We carried out a comprehensive inspection of Norbury Crescent on 4 October 2018. The inspection was announced 48 hours in advance because we needed to ensure the provider or registered manager was available. At our last inspection in September 2017 we rated the service requires improvement. This was because improvements were required to some aspects of medicines management, assessing risks, water safety, involving people in planning their care and quality assurance. At this inspection we found the service had improved and we rated it good overall.

This service is a care home and a domiciliary care agency. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Norbury Crescent does not provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Through the domiciliary care agency Norbury Crescent provides personal care to people living in their own houses and flats and specialist housing. The service provides a service to adults with learning disabilities.

There was one person living in the care home and three people using the domiciliary care agency at the time of our inspection.

There was a registered manager in post. 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 provider had improved medicines management and people received their medicines safely. The provider checked staff were competent to administer medicines and audited medicines management to ensure staff followed best practice.

The provider had also improved their risk assessment and care planning processes. Risks to people’s care were reduced as the provider assessed risks and put guidance in place for staff to follow. People were involved in their care plans and care plans set out how people wanted to receive their care.

The leadership of the service improved. The provider had improved their quality assurance processes to check the service was meeting the fundamental standards. Leadership was visible and the registered manager and staff understood their roles and responsibilities.

People and relatives were positive about the staff who provided support. People received consistency of care and staff knew the people they supported. People were supported to do activities they were interested in. The provider gathered feedback from people, staff and professionals and communicated open with them. The provider responded appropriately to concerns and complaints. The care home premises were suitably maintained with a range of health and safety checks so the environment remained safe for people. Staff followed suitable infection control procedures and the care home was clean and free of malodours.

Staff understood the signs people may be being abused and how to respond to keep people safe. Staff received training in safeguarding adults at risk. Staffing levels were suitable to care for people safely. The provider carried out the necessary checks on staff to ensure they were suitable to work at the service. Staff were supported to understand people’s needs with training and supervision and staff felt well supported. People received food and drink of their choice. Staff supported people with their day to day health needs. People received care in line with the Mental Capacity Act 2005 and received choice in relation to their care.

This inspection took place on 7 September 2017 and was announced. We gave the provider 24 hours’ notice to ensure they were available to facilitate our inspection. This was the first inspection of the service since it registered with us on 21 September 2016.

The service provides personal care and support for up to three people within a small care home setting, as well as providing personal care to people in their own homes. The service specialises in providing care to people who have learning disabilities and autism. There was one person using the care home service and one person using the homecare service.

There was a registered manager 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.

Although we did not identify any medicines administration errors, people’s medicines may not have been managed safely as the provider was unable to confirm the medicines stocks they should have in place. In addition, records relating to medicines were not always robust to reduce the risk of medicines being administered inappropriately. The provider did not always assess risks relating to people’s care and ensure management plans were in place to guide staff in mitigating the risks.

The premises and equipment were managed safely in the main, although water safety was not managed well. The provider did not carry out checks of water temperatures to reduce the risk of scalding. In addition the provider did not have systems to reduce the risk of a Legionella bacterium accumulating in the water, in accordance with legal requirements. The provider confirmed they would take action to reduce these risks as soon as possible.

People were not always involved in planning their own care. The provider did not always ensure care plans were in place to guide staff in relation to all their needs.

The quality assurance processes in place required improvements as they had not identified the issues we found during our inspection.

People were safeguarded from abuse by the provider as staff understood their responsibilities in relation to this. Staff received training in safeguarding adults, from the provider.

People were supported by sufficient numbers of staff to meet their needs. The provider followed recruitment process so that only suitable staff worked with people.

Staff were well supported in their roles as the provider had a suitable programme of induction, training and support and supervision in place. The support in place helped staff to understand and meet people’s particular needs.

People were supported in line with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. Staff received training in the MCA and DoLS and understand their responsibilities in relation these.

People received a choice of food and drink and the right support in relation to their dietary needs. Staff also supported people to monitor and maintain their health and people had access to the healthcare professionals they needed.

People were supported by staff who were kind and treated them with respect. Staff understood the people they were working with including their needs and backgrounds and this information was recorded in care plans to guide staff in the best way to support people. Staff supported people to be as independent as they wanted to be and to take part in activities they were interested in. People were provided with information when they needed it, for example a person with autism had a visual schedule in place showing their programme of structured act