This inspection took place on 20 December 2018 and was unannounced.

North Downs Villa is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. North Downs Villa does not provide nursing care.

North Down Villa accommodates up to eight people in one adapted building, and a further two people in a separate bungalow on the same grounds. At the time of our inspection eight people were using the service and the bungalow was no longer in use. North Downs Villa provides a service for people with learning disabilities and/or a mental health diagnosis.

We carried out an unannounced comprehensive inspection of this service on 6 July 2018. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to staffing and good governance.

We undertook this focused inspection to check that the provider had followed their plan in relation to the key questions ‘Is the service Effective and Well led?’ and to confirm that they now met legal requirements in relation to the warning notice we served. This report only covers our findings in relation to those requirements and we will inspect in relation to the other issues we identified previously at our next comprehensive inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for North Downs Villa on our website at www.cqc.org.uk.

The service had 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.

At this inspection we found the provider had met the requirements of the warning notice. The provider had improved the arrangements for staff training and supervision to ensure that people received appropriate care and support. Further improvements were planned which we will check at our next inspection.

The provider had systems for monitoring the quality and safety of the service although these needed to be embedded and sustained in practice, to ensure the provider had effective oversight.

Whilst the provider had taken sufficient action to meet the legal requirements that were being breached at the last inspection, we have not improved our rating for the service. We need to see consistent improvements over time before we are able to change the rating of this service from ‘requires improvement’.

North Downs Villa is a ‘care home’. 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. North Downs Villa does not provide nursing care.

North Down Villa accommodated up to eight people in one adapted building, and a further two people in a separate bungalow on the same grounds. At the time of our inspection nine people were using the service. North Downs Villa provides a service for people with learning disabilities and/or a mental health diagnosis.

At our previous inspection on 19 February 2018 we rated the service ‘requires improvement’ and found the provide in breach of four regulations of the HSCA 2008. This included in relation to staffing, premises, need for consent and good governance.

We undertook an unannounced comprehensive inspection on 6 July 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our February 2018 inspection had been made. The team inspected the service against all of the five questions we ask about services. This is because the service was not meeting some legal requirements in four of the questions so we wanted to review the quality and safety of all areas of service delivery.

A registered manager remained 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.

At this inspection we found some improvements had been made, however, there continued to be some concerns and the service continued to be rated ‘requires improvement’ overall. We found the service continued to be in breach of regulations relating to staffing and good governance. You can see what action we have asked the provider to take at the back of the main report.

Staff continued to not receive adequate training opportunities meaning there was a risk that staff would not have the knowledge and skills to meet people’s needs and support them safely. We also found that staff continued to not receive supervision meaning there was a risk that staff were not adequately supported to undertake their duties.

Governance processes had been strengthened and regular cleanliness and environmental checks had been introduced. However, we found that quality assurance processes still needed improving to ensure they reviewed all areas of service delivery and ensure they were effective in implementing improvements in a timely manner.

Improvements had been made since our previous inspection to ensure a safe, pleasant and fit for purpose environment was provided. The bathrooms had been renovated and new window restrictors had been installed. We also saw improvements had been made to ensure people were only deprived of their liberty when staff were legally authorised to do so. The registered manager had applied to the local authority for authorisation to deprive people of their liberty where they did not have capacity to ensure their safety in the community.

Improvements had also been made to ensure there were sufficient staff to meet people’s needs. New staff had been recruited which meant there were now sufficient numbers of staff on each shift to meet people’s needs and to allow staff to have sufficient breaks between shifts. However, we saw recruitment practices needing improving to ensure sufficient references were obtained from previous employers.

People’s care records had been reviewed and updated. Improvements had been made to ensure these records incorporated advice from health and social care professionals and that care records were developed in a timely manner so staff had information about people’s historic and cu

North Downs Villa is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. North Downs Villa accommodates up to ten people with mental ill-health and/or learning disabilities in one adapted building. At the time of inspection nine people were using the service. North Downs Villa does not provide nursing care.

At our last inspection on 5 January 2016 we rated the service ‘good’ overall and for each key question. At this inspection we found the quality of the service had deteriorated and the service was now rated ‘requires improvement’ overall and in four key questions.

A registered manager was 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.

There were insufficient staff employed to meet people’s needs. The management team told us they had struggled to recruit staff and there were currently a number of vacancies in the staff team. This meant that staff were being required to work very long hours and not have adequate breaks between shifts. The pressures on staff’s time also meant new staff were not being adequately supported and given the time to complete the provider’s mandatory training in a timely manner impacting on their knowledge of key processes. Staff were also not receiving regular supervision.

The premises were not adequately maintained in order to provide a safe and pleasant environment for people to use. Two of the bathrooms needed refurbishment. Water damage had affected the flooring in one bathroom which was posing a trip hazard and impacted on the ability to maintain a clean environment. The window restrictors in place could be overridden meaning people were not adequately protected from the risk of falling from height.

There were insufficient systems in place to monitor and improve the quality of service delivery. The management team did not have systems in place to review the cleanliness of the service and ensure infection control procedures were adhered to. There was no formal tool in place to review the health and safety of the environment. Systems were not in place to review arrangements regarding management of people’s finances. Complete and contemporaneous care records were not always maintained in a timely manner and care records were not always updated to reflect changes in people’s needs and incorporate advice from specialist healthcare professionals.

Staff did not consistently adhere to the Mental Capacity Act 2005 and had not consistently applied for legal authorisation to deprive a person of their liberty. Whilst the registered manager had followed process to ensure staff were legally authorised to deprive two people of their liberty, we saw for a further two people using the service the registered manager had not followed process in regards to the deprivation of liberty safeguards (DoLS).

Staff adhered to safeguarding adults’ procedures. Staff liaised with people’s mental health care team to identify and manage risks to people’s safety. Incidents were reviewed and learnt from to improve the quality of risk management. People received their medicines as prescribed. Staff supported people with their nutritional needs and liaised with healthcare specialists in order to support people to have their physical and mental health needs met.

Staff had built friendly and caring relationships with people. Staff were aware of people’s communication needs and communicated with people in a way they understood. Staff respected people’s privacy and their individual differences. People were supported to maintain relationships

The follow up inspection was carried out by an inspector during one afternoon. We did not review any information in relation to the questions ‘Is the service caring', 'Is the service responsive' 'Is the service effective'. This was because this was a follow up inspection to check that a compliance action made at the last inspection had been met.

During this inspection we met with two of the people using the service, two support workers and the manager.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service Safe ?

At the inspection on 29th May 2014 we found the quality assurance checks were inconsistently carried out, and nobody was checking when the audits took place or if the areas needing attention were addressed. This was a follow up inspection to check that the compliance actions had been met. At this inspection we found that the new manager had introduced more robust methods that promoted the safety and welfare of people using the service and of staff. An external consultant had completed a fire risk assessment, and this identified a number of areas requiring attention in the premises. To address the issues the manager arranged with the contractor to undertake the remedial work. This took place and included new emergency lighting, fire exit changes and new signage.

Is the service well led?

We saw that the newly appointed manager had provider direction and clear leadership to the staff team. They helped make the necessary improvements to quality assurance processes. They introduced regular formal supervision to help ensure staff were effectively supported. The manager established forums for staff through regular team meetings, and people using the service had regular care reviews. The manager has contributed to improvements in communication with external health professionals which was of benefit to people using the service.

One 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.

Below is a summary of what we found.

The summary is based on our observations during the inspection, speaking with four of the five people using the service, speaking with the staff and from looking at records. We requested information from the provider and spoke with three community based mental health care professionals who visited the service on a regular basis.

Is the service safe?

People were protected from the risk of abuse. Staff were knowledgeable in recognising signs of abuse and were aware of the reporting procedures to the local safeguarding team. Risks to individuals and to others using the service were identified and managed appropriately.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded as required.

People were not totally safe because of risks associated with the premises that needed to be addressed. There was a schedule of work required to address these concerns following a recent fire risk assessment. The manager confirmed the planned schedule of work was to commence 12th June. We shall return to the service at a later date to check if the work is completed.

Is the service effective ?

Individual support/care plans were in place detailing the care and support needs of people who used the service. People used all the information to deliver the care and support people needed. People benefited from having support from staff that were knowledgeable and competent.

A care co-ordinator from the local NHS mental health trust told us they found people received the care and support they required. They said staff were proactive and kept them up to date on a person’s progress, and worked closely with them so that they were made aware if there any setbacks or concerns.

Is the service caring ?

People who used the service told us they enjoyed life in this home. One person told us, “this is my home, the happiest place I have been, people looking after me are caring, and understand how to make me smile if my mood is down." People liked the staff team and felt they gave them the support and encouragement they needed.

People were involved in decisions about their care. We saw that, when they wished, people signed their support plans to indicate they were in agreement with the plans in place.

Is the service responsive to people’s needs?

People found staff were responsive, for example a person said "I needed help with my diabetic diet, and staff have helped me". Two care coordinators from a mental health team told us staff were responsive to people’s needs. They found staff were innovative and focused on delivering the support that met individual interests and preferences. The service empowered people and enabled them participate in the local community.

Is the service well-led?

The service was without a manager for a substantial period before April 2014, this directly impacted on the service and the processes in place to monitor and evaluate the quality of the service. Any areas for improvement were not identified and addressed.

Since the appointment of a new experienced manager we found improvements to the quality assurance audits and processes were in progress. There were regular staff meetings to discuss any changes to service provision and to give information to the team about changes in practice.

Meetings had also begun with people using the service. The manager had developed quality surveys and was seeking the view of people using the service, and those of staff and stakeholders.

At our last inspection in December 2012 we identified areas where the provider was not meeting the essential standards of quality and safety. The provider sent us an action plan to tell us how it was going to become compliant with the regulations. We carried out this inspection to review improvements.

We spoke with two members of staff and the registered provider who was also managing the home. Following our inspection we also spoke with two social care professionals involved with the service.

We met with three of the four people using the service. They were happy with the support they received. Their comments included, “I like it here” and “the staff are ok, they take me bowling.” A social care professional said that the provider “worked well with the team (mental health services) and passed on information appropriately.”

People told us that staff listened to them and that they felt safe. People said they could talk to staff if they had any worries or concerns. They met regularly with other health and social care professionals to ensure that they stayed as well as possible.

People using the service had personalised care plans, which were current and outlined their agreed care and support arrangements. This meant staff had the information they needed to meet people’s individual needs.

At this inspection we found there had been improvements. There were sufficient numbers of staff to meet people’s needs and the provider had taken some action to improve upon staff training and supervision. The service’s recruitment process and quality monitoring systems had been strengthened. We were told that a new manager had been appointed and they were applying for registration with us.

There were four people using the service and we met with all of them during the course of our visit. We also spoke with two members of staff and the registered provider. Prior to our inspection we were informed that the registered manager had left.

People spoke positively about the support they received and their experiences of the home. Comments included, “I like it here and the staff are friendly” and “the staff are caring and listen.”

We received positive comments about the meals provided and the home environment. They included, “the food is nice, I get a choice” and “all meals are home cooked.” People said they chose their rooms and had furnished them as they liked.

People confirmed they felt safe living in the home and that staff listened to them and were approachable. One person commented, “they are always available to talk to.”

People told us they received ongoing advice and treatment from health and social care professionals to ensure that they stayed as well as possible.

We found however that staffing levels were insufficient to meet the needs of the people using the service. There were also inadequate arrangements to ensure that staff were appropriately recruited, trained and supervised. The registered provider was not fully aware of the government standards of quality and safety which may adversely affect the quality of care that people receive. The home also needs a registered manager who is qualified, competent and experienced.

This was an unannounced inspection that took place on 5 and 6 January 2016.

North Downs Villa is a care home that can accommodate up to eight adults who have a range of needs including learning disabilities, autism and a past or present experience of mental ill health. The service offers respite care breaks as well as long term residential care. There were six people living at the home

The home had 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 and associated Regulations about how the service is run.

In September 2014, our follow up inspection found that the service met the regulations we inspected against. At this inspection the home met the regulations.

People said they liked living at the home and that staff provided a good supportive service. They were given the opportunity to choose activities and whether they wished to participate in them. They felt staff provided the care they needed in a way that suited them.

We saw that the home’s atmosphere was warm, enabling and inclusive. People came and went as they pleased during our visit. The home provided a safe environment for people to live and work in and was well maintained, furnished and clean.

The records were comprehensive and kept up to date. The care plans contained clearly recorded, fully completed, and regularly reviewed information. This enabled staff to perform their duties appropriately.

The staff were knowledgeable about the people they worked with as individuals and had appropriate skills, qualifications and training. They were focussed on providing individualised care and support in a professional, friendly and enabling way. They were trained and skilled in behaviour that may challenge and de-escalation techniques. Whilst professional they were also accessible to people using the service and their relatives. Staff said they had access to good training, support and career advancement.

People were protected from nutrition and hydration associated risks by being encouraged to have balanced diets that also met their likes, dislikes and preferences. They said the choice and quality of provided was good. People were encouraged to discuss health needs with staff and had access to community based health professionals, as required.

The management team at the home, were approachable, responsive, encouraged feedback from people and consistently monitored and assessed the quality of the service provided.