This inspection took place on 27 April 2017 and was unannounced. The last Care Quality Commission (CQC) comprehensive inspection of the service was carried out in April 2016. We gave the service an overall rating of 'requires improvement'. We found the provider in breach of one of the regulations. The provider had not maintained up to date and accurate records relating to people and to the management of the service. We also found some aspects of the service were inconsistent. In their assessments of the safety of the environment the provider had not fully documented how they would reduce potential risks to people posed by the premises and equipment. Some aspects of medicines administration did not reflect current best practice. We asked the provider to take action to make improvements in respect of the breach in regulation. The provider sent us an improvement plan in November 2016 and said they had taken all the action needed to meet legal requirements.

Restoration Residential Care Home is a small care home which provides care and accommodation for up to four adults. The service specialises in supporting people with mental health needs. At the time of our inspection there were four people living at the home.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the provider, who was also the registered manager, had taken the necessary action to make improvements needed to meet legal requirements. People’s care records now contained current information about their care and support needs so that people were protected against risks that could arise if this information was inaccurate or out of date. Records were stored securely but easily accessible when staff needed them. The provider had reviewed and updated the service’s policies and procedures and staff now had access to current information on how to undertake their roles appropriately to meet required standards.

We also found improvements had been made to the management of risks at the service. Risk assessments now detailed the measures put in place to minimise injury or harm that could be caused to people by an unsafe environment. The premises and equipment were regularly maintained and serviced to ensure these were safe and the environment was kept clean.

The provider had reviewed and updated management arrangements for medicines. The service’s medicines policy now reflected best practice. There was also now written guidance for staff on how and when to administer ‘as required’ medicines. People received their medicines as prescribed and these were stored safely.

The provider had improved the frequency of their audits and checks of the service to identify any shortfalls in the quality of the service so that prompt action could be taken to address this. They continued to ask for and act on people’s people views about the quality of the support they received and how this could be improved. Surveys were now also sent to healthcare professionals involved in people’s lives to seek their feedback about the quality of the service.

In order to sustain the improvements made, the provider had appointed a deputy manager to provide additional management support and oversight of the service. The deputy manager was well supported by the provider to make any changes that were needed when these were identified.

People were safe at the service. Staff knew how to protect people from the risk of abuse or harm. They took appropriate action to ensure identified risks to people's health, safety and welfare were minimised. The provider ensured there were enough staff to support people and keep them safe. They maintained appropriate

This inspection took place on 28 April 2016 and was unannounced. At the last inspection in August 2014 we found the service was meeting the regulations we looked at.

Restoration Residential Care Home is a small service which provides care and accommodation for up to four adults. The service specialises in supporting people with mental health needs. At the time of our inspection there were three people living at the home.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the provider in breach of their legal requirement with regard to good governance. This was because not all records kept by the service had been maintained in such a way as to ensure these were accurate and up to date. You can see what action we told the provider to take with regard to this breach at the back of the full version of the report.

Assessments undertaken of the safety of the environment had not fully documented all the potential risks to people posed by the premises and equipment within it. Assessments of people’s individual rooms and communal areas in the home did not record some key risks that could be harmful to people. The registered manager confirmed measures were in place to manage these risks. However the lack of information in risk assessments meant there was no record for how the service ensured people were protected from the risk of injury or harm from these risks. Staff demonstrated a good understanding of how to keep people safe from risks posed by the environment. Where risks to people had been identified and documented, plans were in place to minimise these. Staff ensured the premises and equipment were clean, tidy, free from hazards and subject to maintenance and service checks.

Arrangements were in place to check the quality and safety of the service. The registered manager carried out a six monthly review of key aspects of the service. No issues had been identified at the last review in September 2015. However the registered manager acknowledged the frequency of checks needed to be reviewed in light of the issues about the quality of records. The registered manager had been proactive in making improvements when shortfalls in the service had been identified. Following visits made by the pharmacist and London Fire Brigade to the service, they took action to implement recommendations they had made.

People were asked for their views about how care and support could be improved, through surveys and residents meetings. However a survey was last done in April 2015 and minutes from recent resident meetings had not been recorded. This meant we could not gain a consistent view about the current effectiveness of the service in dealing with people’s suggestions for improvement.

The registered manager understood their role and responsibilities and encouraged an open culture within the service. People were satisfied with the care and support they received. People said they were comfortable talking to staff about any issues or concerns they had and they told us they felt listened to. The provider had arrangements in place to deal with any concerns or complaints people had in the first instance. However people were not correctly informed about how they could take their concerns or complaints further. The registered manager was taking action to rectify this.

People were supported by staff to take their prescribed medicines. Medicines were stored safely. Our checks of stocks and balances of medicines confirmed these had been given as indicated on people's records. We also identified there was no written guidance for staff on how and when to administer an ‘as required’ medicine. ‘

At our last inspection of the service on 1 July 2014 we identified the provider had not carried out appropriate checks to ensure people employed by the service were of good character, fit to work with vulnerable adults and had the necessary qualifications, skills and experience.

Following that inspection we asked the provider to take action to achieve compliance with the appropriate regulation. The provider sent us an action plan on 24 July 2014 setting out the steps they had taken to do this. During this visit we checked these actions had been completed.

This visit was carried out by a single inspector who helped answer one of our five questions:Is the service safe?

Below is a summary of what we found. The summary is based on what we saw from looking at records and from speaking with the provider. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found at this visit the provider had ensured appropriate pre-employment checks had been undertaken on staff employed by the service to ensure they were of good character, physically and mentally fit to perform the work and had the necessary qualifications, skills and experience to care for people using the service. We saw the provider had introduced monthly checks of records to ensure correct recruitment processes had been followed when people were employed to work at the service.

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection and from looking at records. We also spoke with the person using the service, their care manager, the provider (who was also the registered manager), and the senior carer.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There was one person using the service at the time of our inspection who told us they felt safe living at the home.

The provider had assessed potential risks to their safety, health and welfare both within the home and in the community and made sure there was appropriate guidance for staff on how to manage these risks, to keep them safe from harm when providing care and support. Staff had also received appropriate information and training on how to protect people from the risk of abuse, harm or neglect.

However people were put at risk of unsafe or inappropriate care as the provider did not carry out all the checks they were supposed to, in respect of staff working at the home. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to recruitment.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted the provider understood when an application should be made, and how to submit one.

Is the service effective?

We saw staff had involved the person using the service in planning their care and support. Their views and experiences had been used to develop their plan of care. Their specific needs were taken into account. Staff we spoke with demonstrated a good understanding and awareness of their needs and in particular, what was important to them. Staff received regular training to support them in their roles, so people could be assured their needs were being met by appropriately skilled and trained staff.

Staff supported the person using the service to keep healthy and well by encouraging them to maintain a well-balanced and healthy diet and through regular exercise. Staff ensured they attended scheduled medical and healthcare appointments so that they got the medical care and attention they needed, promptly.

Is the service caring?

The person using the service told us staff were friendly and nice. They also told us staff encouraged them to maintain their independence by supporting them to do activities and tasks both in the home and out in the community.

Staff we spoke with knew how to maintain people’s privacy and dignity, particularly when providing personal care. From our own observations we saw staff were kind and respectful and asked permission before carrying out any care and support.

Is the service responsive?

The person using the service was positive about the care and support they received from staff. We spoke with their care manager who told us they had noted a positive change in their overall health and wellbeing in the time they had been living at the home. They confirmed they had no concerns or issues about the care and support provided by the service.

Is the service well-led?

The provider had systems in place to monitor the quality of service provided. However it was too early to judge the effectiveness of these as the service has only been operational since April 2014. In the absence of formal quality assurance we found the provider had taken other steps to review and evaluate the care and support provided to ensure the needs of the person using the service were being met.

The person using the service told us their views about how their care and support was provided were listened to by the provider.