuring that people and others who accessed the premises were protected against risks associated with unsafe or unsuitable premises due to inadequate maintenance.

The registered manager told us that audits were completed, however audits viewed showed that these were not always completed. The service did not have effective systems in place to ensure areas of concerns identified by audits were escalated to higher management within the service.

The service had not gained feedback from people, relatives and professionals who visited the service for the last two years. It was therefore not clear whether people who use the service and/or their representatives were asked for their views and they were acted on.

Staff were appropriately vetted to ensure they were suitable people before starting work.

People’s health needs and risks were assessed and care records were available. Staff we spoke with were knowledgeable about people’s needs. We saw that people were treated with dignity and respect by all staff during the inspection.

People were supported to maintain relationships with friends and relatives, staff were aware of the activities people enjoyed and supported them to access these.

After the inspection we spoke with the registered manager and requested additional information about the service. We also spoke with professionals from the local authority safeguarding team, the local environmental health department at the local council as well as the provider’s Chief Executive Officer (CEO).

We found a number of breaches 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 this report.

We spent time with five of the six people who use the service, as one person was away with their family at the time of the inspection. 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 spoke with three staff members and the deputy manager, and looked at three people’s records in detail and five staff records.

Our observations indicated that people received appropriate care and support within the home. They were given choices, and supported to make decisions about their care and lifestyles. They were supported to live in a clean and hygienic environment and had their medication needs safely met.

People had formed good and supportive relationships with staff and management, with sufficient staff working at the home to meet people’s needs. 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 with all of the people who use the service. They had complex needs which meant they were not able to tell us about their experiences. Therefore in addition to speaking with them, 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 relaxed and at ease within the home, and indicated that they were provided with the care that they needed. We saw people being given choices, and noted that they had formed good and supportive relationships with staff.

People’s privacy and dignity were respected within the home, and they received appropriate support to meet their needs, including personal and health care needs, and support to engage in a variety of activities.

The home environment was generally maintained appropriately, and was clean, and comfortable.

Staff working in the home were appropriately trained and supervised, and appropriate quality assurance procedures were in place to ensure that people received appropriate care and support.

Observation of people at the home indicated that they were very well settled, and able to express their needs and preferences to staff who knew them well.

People had access to healthcare professionals when needed, and they received their medication at the prescribed times. They appeared to enjoy the food served in the home, and the variety of activities available to them. Their privacy and dignity was respected and they were protected by appropriate safeguarding procedures. They were supported in working towards achievable goals, and had formed good relationships with staff members. Appropriate quality assurance procedures were in place to ensure that people received consistently high standards of care and support.

The majority of records kept at the home were of a high standard, however people would benefit from improved recording in a small number of areas.

We carried out an unannounced comprehensive inspection of this service on 25 July 2014. A breach of legal requirements relating to the safety and suitability of the service premises was found and we issued a warning notice instructing the provider to meet the requirements. As a result we undertook a focused inspection on 5 February 2015 to follow up on whether action had been taken to deal with the breach.

You can read a summary of our findings from both inspections below.

Comprehensive Inspection of 25 July 2014

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.

No concerns had been raised and the service met the regulations we inspect against at their last inspection on the 11 July 2013.

This inspection was unannounced.

The service had a registered manager in place. 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.

HAIL (Haringey Association for Independent Living) - Granville Road provides accommodation and support with personal care for up to six people with learning disabilities and autism. People had their own room with a sink and shared communal facilities.

People’s safety was being compromised in a number of areas. This included how the service was managing maintenance of the premises, the suitability of equipment used by people living at the service, cleaning the service to an adequate standard and ensuring medicines were kept safely. We saw that the provider and the registered manager were not ensuring that people and others who accessed the premises were protected against risks associated with unsafe or unsuitable premises due to inadequate maintenance.

The registered manager told us that audits were completed, however audits viewed showed that these were not always completed. The service did not have effective systems in place to ensure areas of concerns identified by audits were escalated to higher management within the service.

The service had not gained feedback from people, relatives and professionals who visited the service for the last two years. It was therefore not clear whether people who use the service and/or their representatives were asked for their views and they were acted on.

Staff were appropriately vetted to ensure they were suitable people before starting work.

People’s health needs and risks were assessed and care records were available. Staff we spoke with were knowledgeable about people’s needs. We saw that people were treated with dignity and respect by all staff during the inspection.

People were supported to maintain relationships with friends and relatives, staff were aware of the activities people enjoyed and supported them to access these.

After the inspection we spoke with the registered manager and requested additional information about the service. We also spoke with professionals from the local authority safeguarding team, the local environmental health department at the local council as well as the provider’s Chief Executive Officer (CEO).

We found a number of breaches 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 this report.

Focused Inspection of 5 February 2015

After our inspection of 25 July 2014, the provider told us the improvements they planned to make to ensure the service premises were safe and suitable for the people who use the service, staff and visitors. We undertook a focused inspection on 5 February 2015 to check they had taken appropriate action and the service premises were now safe.

We found that the service premises had been completely redecorated since our last visit, safety concerns had been addressed and the environment of the service was pleasant and comfortable.