The inspection took place on 15 October 2018 and was unannounced. Our last inspection was a focused inspection in August 2017 and the service was rated good at that time.

Hampstead Road is a 'care home'. People in care homes receive accommodation and nursing or 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.

Hampstead Road accommodates up to 12 people in two adapted buildings. There were 11 people at the home on the day of our visit.

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 for 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.

Staff supervision and some training for some of the team was not up to date. This put people at risk of receiving ineffective care if they were supported by staff that were not fully supported and trained in their role. The registered manager had identified this shortfall, that had occurred over the last 12 months. An action plan was in place to bring all staff supervision and support meetings, as well as training, up to date.

We observed a person being assisted with meals by staff who stood up next to them. Staff told us the person had an identified need around eating. Specifically, sometimes staff told us they needed to assist the person with the meals by standing up next to them. Recognised good and safe practise is to sit down next to a person when directly assisting them to eat and drink. There was however no assessment to set out that this was the safest way to assist this person. Nor was there a risk assessment to show that risks were monitored and mitigated to reduce the chance of harm. This in turn meant there was no record of this aspect of care provided to the person concerned.

Medicines were administered safely and the systems in place to check and monitor the recording of medicines were up to date. This helped ensure that any errors would be picked up. There was guidance in place so that medicines were administered as people preferred.

People were protected from abuse. Staff were knowledgeable about the risks of abuse and reporting procedures. We found there were sufficient staff available to meet people's needs and that safe and effective recruitment practices were followed. Staff had good relationships with people who lived at the home and were attentive to their needs.

There were systems in place to ensure that the requirements of the Mental Capacity Act 2005 were followed. This law protects people who lack capacity to make informed decisions in their daily lives. Applications were in place for people at the home, under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. These helped ensure the necessary safeguards were in place for people at the home.

People were supported to have food and drink they liked. There were suitable arrangements for the provision of food to ensure that people's dietary needs were met.

People's needs were assessed and plans were developed to identify what care and support people required to maintain their health and wellbeing and build up their independence where possible.

People's needs were met and staff were informed of changes occurring within the home through daily handovers and staff meetings. Staff told us that they received up to date information and had an opportunity to share good practi

The inspection took place on 11 August 2017 and was unannounced. At our last inspection we had found that there had been a breach of a Regulation because the provider had not ensured that effective recruitment procedures were maintained. At this inspection we found that action had been taken.

We undertook this focused inspection to ensure that people using the service were safe, and received a service that met their needs. This report only covers our findings in relation to these areas. When we last inspected the service in March 2016 we rated the service as ‘Good’. You can read the report from our last comprehensive inspection, by selecting the ‘All reports’ link for Hampstead Road on our website at www.cqc.org.

There was an acting manager for the service who was going to apply to be registered with us. 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.

There were some avoidable health and safety risks in the environment. We saw for example some nails left in a communal area that could easily have been swallowed by someone at the home. Maintenance of a kitchen drawer was carried out in the kitchen, on top of the kitchen surface. This could have posed an infection control risk.

People were safely supported with their medicines. These were stored, administered and audited safely. Staff were trained to make sure they knew how to safely support people to take the medicines they required for their health and wellbeing.

Staff were attentive to people and we observed that they provide peopled with safe care. The staff used moving and handling equipment safely for example and made sure people were safe when they were seated in their wheelchairs. They also supported

We undertook an unannounced inspection of Hampstead Road Care Home on 25 and 26 August 2016. When the home was last inspected in June 2014 no breaches of the legal requirements were identified.

Hampstead Road Care Home provides accommodation and nursing care for up to 12 people. People at the home had a learning disability. At the time of our inspection there were 12 people living at the home.

A registered manager was in post 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.

The home was not consistently safe as the provider’s policies in regards to recruitment had not been adhered to. This meant that staff had begun work without the full range of checks being completed or documented. Medicines were administered safely. However, systems in place to check and monitor the recording of medicines had not been consistently completed. This meant that errors would not always be identified. Guidance was in place so that medicines were given as people preferred.

The registered manager was aware of their responsibilities in regards to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to care or treatment or need protecting from harm. The registered manager kept clear records of the steps taken in the DoLS process. Staff were aware how the Mental Capacity Act 2005 was relevant to their role and applied the guiding principles through choice and enablement. When a person lacked the capacity to make a particular decision, it was recorded clearly how this had been established. When a best interest decision was needed, this was fully documented with the involvement of family and health and social care professionals.

Staff received effective training and additional training specific to the needs of people. Staff were confident in supporting people as directed in their care records and were knowledgeable about people’s needs. Staff were well supported by senior staff members through supervisions.

We observed positive relationships between people and staff. Staff were kind and caring. Staff spoke to people with respect and ensured people’s privacy and dignity was maintained.

Care and support was person centred and care records reflected this. People were engaged in activities they enjoyed. The home was developing the provision of activities to be able to offer more choice. Staff supported people to maintain important relationships.

The home was well-led. Relatives and staff spoke of the improvements within the home. A positive staff culture had developed. Systems were in place to monitor the quality of care provided. However, audits did not always identify documentation which had not been fully completed.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of this report.

The inspection was carried out by one inspector, who answered the five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service had risk assessments in place to help ensure that they were supported in a safe and appropriate way. Records of the risk assessments showed that all options for the person’s support had been considered and what measures needed to be in place to ensure they were safe.

People’s rights were protected in line with the Mental Capacity Act 2005. When people did not have the capacity to make decisions, arrangements were in place to ensure that decisions were made in their best interests.

People were supported to receive their medications safely. Where people were prescribed PRN (‘as required’) medications, there were protocols in place to explain how they should be used. Medications were stored securely.

Is the service effective?

Staff worked well with other healthcare professionals to ensure that people’s health needs were met. Staff told us that any recommendations made by another professional were shared at team meetings and handovers to ensure a consistent approach amongst staff.

Support plans were monitored regularly to ensure they were reflective of people’s needs. Keyworkers wrote monthly reports on each person in the home and this helped ensure that support was kept under review.

Is the service caring?

People who used the service weren’t able to speak with is directly about their experiences of living in the home. However, we observed staff interacting with people in a calm and appropriate tone. People appeared content and settled in the presence of staff.

On occasions when people had spent time in hospital, staff from the home, staff made regular contact with the ward to check on their welfare. This also ensured a flow of information amongst all the professionals involved in the person’s care.

Is the service responsive?

When there were concerns about a person’s health, we saw that the relevant professional was contacted promptly to discuss the issue. In one case, concerns had been identified about a person’s weight and so staff had made contact with the person’s dietician.

As part of the service’s quality monitoring, the views of representatives of people in the home had been sought. This had led to action points arising and the manager responding to them. In one case a family had been unaware of the complaints procedure and so the manager had then gone through the procedure with them.

Is the service well led?

There were systems in place to monitor the quality and safety of the service. This included a programme of audit and monitoring of incidents and accidents.

We did not consult with people who live in Hampstead Road about their care. This was because people living in Hampstead Road had a learning disability and a physical disability and used non verbal communication to communicate their needs.

As part of this inspection we followed up areas of non-compliance from our inspection in January 2013. The provider demonstrated compliance to the areas identified. Some areas were still work in progress including the organising of activities for the people living in Hampstead Road and training for the staff. However, improvements had been noted in both areas with an action plan in place.

During our visit we observed people being supported in the home and looked at the care plans for three people. We spoke with six members of staff and one agency nurse. A senior manager was present for part of the inspection process.

People's personal and health care needs were being met. Improvements were seen in respect of how the service supported people with their social needs. Structured activity plans had been introduced however these needed to be embedded in to practice.

People were now being supported by staff that had received mandatory training. Where there were gaps in training there was a plan in place to ensure staff attended or completed the relevant training.

People could be confident that their care records reflect their current needs and these were being kept under review.

People living in Hampstead Road have a learning and physical disability and use non verbal communication to communicate their needs. This made it difficult to fully gain the views of the people who use the service. We did observe people who use services and spoke with staff to gain an insight into the care being provided to the individuals at Hampstead Road.

Staff were observed supporting people in a sensitive and respectful manner. Staff clearly described how they supported the individuals living in the home ensuring their dignity and privacy was maintained.

People were offered opportunities to participate in activities both in the home and the local community. Activities included going shopping, swimming, out for meals, going to football matches and going to the theatre.

People were supported to take an annual holiday. Two people were going on holiday on the day of our visit, with two members of staff.

Staff told us individuals were encouraged to be as independent as they were able ensuring they maintain existing skills. We were told the care or an activity was delivered at the pace of the person and not for the ease of the staff.

We observed people being offered their medication discreetly and sensitively. People were offered sufficient time to enable them to take their medication safely.

The staff we spoke to were aware of their responsibilities regarding safeguarding people who use the service and would use the whistle blowing procedure if required. Information on reporting safeguarding concerns was available to staff including access to the local authority procedures for reporting abuse.

People were being supported appropriately and sensitively during the meal time. Where people were able to be independent in eating this was promoted.

We observed people being supported in a sensitive manner. Staff were observed providing personal care behind a closed bedroom or bathroom door ensuring the person’s privacy was respected.

Staff were observed involving the people they were supporting, fully explaining what they were doing. Staff were seen observing people’s facial expression to ensure they were happy with what was happening during the meal time and whilst assisting people with their posture or needs in the communal areas.

We observed staff supporting people appropriately with manual handling.

We did not consult with people who live in Hampstead Road about their care. People living in Hampstead Road have a learning disability and a physical disability and use non verbal communication to communicate their needs.

During our visit we observed people being supported in the home, looked at the care plans for three people and spoke with the staff on duty. We spoke with four members of staff, two agency staff and the temporary manager.

People’s personal and health care needs were being met. However, people’s social, emotional and psychological needs were not being addressed. There were no structured activities being organised in the home or the local community.

People were being supported by staff that had not received regular training. This potentially could put people using the service at risk of harm as this included health and safety, moving and handling, food hygiene, safeguarding adults, first aid and fire training.

The Brandon Trust had reviewed the service and had found significant concerns relating to record keeping, staff training, support of the individuals and risks relating to moving and handling.

The service was now being supported by a senior manager who was temporarily managing Hampstead Road to implement the action plan that had been developed by the provider.

Records relating to care were not consistently being completed.