This unannounced inspection took place on 4 July 2017. At our previous inspection on 5 August 2015 the service was not meeting legal requirements relating to managing medicines safely. During this inspection significant improvements had been made.

The service provides accommodation and support with personal care to a maximum of 18 people in the London borough of Redbridge. The building has an accessible garden with a water feature and has access to facilities of a neighbouring sister sheltered accommodation scheme. On the day of our visit there were 16 people using the service.

On the day of our visit a registered manager was in place. 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 told us they felt safe and trusted the staff that gave them support. Staff had attended safeguarding training and were aware of the procedures to follow in order to protect people from avoidable harm.

Medicines were managed safely with the exception of room temperature checks where action taken following temperatures above 25 degrees was not always recorded. We made a recommendation about this.

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.

The premises were clean and well maintained although we noted some clutter such as wheelchairs and hoists stored in the main lounge which were a potential health and safety risk.

People told us they were treated with dignity and respect. They told us staff were supportive, pleasant and kind and enabled them to pursue their personal and religious preferences. They were confident that any complaints would be dealt with promptly.

Care plans were person centred with an effective key working system in place to ensure peoples physical, emotional and religious support needs were being met.

The service was well-led by a visible management team. People knew the registered manager by name and thought they were approachable. There were effective quality assurance systems in place to ensure people, their relatives and staff feedback back was sought and acted upon.

This unannounced inspection took place on 5 August 2015. The service was last inspected on 30 May 2014 and was meeting all regulations inspected.

Homesdale (Woodford Baptist Homes) Limited is registered to provide accommodation for persons who require nursing or personal care for 18 older people some of whom have dementia. At the time of the inspection there were 17 people using the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 found people were mostly safe living in Homesdale (Woodford Baptist Homes) Limited. People and relatives told us there were enough staff to provide care. Staff were checked before starting work at the service and had access to various training programmes including the Mental Capacity Act 2005 (MCA). The MCA is a law designed to protect and empower people who may lack the mental capacity to make their own decisions about their care.

People's medicines were not always managed well. We found that staff signed medicine administration record sheets (MARS) for medicines which were not administered. This was a risk to people's health because they did not have their medicines as prescribed by their GPs.

This demonstrated a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the action we have asked the provider to take can be found at the back of this report.

Staff received training and support to ensure they provided appropriate care. Staff understood people's needs and supported them in a way that ensured their privacy and dignity. There was good communication with staff having handover and team meetings, and liaising with relatives.

People told us they received good care and staff promoted their independence. Risk assessments were completed to ensure risks to people were appropriately managed. People and relatives were positive about the quality of the service. People told us they knew how to make a complaint if they were not happy about the service they received.

Each person had a detailed care plan based on their assessed needs. This ensured that the care people received was personalised and reflected their needs.

There was a clear management structure in place and staff knew their roles. The registered manager carried out regular audits and checks of the quality of the service and ensured that appropriate improvements were made as required.

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?

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?

We observed that staff were supervising people to ensure that they were safe. Care records contained risk assessments which provided guidance to staff on action to take to keep people safe. Health and safety checks had been carried, and people told us that they "felt safe" in the home.

Safeguarding procedures were in place and staff had been provided with safeguarding training. They were aware of action to take in response to allegations or safeguarding incidents. Staff had an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The manager told us they were contacting the local authority for authorisation of liberty safeguards for people living in the home.

Is the service effective?

People's care needs had been assessed with the help of their relatives and representatives. Their likes and dislikes were

recorded and we observed that staff were aware of people's needs. Care files showed that people's care plans were regularly reviewed and people had access to healthcare professionals. We saw that people were engaged with the activities provided by the home.

Is the service caring?

Each person's needs were assessed and reviewed regularly. The provider had systems in place to ensure that the service people received reflected their needs. We noted that there was a friendly atmosphere in the home and staff treated people with respect and dignity.

Is the service responsive?

Staff had a good understanding of the needs of people. We saw that people were supported to receive medical assistance, when needed. We also noted that staff supported people to attend a place of worship. Arrangements were in place for people, their relatives and professionals to be involved in the review of assessments and care plans.

Is the service well-led?

The provider visited and carried out monthly audits of the service. The service had a registered manager who was supported by senior care workers. We saw that people who used the service and stakeholders were consulted about the quality of the service.

People told us that they were treated with respect by the staff. One person told us "they look after all our needs. Everybody is always kind and caring." People and their relatives told us that their views and experiences were taken into account in the way the service was delivered. Care was planned and delivered in line with individual care plans because people's needs were fully assessed. We observed that staff were caring and supportive to people. People were supported to access health professionals when required. People who used the service and their families told us they were involved in making decisions around their care and support planning. A relative told us "we are very pleased with the way she is looked after here." Another told us " my mum is very content here. Her health has improved because she is well cared for."

We spoke to staff who had a good understanding of their responsibilities with regard to safeguarding vulnerable adults were able to name the different types of abuse and knew who they should report any suspicions of abuse to. People told us that they felt safe with the staff and they would raise any concerns with the manager or their relative. Appropriate records were maintained by the home to ensure that people received safe care. The service had appropriate staff recruitment procedures.

People were supported to access health and social care professionals when required with their consent. A relative said "my mother receives the care that she needs and she can see the doctor or district nurse whenever she needs to." People were happy with the care that they received. One person told us “the staff are very kind and helpful." Relatives told us that they and their loved ones were always consulted about their care as much as possible. We observed that there was a relaxed atmosphere in the home with staff discreetly offering assistance to people if needed. A relative said," I have never found any staff irritable or complaining even the night staff are very friendly and caring."

People and their relatives were aware of the complaints procedure and were confident that their complaints would be listened to and appropriately acted upon by the manager.

The people we spoke to were very happy with the care they received. People said,

“The staff are very good,we couldn’t have better carers”. Another person said, ”they keep an eye on you.”

When asked what the food was like, all the people spoken to said, “the food is very good.”

People who use the service told us they were happy with the general environment of the home and their rooms.

Relatives spoken to said, “I can’t speak highly enough of this home. The staff are very good, they look after my mother really well. They listen to us and sort out any problems straight away.”

“The food is really good and freshly prepared.”

“The staff are very caring and helpful.”

“If there is a problem they always inform us.”

“I would recommend this home to others.”