We undertook this unannounced inspection on 20 & 21 October 2016. Lee Valley Care Services Limited is registered to provide personal care and accommodation for a maximum of seven people, some of whom may have dementia or other mental health conditions. At this inspection there were five people living in the home.

At our last inspection on 20 April 2016 we found a breach of legal requirements and sent the provider and registered manager a warning notice. We send warning notices to a registered person where the quality of the care they are responsible for falls below what is legally required. Legal requirements can include the Health and Social Care Act 2008 (‘the Act’) and the regulations made under it, but also other legislation that registered persons are legally obliged to comply with in delivering the service. We found a breach in respect of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to inadequate staffing levels. A warning notice was issued in respect of this breach. We asked the registered provider and registered manager to comply with this breach by 13 May 2016.

At our previous comprehensive inspection on 1 December 2015 we rated the service as “Requires Improvement”. We found two breaches. The first was in respect of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to unsafe or unsuitable premises because of inadequate maintenance. The second was in respect of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the provider did not have adequate systems in place to identify and manage risks to the safety of people who use services and others.

The home has 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 of the Health and Social Care Act and associated Regulations about how the service is run.

People informed us that they were satisfied with the care and services provided. They said that people were treated with respect and they were safe. There was a safeguarding adults policy and suitable arrangements for safeguarding people. People’s care needs and potential risks to them were assessed and suitable arrangements were in place to ensure their safety. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. The premises were clean and no offensive odours were detected. There was a record of essential inspections and maintenance carried out. There were suitable arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract. Personal emergency and evacuation plans (PEEPs) were prepared for people and these were seen in the care records. Care workers were aware of action to take in the event of a fire.

Care workers had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their managers. There were enough care workers to meet people's needs. There was always a minimum of two care workers on duty during the day and night shifts. Care workers worked as a team and communication was good.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate proce

We undertook this unannounced inspection on 20 April 2016. Lee Valley Care Services Limited is registered to provide personal care and accommodation for a maximum of 7 people, some of whom may have mental health care needs. At this inspection there were 6 people living in the home.

At our last comprehensive inspection on 1 December 2015 we found two breaches of legal requirements. This is because the provider did not have effective systems for safe care and treatment and for monitoring the quality of care. After the comprehensive inspection, the registered provider sent us an action plan telling us how they would meet legal requirements. We undertook this focused inspection on the 20 April 2016 to check that they had followed their plan and to confirm that they now met legal requirements in relation to safe care and treatment. This inspection was also undertaken following a fire incident in the home.

This report only covers our findings in relation to safe care and treatment. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Lee Valley Care Services Limited’ on our website at www.cqc.org.uk’.

The home has 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 of the Health and Social Care Act and associated Regulations about how the service is run.

At this focused inspection, we found that the provider taken action to comply with some aspects of safe care and treatment. Most fire safety arrangements were in place and maintenance deficiencies we previously identified had been rectified. A new fire risk assessment had been carried out and the full report was received by the provider the day after our visit. Risk assessments had been carried out to identify potential risks to people and these included PEEPs (personal emergency and evacuation plans). Some essential information related to fire safety were not available as the registered manager stated that they were with the London fire service who were investigating the recent fire incident. We however, observed that risk assessments related to people smoking were in place. We also observed that people smoked in a designated area outside the home.

When we arrived at the home at 8.30 am, we found only one care worker on duty during the night shift. Two care workers were due to be on duty as indicated on the rota. This staffing level is inadequate and may put people at risk in the event of a fire or an untoward incident. Adequate staffing levels are also needed as some people have extra care needs which may put them and others at risk. We have issued a warning notice in respect of this deficiency.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have served a warning notice in respect of this breach. You can see what actions we told the provider to take at the back of the full version of the report.

We undertook this unannounced inspection on 1 December 2015. Lee Valley Care Services Limited is registered to provide personal care and accommodation for a maximum of 7 people, some of whom may have dementia. At this inspection there were 7 people living in the home.

At our last inspection on 10 April 2014 the service met all the regulations we looked at.

The home has 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 of the Health and Social Care Act and associated Regulations about how the service is run.

People and their representatives informed us that they were satisfied with the care and services provided. They said that people were treated with respect and they were safe. There was a safeguarding adults policy and suitable arrangements for safeguarding people. People’s care needs and potential risks to them were assessed. Staff prepared appropriate care plans to ensure that that people were safe and well cared for. Their healthcare needs were monitored and attended to. Staff were caring and knowledgeable regarding the individual choices and preferences of people.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Consultation meetings had been held for people. The home had an activities programme but effort is needed to ensure that people were encouraged to participate in more activities so that they received more social and therapeutic stimulation.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS).

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. People were mostly satisfied with the meals provided. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory.

Staff had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their managers. There were enough staff to meet people's needs. Staff worked as a team and communication was good.

People and their representatives expressed confidence in the management of the service. The results of the last satisfaction survey and feedback from people indicated that they were satisfied with the care and services provided. Staff were aware of the values and aims of the service and this included treating people with respect and dignity and promoting their independence.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. We however, noted that on arrival at the home there was an unpleasant odour. The registered manager was taking action to rectify the problem. A sofa in the lounge had a hole in it. The registered manager stated that a person who used the service had damaged it recently and it would be repaired. Following the inspection, they have advised us that they have replaced the sofa. The bottom of the ground floor lounge door was worn and in need of repairs or replacement. The fire safety arrangements were not satisfactory and action was needed to rectify deficiencies identified. We have made a requirement in this report in respect of these. The registered manager stated that action would be taken to rect

We carried out an inspection on the 15 April 2013 and found that people were not always protected from the risks of unsafe or inappropriate care and treatment because appropriate records and information related to the care of people were not always maintained.

We carried out an inspection on the 23 December 2013 to ensure improvements had been made. We found that records were kept appropriately and were fit for purpose.

People told us that they enjoyed living at the service and that staff cared for them well. Their comments included, "Staff always ask us if we are happy and what things they can do to make it better” and “I love living here.”

People who use services generally told us that they are happy with care and support they received. They confirmed that they are treated with respect and that staff ask them about support before providing it. People spoke positively about health support, with comments such as “If things go wrong, it’s seen to.” Staff were generally spoken about positively.

People confirmed that they were generally happy with the food provided and the physical environment. They felt safe at the service, and there were comments about security such as, “You don’t lose money here.” People confirmed that they can make and receive phone calls from the service. People generally told us that concerns are listened to. As one person put it, “If I don’t like something, I say so, and they’re fine about it.”

In summary, most people spoke positively about the service. One person’s comment summed up the majority view about the service: “They’re very good.”

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

We met four people who were currently using the service, and four members of staff, including the Registered Manager. Most of the people who used the service were not able or willing to communicate verbally with us. We spent some time observing how staff interacted with them and how they communicated their needs and wishes to the staff. We followed the written guidance for communication for one person. At first they responded with “yes” and “no” to our questions, but then held a conversation with us about what they enjoyed doing and their life before living at Lee Valley services Limited.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

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

Is the service safe?

People who we spoke with said that they felt safe in the home. One person told us about their previous life, which included a time when they were homeless. They said that Lee Valley Care Services Limited provided them with accommodation that they liked and the support that they needed.

The communal rooms and bedrooms were furnished with comfortable domestic style furniture. Bedrooms could be locked to ensure privacy for the people who used them. We observed an improvement to safety in the premises since our last inspection. The carpets in the downstairs hallway and first floor landing had been replaced with wood laminate flooring to ensure that there was no risk of tripping on worn carpets.

Training records showed that staff had received training in safeguarding vulnerable people from abuse. The staff we spoke with understood how to safeguard the people they supported.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The provider had previously sent appropriate notifications of two applications for Deprivation of Liberty Safeguards (DOLS) authorisations to ensure the safety of a person who used the service. These were no longer required, and no one who currently used the service required any restrictions to ensure their safety. The Registered Manager was aware of the procedures for applying for a DOLS authorisation if required.

Is the service effective?

We saw assessments and care plans which included each person's wishes and preferences, and were signed by the person. Care plans contained clear information on each person's personal and healthcare needs to enable the care staff to meet their individual preferences.

Care plans showed that each person was encouraged to be as independent as possible, both in personal care and in practical tasks. One person told us that they liked the meals that were provided, and that they could ask for an alternative if they did not want what was on the menu for any meal. We observed staff encouraging people to eat independently, to clear plates from the table and to get themselves ready to go out during the afternoon.

The care plan and records for one person showed that they had improved in managing to control aggressive outbursts. Guidance was in place for the staff and the community psychiatric nurse visited regularly to monitor the person’s progress.

Is the service caring?

Staff we spoke with told us that care plans provided them with the information they needed to care for each person appropriately. There were good records of appointments with appropriate medical professionals such as GP, dentist and community psychiatric nurse.

Care plans recorded how each person ate and the support they needed. For example, one person ate very slowly, but ate all their food with encouragement and if they were given time. We observed staff during lunch encouraging the person to eat, but not rushing them to ensure that they ate as much as they wanted.

We saw records of regular one to one meetings that each person had with a member of staff where they were able to give their views about the service and discuss any concerns. One person who we spoke with told us that if they had any worries it helped to talk with a named member of staff.

Is the service responsive?

People were supported to take part in activities that they enjoyed. Care plans recorded the activities that each person enjoyed and the support they needed. One person told us that they enjoyed attending a day centre once a week, and they sang a song that they had learned there. They said that they also enjoyed going to the café of a local supermarket for a meal.

There were monthly meetings for the people who used the service. Subjects discussed included menu choices and activities. At one meeting one person had raised a concern about privacy, and people were encouraged to respect each other’s personal space. It was recorded that the minutes were read back to the people who attended the meeting, to ensure that they understood and agreed with the decisions that were made.

No formal complaints were recorded, but the outcomes of showed that the provider acted on any concerns as soon as they were raised in meetings for people who used the service and staff or in responses to satisfaction surveys. Following comments in a survey from one of the relatives a bannister rail was attached to the stairs. A visiting nurse had commented that they would recommend the home to a family member.

Is the service well-led?

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. This ensured that the quality of the service was continually improving. The Registered Manager carried out a monthly audit of the premises and any repairs needed were acted on immediately.

Staff told us that they were clear about their roles and responsibilities. One member of staff said that the Registered Manager and senior staff were always available to provide support or to answer any questions. Records showed that training and one to one supervision provided appropriate skills and support for staff to meet the needs of the people who used the service.

The supervision records and minutes of staff meetings showed that the Registered Manager supported and encouraged staff to understand the ethos of the home and to improve the quality of the services they provided. The minutes for one staff meeting recorded praise from the Registered Manager for staff on maintaining cleanliness in the home.