The unannounced inspection took place on 4 and 6 December 2018.

The last comprehensive inspection took place on 15 June 2016. At this inspection we rated the service requires improvement for the key question, 'is the service well-led?' and found breaches of the Health and Social Care Act 2008 (Registration) Regulations 2009 because the provider did not always notify us about significant events. We carried out a focussed inspection on 2 March 2017. At this inspection we found that the provider had made improvements but these improvements had not been consistent and we continued to rate the key question, 'is the service well-led?' as requires improvement. The overall rating of the service was good.

Life Opportunities Trust - 329 Martindale Road is a care home situated in a residential street in Hounslow. 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.

People using the service had multiple or complex needs such as profound learning and physical disabilities and were living with additional conditions, including epilepsy and dementia. People required varying degrees of support from staff throughout the day, ranging from verbal prompting and intensive one-to-one support to interact with others, to full assistance to eat and one or two staff to support them with personal care and to use their wheelchairs. People had very limited or no ability to verbally communicate with others. The service was managed by the Life Opportunities Trust, a registered charity which also ran six other care homes and one personal care service for people with learning disabilities in north-west London and Hertfordshire.

There was a registered manager who has been in post since the last 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 care service has not 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 were not supported to live a good and meaningful lives just as other citizens expect to.

Staff did not always treat people with dignity and respect. Some of the staff's approaches were not always appropriate and demonstrated a lack of empathy for people using the service. Some of the staff interactions with people were task-based and communication was sometimes limited to a word or two at a time. Staff did not respond to people appropriately when people communicated with them.

People's independence was not always respected and promoted.

The way in which care was provided was not always person centred and did not reflect nationally recognised good practice guidance. People had some opportunities to access the community and some planned activities, but did not regularly benefit from meaningful activities or positive interactions with the staff team while they were at home.

Risks to people's safety and wellbeing were not always being reasonably mitigated.

The service was not supporting people in line with the principles of the Mental Capacity Act 2005.

Quality assurance and audit systems had not always been effective as they had not identified or addressed issues of the quality and safety of the service.

The provider did not display a CQC rating for this service on its website as required by law.

The provider did not have an effective management process for ensuring that it submitted information to the CQC when required in that they had not completed and sent

This unannounced inspection was carried out on 2 March 2017. The last inspection of the service took place on 17 and 18 May 2016. We rated the service as Good overall but identified two breaches of the Care Quality Commission (Registration) Regulations 2009 as the provider had not notified us of certain events that must be reported to the Care Quality Commission. These included notifications for deprivation of liberty safeguards authorisations and for the absence of the registered manager who was no longer managing the service.

At this inspection we checked that notifications were being submitted to the Care Quality Commission (CQC). We found improvements had been made in the reporting of notifiable changes, events and incidents to the CQC and we found the provider and the manager were now reporting appropriately to meet the requirements of the Care Quality Commission (Registration) Regulations 2009.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Life Opportunities Trust – 329 Martindale Road’ on our website at www.cqc.org.uk.

329 Martindale Road is a care home providing personal care for up to 7 adults. People living at the service have a range of needs including learning and physical disabilities.

The service is required to have 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. There was a manager in post and they had commenced the process of applying to register with the CQC.

The inspection took place on 17 and 18 May 2016 and the first day was unannounced. The last inspection took place on 17 July 2014 and the service was compliant with the regulations we checked.

329 Martindale Road is a care home providing personal care for up to 7 adults. People living at the service have a range of needs including learning and physical disabilities.

The service is required to have a registered manager. 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 service had a registered manager who had been in post since 2013, however although they still worked for the provider they were no longer managing the service. There was an acting manager in post at the time of inspection.

The Care Quality Commission had not received notification of events that the provider was required to inform us of.

Systems were in place to safeguard people against the risk of abuse and staff understood these.

Staff recruitment procedures were in place and being followed. There were enough staff available to meet the needs of people using the service.

Risk assessments were in place for maintaining people’s safety and were being followed. Servicing of equipment was carried out to keep the service safe.

People were receiving their medicines safely.

Staff received training to provide them with the skills and knowledge to care for people effectively.

Staff understood people’s rights to make choices about their care and the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), so they acted in people’s best interests. This is where the provider must ensure that people’s freedom is not unduly restricted.

People’s dietary needs and preferences had been identified and were being met.

People’s healthcare needs were identified and they were supported to receive the input they needed from healthcare professionals.

Support plans were in place for people’s identified needs and interests to provide staff with the information they needed to meet these. People’s needs were reviewed to ensure changes were identified and could be met.

Activities took place and people’s individual interests were identified and responded to.

There was a complaints procedure in place and relatives said they would feel able to raise any concerns they might have so they could be addressed.

The service had an acting manager and relatives, staff and healthcare professionals said she was approachable and supportive.

There were systems in place to assess and monitor the quality of the service.

We found two breaches of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

At the previous inspection 20 May 2014 we found that some of the information in people's care records did not show that they had been reviewed on a regular basis and not all the information on risk assessments was accurate. This could have placed people living in the home at risk of harm or unsafe care. The manager informed us that this would be addressed by 7 July 2014.

At this visit we talked with two staff members and the manager. We also carried out observations, as due to people's individual communication needs they were not able to talk with us about their experiences of the home. We also viewed three people's care records.

We observed people were relaxed with staff and staff regularly engaged with people, talking with them, explaining tasks to them and checking that people were ok. We saw staff responding quickly to people's needs and considered people's well being if they did not seem well.

Overall people's care records had improved and detailed people's current needs using words and pictures and photographs. Where we noted some information was missing, such as two people's weight for June 2014 had not been recorded, the manager addressed this the day of the visit. Health appointments had been recorded along with the outcome so that staff could support people appropriately. One person's support plan stated they would see a chiropodist every six months, however, the records showed they had not seen a chiropodist since September 2012. The manager informed us the day after the visit that he had arranged a chiropody appointment on 19 July 2014.

Explanations were now in place to inform staff about how risks were assessed and scored. This information enabled staff to know if the risks to the person and/or others was high or low and therefore inform them on how to support the person safely.

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 a family member thought about the service and what staff told us, what we observed and the records we looked at. The manager was not working on the day of inspection.

Is the service safe?

Due to people's complex needs we could not directly speak with them to obtain their views. The family member told us they felt their relative was safe in the care of staff. All three staff we spoke with understood about the safeguarding procedures required to protect the people they supported. Staff received safeguarding training.

The senior member of staff was aware of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although no applications had been submitted. We saw people living in the home needed continuous supervision and support. People were unable to leave the home without the assistance of staff. This may mean deprivation of liberty authorisations were required.

We saw systems were in place to protect people against the risks associated with medicines.

Is the service effective?

People's health and care needs were assessed. Staff told us care plans assisted them to meet people’s needs.

Is the service caring?

Staff showed patience and gave encouragement when supporting people. We asked the family member their views on the staff. They said staff were, “Alright.”

People's preferences and diverse needs had been recorded in their support plans.

Is the service responsive?

We saw evidence of systems which had been put in place to ensure staff learnt from events such as accidents and incidents which were discussed at staff meetings. There were shortfalls in accurate record keeping. We saw people's risks were not fully considered and acted upon.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to assessing people's needs accurately to reflect their risk assessments and care plans.

Is the service well-led?

We saw that the service was well-led. For example, processes were in place to support staff with regular supervision.

This small service has started to introduce quality assurance systems to identify areas for improvements and address issues. All members of staff we spoke with told us they were clear about their roles and responsibilities.

The previous visit carried out on the 31st October 2012 found the home was not compliant with four of the Health and Social Care Act 2008 (Regulated Activities Regulations) 2010. We had concerns about how people using the service were supported and talked to, the care records had conflicting information in them and were not all accurate. Furthermore we found there were not sufficient numbers of staff working on each shift to appropriately support people.

During this visit on the 30th April 2013 we spoke with the manager and six members of staff. We also received feedback from a regular visitor to the home. Due to people’s complex needs we could not directly speak with them to obtain their views. However we observed interactions between staff and people who use the service. We also viewed two people’s care records.

At this visit we found improvements had been made and interactions between staff and people using the service were professional and caring.

Care records reflected people’s needs and had been reviewed and included people's preferences and abilities.

The systems for managing medicines in the home protected people and ensured they received their prescribed medicines. Staff attended training on medicine management.

New staff had been recruited to the team since the last visit and staff confirmed to us that enough staff worked on each shift. There was a daily planner in place which informed each member of staff of their roles and responsibilities.

People using the service had complex needs which meant they were not able to tell us their experiences. Therefore we carried out observations and spoke to three members of staff, the manager and received feedback from four healthcare professionals.

One professional said the staff were competent whilst another professional told us that people appeared well presented and that health appointments were followed up.

Staff explained that they watched people’s body language to see if they were happy or sad. They said people communicated in different ways, such as making sounds and noises, such as screaming or saying ”no”. We observed staff interactions during the visit and staff sometimes used inappropriate language when supporting and encouraging people.

There were some inconsistencies in the information seen on two people's files, some information had been reviewed, such as support plans and risk assessments, whilst other information was either inaccurate, missing or had no date to evidence the documents had been checked. This meant that people's needs might not be effectively met if the information was not relevant or available.

Staff received training and support however there were insufficient numbers of staff working to meet the needs of the people living in the home. We observed that staff were not engaging people in activities in the home as they were busy carrying out other tasks, such as cooking and providing personal care support.

One person who uses the service was able to speak to us. They told us that they are asked for their views on the care they receive and other aspects of their care, such as the activities programme. They said that that they are able to either give or refuse consent to the care and support they receive.

The person told us“I love it here”. They added “I’m very well looked after here. The staff are very kind”. They described the various trips and activities they had experienced which included attending a community group, going out for a meal and a trip to the coast. They said that the food is good and that they are able to choose what they want to eat.