This inspection of Parkside took place on 25 July 2017. Parkside is a care home registered to provide accommodation for three people with learning disabilities. The service is also registered to provide personal care. This registration relates to care provided at a nearby supported living service. At the time of our inspection there were three people living at the care home and three people at the supported living service. The people who used the service had significant support needs because of their learning disabilities. The majority of people had additional needs such as autistic spectrum conditions, mental health conditions, and communication impairments.

The previous inspection was carried out on 1 June 2015. During this inspection, we found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of medicines storage and safeguarding in relation to the processes in place for safeguarding people’s monies.

At the previous inspection the service was rated Good.

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.

During this inspection on 25 July 2017, we found that the service had taken appropriate action in respect of the previous breaches of regulations and made improvements.

People who used the service told us they felt safe in the home and around care staff. During the inspection, it was evident that positive caring relationships had developed between people who used the service and care staff. People who used the service and relatives spoke positively about care staff, the registered manager and the care provided at the service.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Care staff we spoke with demonstrated a good understanding of how to recognise and report allegations of abuse. Risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to people.

The previous inspection in June 2015 found a breach of regulation in respect of safeguarding money procedures in place. During that inspection, we found that the service did not have a budget for staff expenses when supporting people outside of the home specifically in relation to the use of Oyster Cards. During the inspection in July 2017, we found that the service had taken appropriate action in respect of this and showed us evidence that care staff now had a separate Oyster Card which they used when they accompanied people on outings.

The previous inspection in June 2015 found a breach of regulation in respect of medicines storage at the supported living service. We found that medicines were stored in a lockable filing cabinet and this was not a suitable storage facility. During the inspection in July 2017, we found that the service had taken appropriate action and had obtained a suitable medicines storage facility.

Appropriate arrangements were in place in relation to the recording, disposal and administration of medicines at the home and the supported living service. However, we did note that the service was not recording the temperature of the medicines storage facility on a daily basis at both the home and supported living service. Following the inspection, the registered manager confirmed that they had commenced this.

Care staff had completed training in areas that helped them when supporting people. The registered manager explained they provided classroom based training to ensure care support staff received practical training. Care staff spoke positively about the training they had received. Care staff we spoke with told us they were w

This inspection took place on 1 June 2015 and was announced. We had visited the service on 29 May 2015 and found that people were away on a planned activity, so we informed the provider that we would visit on the next working day to ensure that people were at home.

Parkside is a care home registered for three people with a learning disability situated in the London Borough of Brent. The service is also registered to provide personal care. This registration relates to care provided at a nearby supported living service that provides accommodation for three people. At the time of our inspection there were two people living at the care home and two people at the supported living service. The people who used the service had significant support needs because of their learning disabilities. The majority of people had additional needs such as autistic spectrum conditions, mental health conditions, and communication impairments.

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.

During a previous inspection of Parkside on 5 August 2014, we found that the service was in breach of two regulations. These were in relation to training in the Deprivation of Liberty Safeguards (DoLS) that are part of The Mental Capacity Act (2005), and ensuring that actions taken in respect of issues arising from quality assurance processes were addressed. During this inspection we found that the provider had taken significant steps to improve the service in order to address the concerns raised at the previous inspection.

A person who used the service that they felt safe, and this was confirmed by family member whom we spoke with. We observed that people appeared comfortable and familiar with the staff supporting them.

People were protected from the risk of abuse. 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. However we had concerns about the management of people’s monies. People were paying expenses for staff members supporting them on community outings, but there was no record of agreement for this. The Oyster Cards that staff members used when accompanying people on public transport were not registered and the provider had no way of ensuring that statements of journeys undertaken showed that they were being used appropriately.

Medicines at the service were generally well managed. People’s medicines were managed and given to them appropriately and records of medicines were well maintained. Although medicines in the care home were securely locked in a medicines cabinet, medicines at the supported living service were stored in a filing cabinet that was unlocked although the door to the office where the cabinet was placed was locked. Current guidance provided by the Royal Pharmaceutical Society is clear that filing cabinets are not suitable storage where medicines are stored centrally within a service.

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.

Staff who worked at the home 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 were suitable for the work that they would be undertaking. All staff members received regular supervision form a manager, and those whom we spoke with told us that they felt well supported.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. Staff members had received training undertaken training in MCA and DoLS, and those we spoke with were able to describe their roles and responsibilities in relation to supporting people who lacked capacity to make decisions.

People’s nutritional needs were well met. Meals provided were varied and met guidance provided in people’s care plans. Alternatives were offered where required, and drinks and snacks were offered to people throughout the day.

Care plans and risk assessments were person centred and provided detailed guidance for staff around meeting people’s needs. Care plans were provided in easy read picture-assisted formats.

The service provided a range of individual and group activities for people to participate in throughout the week. Staff members engaged people supportively in participation in activities. People’s cultural and religious needs were supported by the service and detailed information about these was contained in people’s care plans.

The service had a complaints procedure that was available in a picture-assisted version. A family member told us that they knew how to make a complaint, and we saw evidence that complaints were dealt with quickly and appropriately.

The care documentation that we saw showed that people’s health needs were regularly reviewed. The service liaised with health professionals to ensure that people received the support that they needed.

We saw that there were systems in place to review and monitor the quality of the service, and action plans had been put in place and addressed where there were concerns. Policies and procedures were up to date.

People who used the service, their relatives and staff members spoke positively about the management of the home.

We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

A single adult social care inspector undertook this inspection. We spoke with one person who used the service, a relative of a person who used the service and three staff members. We looked at various records held by the service. We focused on the five key questions of : is the service safe, effective, caring, responsive and well-led?

Is the service safe?

People received good levels of support and this helped to keep them safe. There were enough staff with the right skills and experience to ensure people's needs could be met.

Risk assessments and care plans had been completed but there were no current records for the administration of over-the-counter medicines. Incident reports were completed and we saw that one report documented a person had unexplained bruises on their arm. However, senior managers had not properly reviewed this report and had not made a safeguarding referral.

Is the service effective?

Staff had not received training in Deprivation of Liberty Safeguards (DoLS) and they appeared to be unaware that these safeguards applied to all people receiving support in supported living settings. We found that staff were depriving one person of their liberty and had not applied for a DoLS assessment.

The person we spoke with who used the service felt staff were effective in supporting them well and helping them with any difficulties they had and a relative we spoke with also gave the same view.

The service had not fully completed documentation for consent to administration of medicines which needed to be signed by a relative.

Is the service caring?

The registered manager worked hard to ensure people had enough support to meet their needs.

Staff talked about people in a respectful manner and we observed positive interactions between staff and people receiving support.

A person who used the service told us staff asked them about their views and tried to help them without taking control.

Is the service responsive?

The provider thought about how they needed to keep people safe by making reasonable adjustments. For example, they fitted specialist glass protection to a person's bedroom windows because the person was likely to break the glass and could hurt themselves.

The service had responded positively to a person who made a complaint.

Is the service well-led?

The provider carried out some regular checks thoroughly and recorded these accurately. Complaints and compliments were recorded.

The registered manager's quality monitoring and audit processes identified some areas requiring action but did not document how these actions would be undertaken and reviewed.

During our inspection we spoke with one of three people who used the service and three members of staff.

The person we spoke with told us that they were "very happy and felt safe at the home". They also said that they liked the staff and were treated well.

Care records we looked at indicated that the needs of people had been attended to. The care records contained assessments and care plans. There was documented evidence that the healthcare needs of people had been attended to and there were

records of appointments with healthcare professionals.

We saw that the home was clean and welcoming.

Staff we spoke with told us that they enjoyed working at the home and felt supported by their manager and colleagues.

Staff demonstrated that they were aware of what action to take when responding to allegations or incidents of abuse.

We looked at staff training records and saw that staff had received appropriate training but noted that some staff required refresher training sessions in various areas.

People who use the service told us, that staff were kind and that they respected their privacy and promoted their independence.

People told us staff understood their needs and provided them with the care and support they needed and in the way that they wanted.

People told us that they regularly met with their key worker and discussed their care plan and reviewed any progress made.

They felt safe at Parkside and their comments included, "they look after me very well" and "they stop me from running away and ensure I am safe".

We observed staff being available and ensured that people's needs were met. For example, two staff were provided to enable people to access the community. We asked people about the staff provided and their comments were very positive and included, "I like her very much, she is my favourite member of staff" or "they treat me very well."

A robust quality assurance system ensured that care and treatment was regularly reviewed and improvements made as and when required.