About the service: Ruby House provides support to people living in their own bedsits within one building. The service supports younger adults, with a learning disability and or mental health conditions.

The care 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.

People’s experience of using the service: People and their relatives were positive about the care and support they received.

People received care which met their individual assessed needs. Care records included detailed information including how they wished to be supported. People were involved in their care planning.

Staff were committed to providing person centred care, supporting people to maintain their independence. People were kept safe and staff respected their privacy and dignity.

People were supported to take positive risks and were protected from harm and abuse. Staff were knowledgeable about safeguarding and how to support people to be safe.

Staff recruitment procedures were robust and included a range of pre-employment checks.

Staff told us they were well supported, received adequate training, supervision and competency assessments to enable them carry out their job roles effectively.

People were supported to access a range of healthcare professionals. Staff worked in partnership with healthcare professionals to ensure that people received holistic support.

People’s consent was obtained, choices were respected, and people were supported in line with the Mental Capacity Act.

People were treated with dignity and respect and their privacy was maintained.

People were positive about the management of the service. Feedback was requested and used to help drive continual improvement.

The management team had worked hard to make the improvements required since the last inspection.

Rating at last inspection: Requires improvement (report published 21 May 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. During this inspection we found evidence that the service had improved from an overall rating of requires improvement since the previous inspection to support the rating of good at this inspection. More information is in the full report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

This inspection took place on 3 and 5 April 2018 and was announced.

This service provides care and support to people living in a ‘supported living’ setting. So that 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.

Ruby house can accommodate up to a maximum of six people. On the day of our inspection, there were five people living at the service but only two people were receiving the regulated activity of personal care.

The care service had not 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. We found people had limited choice and were not consistently supported to develop their everyday living skills to reach a greater level of independence.

At our last inspection we rated the service requires improvement. At this inspection, the service had made some improvements, in particular in relation to record keeping. However, we found other aspects of the service still required attention to ensure continued compliance with the regulations.

The service has 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.

People were not consistently treated with dignity and respect. This was because the communal areas used by people were not well maintained and did not provide a stimulating environment for people to develop their everyday living skills and help them to become more independent.

Generally, people interacted well with staff and appeared to be comfortable in their presence. However, one person raised concerns about how staff spoke to them. The service manager agreed to fully investigate this concern.

There was no evidence of people being supported to pursue hobbies or explore or engage with topics that were of interest to them. We observed people to be sitting in a communal lounge watching television for extended periods of time.

People were not consistently protected from the risk of infection. The communal areas of the service were not well maintained or cleaned And the provider had not taken sufficient steps to raise this with the landlord of the property.

People were protected from the risk of harm. There were effective safeguarding procedures in place and staff had received safeguarding training.

Risks associated with people’s care and support had been assessed and personalised risk assessments were in place. The assessments provided staff with detailed information on how individual risks to people could be mitigated.

People received their medicines safely. There were effective systems in place for the safe storage and management of medicine and regular audits were completed.

Safe recruitment practices were followed. There were sufficient numbers of staff deployed to meet people's needs. Staff received regular supervisions and felt supported in their roles. Staff completed an induction when they commenced work at the service followed by an on-going programme of training.

Consent was obtained from people before any care or support was provided.

The service operated within the principles of the Mental Capacity Act 2005 (MCA).

People received care and support which was personalised. Care plans and risk assessments gave clear guidance to staff and had been regularly reviewed and updated.

There was an effective complaints procedure. People attended day care and staff supported people with shopping and attending occasional events in the community.

The s

We undertook an announced inspection at the provider’s registered office address Suite B, Kiln House, 15-17 High Street, Elstree. We also visited Ruby House which is the address where people receive support as we were told by the registered manager that some of the documents required during the inspection were kept at Ruby House. The service provides supported living for people with learning disabilities, mental health conditions, physical disabilities, and sensory impairments. At the time of our inspection there was one person using the service, who resided at Ruby House.

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. The service also had a manager who was based at Ruby House on a temporary basis.

There were systems in place to keep people safe from harm. Staff had undertaken risk assessments which were regularly reviewed to minimise potential harm to people using the service. There were appropriate numbers of staff employed to meet people’s needs and provide a safe and effective service. Staff we spoke with were aware of people’s needs, and provided people with person centred care. Staff were well supported to deliver a good service and felt supported by each other and the management team.

The provider had a robust recruitment process in place which ensured that staff were qualified and suitable to work with people who used the service. Staff had undertaken appropriate training and had received regular supervision but we found that staff did not always receive an annual appraisal. Staff had received training on how to administer medicines safely; however there were no medicines audits available for us to review. Staff cared for people in a friendly and caring manner and knew how to communicate effectively with people. Staff supported people well and spent time with them.

We saw that the provider sought consent from people; however, we noted that not enough was done to ensure that people understood what they were consenting to. People were encouraged to be as independent as possible and to make decisions about what they wanted to do with their day. There was a system in place to assist people who were not able to make best interest decisions for themselves, which involved advocates and other professionals. People’s choices were respected and we saw evidence that people, relatives and/or other professionals were involved in planning the support people required. People were supported to eat and drink well and to access healthcare services when required. The provider did not have effective system in place to ensure that complaints were recorded and records were kept in an accessible and safe place .