This inspection took place on the 23 and 24 April 2018. It was an unannounced visit to the service.

Totteridge house is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Totteridge house accommodates people in one adapted building. The home is registered for seven people with a learning disability and other associated conditions. At the time of this inspection six people lived there. The provider confirmed they did not intend to accommodate seven people due to the lack of sufficient communal space available to people.

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.” Registering the Right Support CQC policy.

The service had 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.

At the previous inspection the provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question safe, effective and well-led to at least good.

At this inspection of the service we found improvements were made and the service was providing safe, effective, caring and responsive care. Improvements were required to records and auditing of the service to ensure it was well-led.

The majority of relatives spoken with were happy with the care provided. Relatives felt staff were better skilled to provide safe care. They described individual staff as “caring, brilliant, welcoming and friendly”. One relative was unhappy with many aspects of care and felt Totteridge house was not the right place for their family member. Relevant people involved in the person’s care were aware and it was being looked into.

People were safeguarded from abuse and risks to people were identified and managed. People had positive behaviour plans in place to support staff to manage behaviours that challenged. Accident and incidents were responded to. Debriefing meetings took place following an incident to reflect on actions and improve practices.

The required staffing levels were maintained with the rota managed flexibly to meet people’s needs. Staff were inducted, trained and supported. Person specific training had taken place to improve staff skills and their confidence in supporting people. As a result staff were kind, caring, engaging and more responsive to people. They distracted people and prevented escalation of challenging behaviours.

People’s choices, independence and involvement in their care were being developed. Staff worked to the principles of the Mental Capacity Act (MCA) 2005 but needed to be mindful that other professionals made decisions around medical interventions in line with the MCA 2005.

People’s communication needs were identified and person centred tools e.g. pictures, signing and talking mats were used to promote their understanding and communication. Information such as menus, complaints and fire procedure was provided in an accessible format to inform people. People had access to activities and the service was looking at ways to improve community access for people.

Systems were in place to promote safe medicine administration. People had care plans in place which outli

This inspection took place on 25 and 26 April 2017. It was an announced visit to the service. This meant the service was given 24 hour notice of our inspection. This was to ensure we were able to gain access.

Totteridge House is a care home which provides accommodation and personal care for up to seven people with a learning disability and other associated conditions. At the time of our inspection there were six people living in the home.

The service is required to have 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. A manager was in post since December 2016. They had applied to the Commission to be registered and their application was being processed.

This was the first inspection of Totteridge House since the service had been registered with us. This inspection was a comprehensive inspection to enable us to rate the service.

Some relatives were happy with the care provided whilst other relatives were dissatisfied with the care provided, lack of communication and involvement. Health professionals were also dissatisfied with aspects of the service, management and the lack of partnership working. Recommendations have been made to improve those areas of practice.

Staff were suitably recruited however staff were not inducted and trained to ensure they had the specialist skills and training to meet people’s needs.

Records were not accurate, suitably maintained and up to date. Aspects of the service were audited but auditing was not effective in identifying the shortfalls in the service that we found. The home was not being effectively managed and systems were not established to seek and act on feedback on the service.

Systems were in place to safeguard people but the service was not working to local authority safeguarding procedures. The lack of effective communication between the home, other professionals, relatives, the environment and lack of suitably trained staff meant people were not adequately safeguarded.

The required staffing levels were maintained but staff were not deployed properly to ensure people got the required level of supervision they required at all times. A recommendation has been made to address this.

Risks to people were identified but risks to staff already identified were not managed. Improvements were required to medicine practices and staffs understanding of the medicine they administered to safeguard people. Recommendations have been made to address these shortfalls.

Staff were trained in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However the feedback on their practice would suggest they were not working to the principles of the act. A recommendation has made to address this.

Some staff were kind and caring whilst other staff were less engaging with people. People privacy and dignity was promoted but not consistently maintained by all staff members. A recommendation has been made for the provider to monitor staff practice.

Systems were in place to manage complaints but all concerns were not recorded and managed in line with the organisations policy on complaints. Examples were given to the provider to enable them to follow up with staff.

The home was clean, however there was a delay in making repairs safe. The home had access to contractors to carry out remedial work and there was a 10 year warranty on the building to address any structural issues.

The home was registered for seven people but due to the nature of the challenges people presented with the home did not have sufficient communal space to enable people to have adequate space.

People were offered choices and communication care plans were in place to promote and develo