Our inspection took place on 7 June 2018 and was announced.

Mokattam is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection.

The care service has 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 can live as ordinary a life as any citizen.

The service can provide care and support for up to six adults with learning disabilities or autism. At the time of our inspection, the service accommodated six people. Each person had their own bedroom, and there were communal facilities such as dining, lounge and kitchen. The premises were adapted into a care home. The service is due to move to a new location in 2019. We made a recommendation regarding Mokattam’s move to a new house.

The provider is required to have a registered manager as part of their conditions of registration. 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. At the time of our inspection, there was a registered manager in post.

At our last inspection on 15 May 2017, there were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued three requirement notices against the provider and required an action plan. At this inspection, there was evidence that satisfactory changes were made to ensure people’s health and safety was protected, and that the quality of care was monitored and effectively managed. The service has now achieved compliance with the relevant regulations.

We found people were protected against abuse or neglect. There were personalised risk assessments tailored to people’s individual needs. Sufficient staff were deployed to provide support to the person and ensure their safety. Medicines were safely managed. The premises were clean and tidy.

The service was compliant with the requirements of the Mental Capacity Act 2005 (MCA) and associated codes of practice. People were assisted 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.

Staff received appropriate induction, training, supervision and support. This ensured their knowledge, skills and experience were suitable. People’s care preferences, likes and dislikes were assessed, recorded and respected. Access to other community healthcare professionals ensured the person could maintain a healthy lifestyle.

Staff had caring relationships with people who used the service and their relatives. There was complimentary feedback from people, relatives and other healthcare professionals about staff and the service. People’s privacy was respected and they received dignified support from staff.

The service provided very person-centred care to people. People and relatives were included in care planning and reviews. Care plans were detailed and contained information on how staff could provide appropriate support in conjunction with people. Some care plans required more up-to-date information and reviews. There was a satisfactory complaints system in place.

The service was well-led. This had improved since our last inspection. There was a positive workplace culture and staff felt that management listened to what they had to say. The provider had improved methods to measure the safety and quality of care. The service had strong relationships with community

Mokattam was previously operated by another provider until November 2016 when we approved changes to the registration. This is our first inspection of the service under the current provider using the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and the first comprehensive rating.

The service provides care and support for up to six adults with a learning disability or an autistic spectrum disorder. At the time of our inspection six people lived at the service, and there were 13 staff employed with three care worker vacancies.

Mokattam has existed at its current address for some time. Plans are underway to build new premises at a different address which will be a fit-for-purpose care home and include additional capacity for people to receive supported living. It is anticipated that the service will move in approximately 18 months after our inspection

At the time of the inspection, there was 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.

People were safeguarded from abuse and neglect. There was a robust system in place to ensure that people’s safety was maintained. Staff had a good knowledge of what action to take if they felt a person was at risk of harm.

Risks for people were assessed, mitigated, documented and reviewed. Appropriate records were kept and readily available to demonstrate this to us at the inspection. The building and premises risks were assessed and managed to ensure people, staff and visitor safety at all times. However, a prevention and control system for Legionella was not in place.

The service did not have an appropriate system in place to establish whether sufficient numbers of staff were deployed. There was a high reliance on agency workers who were limited in the scope of their role and did not know people as well. Our observations showed that the service was busy at certain times, but overall calm and relaxed and staff were dedicated to the people they supported.

Medicines were safely managed. We examined the handling of people’s medicines during our inspection and found that people were safe from harm. Storage of medicines was correct. A pharmacist had not audited the safety of medicines management and the service did not know which areas of practice required improvement or changes. We made a recommendation about medicines management.

Staff were knowledgeable and competent. However, they received inappropriate levels of training, supervision and support to enhance their knowledge and skills. Relevant training subjects frequently used in the provision of adult social care were in place, but staff had not completed training in a timely way. Staff one to one sessions with their line managers required improvement.

The service followed the requirements of the Mental Capacity Act 2005 (MCA). The recording of consent and best interest decisions meant the service complied with the MCA Codes of Practice. There was however unclear information at the service regarding people’s applications, reviews and expiry dates for standard DoLS authorisations. We made a recommendation about records kept for DoLS.

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.

People received nutritious food which they enjoyed and enough hydration was offered to people to ensure they did not become dehydrated. Snacks and treats were available if people wanted or chose to have them.

We found the service was caring. We used our observations at the inspection to determine compassionate care was provided by staff. We observed staff were warm and fri