This comprehensive inspection took place on 13 and 16 February 2018 and was announced.

The service was last inspected in April 2016 when we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as medicines were not being managed in a safe way. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to address this breach. We found the provider had addressed our concerns about medicines management. However, additional concerns about other areas of care were identified during this inspection in February 2018.

Precious Homes East London provides care and support to people living in two ‘supported living’ settings, so they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. People using the service lived in self-contained one-bedroom flats across two sites located approximately 15 minutes’ walk apart from each other in the London Borough of Newham. Each site had a staff office and one site also had a number of communal areas used for meetings and activities. Not everyone using Precious Homes East London received regulated activity. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. We also take into account any wider social care provided. Four people were receiving personal care within the service.

Precious Homes East London provides support to people with learning disabilities and autism. The 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 had 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.

Care plans and risk assessments lacked details on how to deliver support and had not been kept up to date. Information about people’s healthcare needs lacked detail and was missing key information about people’s healthcare conditions. Although people’s care was reviewed regularly, information from reviews was not used to update care plans or risk assessments.

Staff had not received training identified as being required to meet people’s needs.

Quality assurance systems had identified some of the issues with the quality and safety of the service we found during the inspection, but actions to address the concerns had not been effective as issues remained.

The service had not consistently adhered to the principles of the Mental Capacity Act 2005.

People told us they felt safe in the service and staff were knowledgeable about safeguarding adults from harm. Records showed the service took appropriate action in response to incidents and allegations of abuse.

People received support to take medicines and the service had robust systems in place to ensure this was managed in a safe way.

People and staff told us they thought staffing levels were sufficient to meet people’s needs. Staff were recruited in a way that ensured they were suitable to work in a care setting. Staff received regular supervision from their line managers.

People told us they were involved in the assessment process, and resulting care plans were goal focussed and included information about people’s communication and ability to make certain decisions.

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The inspection took place on 19 April 2016 and was unannounced. At the previous inspection of this service in August 2014 we found they were meeting all the standards we looked at and we rated them as good.

Precious Homes East London provides personal care and support to people with autism spectrum disabilities, learning disabilities and substance misuse in their own apartments on a single site. At the time of our inspection eight people were using the service.

The service had 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.

We found that medicines were not always managed in a safe manner.

We found one breach of 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 this report.

Systems were in place to reduce the risk of abuse at the service. Risk assessments were in place which set out how to support people in a way that mitigated the risks they faced. There were enough staff working at the service to support people. Checks were carried out on staff before they began working at the service.

Staff had access to regular support through training and one to one supervision. The service mostly operated within the Mental Capacity Act 2005 and people were able to make choices about their daily lives. This included choices about what they ate and drank. The service supported people to attend medical appointments.

People told us staff treated them with respect. We saw staff interacted with people in a friendly manner. Staff understood how to promote people’s privacy and independence.

The service carried out assessments of people’s needs to determine if they were able to meet those needs. Care plans were developed and reviewed over time. These included personalised information about how to support individuals. The service had a complaints procedure in place and we found that complaints were responded to appropriately.

People that used the service and staff told us they felt the management team was open and supportive. The service had various quality assurance systems in place, some of which included seeking the views of people that used the service.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

At the last inspection in June 2013 the service was found to be meeting the regulations we looked at. This inspection was announced.

Precious Homes East London provides personal care and support to people with autism spectrum disabilities, learning disabilities and substance misuse in their own apartments on a single site. At the time of the inspection they were providing personal care and support to eight people. 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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt safe and were happy with the care and support provided. We found that systems were in place to help people were safe. For example, staff had a good understanding what constituted abuse and the reporting procedures for such matters. We did not observe any restrictions of people’s liberty during the inspection. The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA).

The registered manager told us staffing levels were reviewed regularly and adjusted accordingly to the needs of people who used the service.

We saw the service followed safe recruitment procedures which meant people were kept safe as suitable staff were employed.

Staff were able to tell us about people’s life histories, their interests and their preferences and these details were included in their care plans. Staff displayed a caring approach and treated people with dignity and respect. People, relatives and other health professionals spoke positively about their relationships with staff. People were able to make choices in relation to their daily lives, for example choosing what they wanted to eat and staff respected these wishes.

Staff were up-to-date with a range of core training and received regular supervision and support. Staff told us they felt supported by the manager.

Staff, people, and other health professionals viewed the registered manager positively. Quality assurance systems were in place which included seeking the views of people that used the service.

People who used the service were positive about the care and support they had. People were encouraged to be independent and one person said “They (staff) try and encourage me and help me.”

People did a variety of daily activities. They said “I go to Dartford FC (football matches) and staff go with me” and “I go out every day to the cinema, museum or college. I like drawing.” One person had been supported to travel abroad because they wanted to attend a games tournament and risk assessments had been carried out for these events.

Medicines were kept safely and there were appropriate arrangements in place in relation to the recording of medicine.

There were enough staff on duty during each work shift. One person told us “it’s better since the building split – less crowded and quiet now. Two teams and enough staff.”

Staff received appropriate professional development and support.