The unannounced inspection of Real Life Options- 96 Harrowdene Road took place on the 18 April 2017.

At our last comprehensive inspection on 11 December 2014 the service was in breach of one regulation which related to the management and administration of medicines. On 26 October we carried out a focused inspection to check the provider had followed their improvement plan and found they had met the legal requirements regarding the management and administration of medicines.

Real Life Options- 96 Harrowdene Road is registered to provide accommodation and personal care for six people. The home provides care and support for people with learning disabilities who may have additional physical needs. On the day of our visit there were five people living in the home. Public transport and a range of shops are within walking distance of the home.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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 cared for by staff who knew their needs well including people's individual ways of communicating. We saw staff engage with people in friendly and respectful manner. People had the opportunity to participate in a range of activities.

Staff respected people's privacy and dignity and understood the importance of confidentiality. People were provided with the support they needed to maintain links with their family and friends.

There were procedures for safeguarding people. Staff understood how to respond to complaints and possible abuse. They knew how to raise any concerns about people’s safety so people were protected.

People's individual needs and risks were identified and managed as part of their care plan so the likelihood of harm was minimised. Accidents and incidents were addressed appropriately.

Staff were appropriately recruited and supported so people were provided with the individualised care and support that they needed. Staff received a range of training to enable them to be skilled and competent to carry out their roles and responsibilities. Arrangements were in place to make sure sufficient numbers of skilled staff were deployed at all times to meet the needs of people using the service.

People were supported to maintain good health. They had access to appropriate healthcare services that monitored their health and provided people with appropriate support, treatment and specialist advice when needed. People’s dietary needs and preferences were supported, and they were encouraged to choose what they wanted to eat and drink.

People were encouraged and supported to make decisions for themselves whenever possible. Staff understood the importance of ensuring people agreed to the care and support they received. Staff knew when to involve others to help people make important decisions. Staff were aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS).

There were systems in place to regularly assess, monitor and improve the quality of the services provided for people.

We carried out an unannounced comprehensive inspection of this service on 11 December 2014. At which a breach of legal requirements was found. This related to the management and administrations of medicines.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 26 October 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Real Life Options- 96 Harrowdene Road’ on our website at www.cqc.org.uk.

Real Life Options 96 Harrowdene Road is a care home that provides accommodation for up to six people who require support with their personal care. The home provides support and care for people who have learning disabilities. There were five people living in the home at the time of our inspection.

At the time of this inspection there was no registered manager in post. The registered manager had left the organisation and cancelled their registration with us in September 2015. An interim manager was currently managing the service until a manager was recruited. 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.

At our focused inspection on the 26 October 2015, we found that the provider had followed their plan and legal requirements had been met.

We found people were receiving the medicines they were prescribed including food supplements. Staff we spoke with were able to tell us about the medicines people had been prescribed including possible side effects. Staff were assessed that they were competent to administer medicines and had received medicines training in the safe handling and administration of medicines.

This unannounced inspection of Real Life Options-96 Harrowdene Road took place on the 11 December 2014. At our previous inspection 01 October 2013, we found the provider was meeting the regulations in relation to the outcomes we inspected.

Real Life Options-96 Harrowdene Road is a care home registered to provide personal care and accommodation for six people who have learning disabilities. On the day of our visit there were five people living in the home. The home is located in Wembley. Public transport and a range of shops are located within walking distance of the 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.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the management of medicines. You can see the action we have told the provider to take at the back of the full version of this report.

The atmosphere of the home was relaxed and welcoming. People participated in a range of activities, and were encouraged and supported to maintain links with their family and friends.

Throughout our visit we observed caring and supportive relationships between staff and people using the service. Staff interacted with people in a friendly and courteous manner, and had a good understanding of each person’s specific communication needs.

Arrangements were in place to keep people safe. Staff understood how to safeguard the people they supported. People’s individual needs and risks were assessed and identified as part of their plan of care and support. People’s support plans contained the information staff needed to provide people with the care they wanted and required.

People were supported to maintain good health. People were provided with a choice of food and drink which met their preferences and nutritional needs. People’s health was monitored and referrals made to health professionals when this was required.

Staff received relevant training and were supported to develop their skills so they were competent to meet people’s needs. Staff told us they enjoyed working in the home and received the support they needed to carry out their roles in providing people with the care they needed.

Staff had an understanding of the systems in place to protect people who were unable to make some decisions about their care and other aspects of their lives. Staff knew about the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

There were effective systems in place to monitor the care and welfare of people and improve the quality of the service.

During the inspection we spoke with all the people who used the service, three care workers, a team co-ordinator and the acting manager. The people who used the service had learning disabilities and were not able to express their views to us. However, some people provided one word answers, gestured, nodded or shook their head in response to the questions that we asked. People who used the service indicated or told us that they were happy living in the home.

Each person who used the service had a plan of care that had been regularly reviewed and included information about the individual support and care that the person needed. People were supported to be involved in decisions about their lives and best interest decisions were made when people were unable to consent about matters to do with their care and treatment.

Numbers and skill mix of staff were flexible to ensure people’s needs were met. Staff knew about their roles and responsibilities in meeting the needs of the people whom they supported. People who used the service approached staff without hesitation and interacted with people in a sensitive and positive manner. People accessed their bedrooms and the communal areas of the home freely.

People’s health, safety and welfare were protected as they received the advice and treatment that they needed from a range of healthcare and social care professionals.

Records were up to date and kept securely.

People who use the service had difficulties in expressing their views due to having learning disabilities. They were unable to give us feedback regarding the quality of the service they received at the home. However, we were able to observe interactions with staff and with each other. We observed that people’s privacy and dignity was respected while they were supported with their morning care routine. People accessed the local community and, we saw that staff treated people as individuals and took time to ensure that people were prepared for their activity that day.

We found that people’s care was reviewed regularly and their needs were met. We saw evidence that referrals were made to involve relevant professionals to ensure people’s well-being when it was needed. Activities were provided according to the various interests of the people who used the service.

Staff told us that they received appropriate training and support in order to provide an adequate level of service.

We saw records that the manager regularly monitored the quality of the service and made appropriate changes to the service to ensure people’s welfare and safety when it was required.

During our visit to Real Life Options - 96 Harrowdene Road we met all the people using the service and spent time talking to them. We asked people questions about what it was like living in the home. Due to their needs most people using the service were unable to speak but made gestures, nodded or shook their head in response to the questions we asked. We also spent a significant part of the visit observing people using the service and their interaction with staff and others.

People told us or indicated they were happy living in Real Life Options - 96 Harrowdene Road. They informed us they liked their bedrooms, enjoyed the food and chose what to eat and wear. People confirmed they had the opportunity to participate in activities of their choice, and received the care and support they wanted and needed. They told us or indicated to us that staff listened to them and were approachable. During our visit people showed signs of ‘well being’. We saw people smiling, laughing and approach staff without hesitation.

Staff spoke of enjoying their job supporting and caring for people at Real Life Options - 96 Harrowdene Road. They told us there was good staff teamwork and they felt supported by the manager and other staff. During our visit we saw staff treat people with respect and interact with them in a positive and sensitive manner.

The manager and records told us that staff received appropriate relevant training to ensure that they had the knowledge and skills to carry out their role in providing people with the care and support that they need.

Records and the manager informed us that the quality of the service was monitored closely and improvements to the service carried out.