At the last inspection on the 4 and 10 October 2016, the service was rated ‘Good’.

Health and Home Ltd – North Road is a ‘care home’. People in care homes receive accommodation and nursing or 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 care home accommodates up to nine people who may be living with dementia or have enduring mental healthcare needs. At the time of the inspection, there were seven people living at Health and Home Ltd – North Road.

Health and Home Ltd – North Road is a large terraced house situated in a quiet residential area in Southend and close to all amenities. The premises are set out on two floors and there are adequate communal facilities available for people to make use of within the service.

The inspection was completed on the 10 January 2019 and was unannounced.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

A registered manager was in post and in addition to managing this service, they managed another of the provider’s ‘sister’ care home. 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.

Quality assurance checks and audits were not robust. These arrangements did not identify the issues we found during our inspection and had not recognised where people were placed at potential risk of harm and where their health and wellbeing was compromised. Complaints management required strengthening as information relating to the investigation, actions taken, outcomes and lessons learned were not recorded.

Although people’s comments about the care provided was positive, our findings at this inspection suggested the service was not always caring in its approach. Not all risks to people’s safety and wellbeing had been identified, and suitable control measures had not always been considered and put in place to mitigate the risk or potential risk of harm for people using the service. The service did not follow relevant national guidelines when giving people their medication and we found discrepancies relating to staff’s prac

The Inspection took place on 4 and 10 October 2016 and it was unannounced.

Health and Home – North Road is registered to provide accommodation and personal care without nursing for up to nine adults with a range of different needs. The service can cater for older people, people living with dementia, physical disability, sensory impairment, learning disabilities with autistic spectrum disorder, alcohol or drug misuse, eating disorders and mental health disorder. There were nine people living in the service on both days of our inspection visits.

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 2008 and associated Regulations about how the service is run.

People received safe care and support. Staff had a good understanding of how to protect people from the risk of harm. The service had employed enough staff to meet people’s assessed needs. The recruitment process was thorough and ensured that staff were suitable to work with vulnerable people. People received their medication correctly as prescribed.

Staff were well trained and supported and had the knowledge and skills to carry out their role. They had access to guidance and information to support them when necessary. The registered manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and had received training to ensure that where people lacked the capacity to make decisions they were protected. People were supported to maintain a healthy balanced diet and their healthcare needs had been met.

Staff were kind, caring and thoughtful and they knew the people they cared for well. They respected people and ensured that their privacy and dignity was always maintained. People expressed their views and opinions and were supported to follow their individual hobbies and interests. The service provided people with advocacy contact details for use if needed.

People’s care and support needs had been fully assessed and they had care plans and risk assessments in place to ensure that they were cared for in a way that they preferred. The care plans provided staff with the information that they needed to meet individual’s needs and preferences and to care for them safely. People were confident that their concerns or complaints would be listened to and acted upon. There was an effective system in place to assess and monitor the quality of the service and to drive improvements.