Medway House is a residential care home for six people with mental health needs. At the time of our inspection there were six people living at the home.

At our previous inspection of Medway House on 14 February 2017 we rated the service good in all areas. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People told us that they felt safe living at Medway House. We saw that people were comfortable and familiar with the staff supporting them.

Staff members had received safeguarding adults training, and were able to demonstrate their understanding of what this meant for the people they were supporting. They were knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.

Medicines at the home were well managed. People’s medicines were managed and given to them as prescribed and records of medicines were well maintained. Staff members had received training in the safe administration of medicines.

We saw that staff at the home supported people in a caring and respectful way, and responded promptly to meet their needs and requests. There were enough staff members on duty to meet the needs of the people using the service.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Information about people’s capacity to make decisions was included in their support plans.

Staff who worked at the home received regular training and were knowledgeable about their roles and responsibilities. Appropriate checks had taken place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking. All staff members received regular supervision from a manager and those whom we spoke with told us that they felt well supported.

We saw that the meals provided to people were healthy and varied. Some people ate vegetarian food in accordance with their religion and we saw that this was respected and supported. People were encouraged to request the food that they wished to eat on a weekly basis and staff purchased these for them when shopping for the home. Some people also purchased their own food. Drinks and snacks were available to people throughout the day. People were supported and encouraged to prepare food for themselves where they were able and willing to do so.

Support plans and risk assessments were person centred and provided detailed guidance for staff around meeting people’s needs. These were regularly reviewed and updated where there were any changes in people’s needs. The plans also showed that people had been supported to develop the confidence and skills they required to move on to supported living services or other suitable accommodation.

People were supported to participate in a range of activities in the local community. Staff members supported people to plan an annual holiday. Staff members also encouraged and supported people to identify new activities of their choice. People’s cultural, religious and social needs were supported by the service and detailed information about these was contained in their support plans.

The home had a complaints procedure that was provided in an easy read format. This was discussed at regular resident’s meetings. People told us that they would tell the manager or staff member if they were unhappy about anything.

The home’s policies and procedures were up to date and reflected legal requirements and current best practice. Regular quality assurance monitoring had taken place and actions had been taken to ensure that concerns arising from these checks were addressed promptly.

People’s physical and mental health needs were regularly reviewed. The service liaised with other heal

We carried out a comprehensive inspection of Medway House on 8 and 14 January 2016 at which a breach of legal requirements was found. This was because the provider had not provided regulatory notifications to CQC in relation to incidents that the home had reported to the police, After this inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to this breach.

On 14 February 2017 we undertook a focused inspection to check that they had taken action in order to meet legal requirements.

This report only covers our findings in relation to the well led topic area. You can read the report of our last comprehensive inspection, by selecting the 'all reports' link for Medway House on our website at www.cqc.org.uk.

At our last inspection in January 2016 we rated the home good in the four topic areas safe, effective, caring and responsive and good as the overall rating. The home was rated requires improvement in the well led topic area.

Medway House is a care home situated in North Wembley and is registered to provide accommodation and personal care to six adults who have mental health needs. At the time of our inspection there were five people living at the home.

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 our focused inspection on 14 February 2017, we found that the provider had taken action to ensure that legal requirements were met. Regulatory notifications had been submitted to CQC and we saw that these corresponded with the records maintained at the home.

During this inspection we also looked at the quality assurance processes in place at Medway House. We found that there were regular checks of systems and practices. A satisfaction survey of people living at the home showed that people had few concerns about their support. Actions had been taken to address issues arising from the home’s quality assurance monitoring.

Our inspection of Medway House took place on 8 and 13 January 2016. This was an unannounced inspection.

At our last inspection of Medway House on 18 December 2014 we found that the home was not meeting the requirements of the law in relation to the following: consent to care and treatment; care of people who use services; records. During this inspection we found that the provider had taken significant steps to improve the service in order to meet the requirements identified at the last inspection.

Medway house is a home situated in North Wembley and is registered to provide accommodation and personal care to six adults who have mental health needs. At the time of our inspection the home had no vacancies. .

At the time of our inspection, a new manager had been appointed and they were undergoing the process of becoming the registered manager for the 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.

People living at Medway House told us that they felt safe. Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.

People had up to date risk assessments to ensure that they were kept safe from avoidable harm. These were person centred and contained detailed guidance for staff about how they should support people to ensure that risks were minimised.

People’s medicines were stored, managed and given to them appropriately. Records of medicines were well maintained.

There were enough staff members on duty to meet the needs of people living at the home. Staff supported people in a caring and respectful way, and responded promptly to support their needs and requests.

Staff who worked at the service received regular relevant training and were knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff members were suitable for the work that they would be undertaking. All staff members received regular supervision from a manager, and those whom we spoke with told us that they felt well supported. A regular programme of staff training was in place which met national training standards for workers in health and social care.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of people’s capacity to make a wide range of decisions were in place and had been undertaken and we saw that these were regularly reviewed. All staff members had received training in MCA and The Deprivation of Liberty Safeguards (DoLS). Those we spoke with were able to describe their roles and responsibilities in relation to supporting people to make safe decisions.

People’s dietary needs were met by the home, and we saw that people were enabled to make choices about food and drink. Some people cooked for themselves, and meals were provided which met people’s cultural requirements.

The care plans maintained by the home were detailed and up to date. These contained guidance for staff about how they should support people. Staff met regularly with people to discuss their views about their care and support and their progress in relation to their care plans. The home liaised with other health and social care professionals to ensure that people received the care and support that they required.

People were supported to participate in range of individual and group activities. The home also supported people’s cultural, religious and language and communication needs.

People told us that they knew how to make a complaint. We saw that a formal c

This inspection took place on 18 December 2014 and was unannounced.

During our last inspection of Medway House on 16 January 2014 we found no breaches of the regulations assessed.

Medway house is a home situated 1n North Wembley and is registered to provide accommodation and personal care to six adults who have mental health needs. The majority of people living at the service were of Asian origin. At the time of our inspection the home had no vacancies. The registered provider was also the registered manager, as they had previously provided direct management to the home. However, at the time of our inspection a new manager had been appointed and they were undergoing the process of becoming the registered manager for the 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.

Written risk assessments for people living at Medway House were not always clear about the actual risk to the person and did not provide guidance for staff regarding how risks were to be managed. They did not always reflect information that was contained elsewhere in people’s files or told to us by staff.

People were protected from the risk of abuse. The provider had taken reasonable steps to identify potential areas of concern and prevent abuse from happening. Staff members demonstrated that they understood how to safeguard the people whom they were supporting. Four people told us that they felt safe living at Medway House. One person raised anxieties about their safety in relation to their finances, and we saw that these had been addressed and that staff were aware of them.

Medicines at the home were well managed.

The physical environment at the home was suitable for the people who lived there. The provider informed us that actions had been taken to address minor maintenance issues. A fire exit was blocked by a sofa, and we were told by the provider that this would be addressed immediately.

Staff recruitment processes were in place to ensure that workers employed at the home were suitable. Staffing rotas met the current support needs of people, and we saw that additional staff were provided to support activities where required.

There was limited evidence to show that people who used the service had been involved in making decisions about their care. Some people did not leave the home unaccompanied, and although there was reference to limited capacity in some care documents, and by staff, there was no evidence of any assessments of capacity for these people as required by The Mental Capacity Act (2005), nor had applications been made for Deprivation of Liberty Safeguards that are part of The Mental Capacity Act. We discussed these concerns with the provider who assured us that action would be taken to address them.

Staff training was generally good and met national standards for staff working in social care organisations. A number of staff members had achieved a relevant qualification. However, Mental Capacity Act training had not been updated to reflect recent developments to the Deprivation of Liberty Safeguards. Staff members received regular supervision, and team meetings took place each month.

People’s dietary needs were met by the home, and there was evidence that people were enabled to make choices about the food and drink that they received.

Other health and social care professionals were involved with people’s treatment and support.

Staff members treated people with respect and dignity. The home was able to meet people’s cultural and language needs.

The care plans maintained by the home lacked guidance in respect of how support should be provided by staff. They had not always been updated to reflect current information about people who used the service that might have a significant impact on their care.

The new manager told us that they had already identified some of our concerns, and the notes of the most recent team meeting showed that they had been discussed.

Policies and procedures were in place and generally met regulatory requirements. However, we did not see a policy in respect of the Mental Capacity Act, although there was one in relation to Deprivation of Liberty that required updating to encompass recent guidance.

People living at the home and their support staff informed us that they were happy with the new manager.

Quality assurance monitoring took place regularly and records of this were in place.

We found three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Records showed that each person who used the service had a care plan in place and this detailed their needs and support which would be given by staff.

We spoke with five people who used the service. A member of staff had to act as a translator for us for four of the people we spoke with. One person told us they were better now than they were before. Another said, "I like the set up here and there is nothing wrong, although at times staff can be patronising, but I understand that this can happen as I am under the Mental Health Act." Another person told us "Staff are good."

During our visit we spoke with five people who used the service and they told us that they attended appointments with various agencies such as the dentist, GP and hospitals.

Appropriate arrangements were in place in relation to the recording of medicines. Records showed that received medcines were noted in a book, detailing the person to whom they related, the name of the medicine, dosage and number of tablets.

We reviewed the files for four members of staff. We found that appropriate checks were undertaken in all the files before staff began work.

We found that each person who used the service had an office file which contained details of their care plan, finances and other professionals involved in their care.

People told us that they were involved in the treatment or care provided, comments

included, "I meet my key worker regularly to discuss my care plan" and "we have regular meetings to discuss issues relating to the home and care received".

Care plans were reviewed regularly and people using the service were involved in the process. This was confirmed by people spoken with and care plans viewed.

People told us that they felt safe at Medway House and staff confirmed that people were protected. Comments made by people included "I am safe here".

We observed staff interacting with people confidently and people confirmed that staff knew "what they were doing".

We visited the home on 24/11/2010, people told us during this visit that they are happy in Medway House, that the food is good and is meeting their cultural needs.

People also told us that they would complain to the manager if they had any concerns about the care and support provided.

During our Random Inspection (RUI) in May 2010 one person told us, “I would complain to my manager, social worker or the Care Quality Commission (CQC) if I had any problems.

One person told us during our visit in November 2010, that he can remember being asked to fill out surveys.

People using the service told us during our site visit in November 2010, that they like to live in Medway House and are happy with the premises.

During the RUI in May 2010 one person told us that they have a very good relationship with their GP and psychiatrist and meets them regularly to discuss the effect of medication and any changes required.

During our RUI in May 2010 people made the following comments. "I would complain to the manager, my social worker or the Care Quality Commission if I had any problems". Another person told us, "I am very happy here and they (staff) look after me very well".

During the RUI on 18/05/2010, we have received very positive comments about the food provided in the home. “I like it here and the food is very good”. Another comment made, “they help me with cooking and to be more independent”.

During a site visit undertaken on 24/11/2010 as part of this planned review. People made the following comments: “I have been involved in my care plan and was asked prior to moving in if I would like to live in Medway House”.

We spoke to two people during our site visit in November 2010 and the following comments were made by both people: “I like living here, staff treat me well”.

During a RUI under the Care Standards Act (CSA) 2001 on 18/05/2010, people using the service told us, that they have monthly meetings to discuss care and support, activities, wellbeing and health. During the same visit we viewed an analysis of a service user survey undertaken in May 2009. The survey was very positive about the service, 65% of service users said that they were very satisfied and 32% of service users said they were satisfied with the care and support provided by the home.