This inspection took place on 26 April 2018 and was unannounced.

The last inspection was carried out in July 2017. The overall rating for the service was inadequate. We found the provider was in breach of Regulations 12 (safe care and treatment), 9 (person-centred care) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During our comprehensive inspection in April 2018 the service demonstrated to us that improvements had been made and no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Towerhouse Residential Home is a care home situated in Willesden which is registered to provide care to up to eight older people. There were four people at the service, the majority of whom were living with dementia.

A registered manager was not 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 had made some improvements. However, further improvements were required. This is because, the systems and processes for monitoring and improving the service were not consistently effective and had failed to identify some concerns about quality and safety of the service. We also found that peoples' risk assessments did not always contain detail required to support them. Risks had sometimes been assessed as higher than they were in practice. The mechanisms in place to monitor and improve the service had not been effective as they had failed to highlight this. Where improvements had been made, it was too early for the provider to be able to demonstrate that these processes were fully embedded and that these improvements could be sustained over time.

Overall there was a system to ensure that people were safe and protected from abuse. Staff knew how to recognise abuse and how to report allegations and incidents of abuse. There was evidence risks to people had been identified, assessed and reviewed. Recruitment of staff was safe and robust. We saw that pre-employment checks had been completed before staff could commence work. There were sufficient numbers of staff to support people to stay safe. Regular safety checks were carried out to ensure the premises and equipment were safe for people. We also saw there were systems in place to protect people and staff from infection. There were suitable arrangements for the recording, administration and disposal of medicines.

Improvements had been made to ensure people were supported to have choice and control of their lives. Their care records showed relevant health and social care professionals were involved in their care. The service was working within the principles of the Mental Capacity Act 2005 (MCA). Care records held best interest decisions including details of people's relatives who were involved in the decision-making process. The service also followed the requirements of Deprivation of Liberty Safeguards (DoLS), which meant that people were not deprived of their liberty unlawfully.

There were arrangements to ensure that people’s nutritional needs were met. We also saw that people’s dietary requirements, likes and dislikes were assessed and known to staff.

People’s privacy and dignity were respected. Staff understood the need to protect and respect people's human rights. We saw they had received training in equality and diversity. People’s spiritual or cultural wishes were respected. Representatives of local churches visited the service regularly for prayer

Our inspection of Towerhouse Residential Home took place on 25 and 26 July 2017. At our last comprehensive inspection of the home on 20, 24 and 25 October 2016 we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safety, staff training and supervision, compliance with the Mental Capacity Act, care planning and quality assurance. We also found one breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following this inspection we imposed conditions of registration on this provider to stop new admissions and to provide us with quality audit information each month.

Towerhouse Residential Home is a care home situated in Willesden which is registered to provide care to up to eight older people. There were five people living at the home, the majority of whom were living with dementia.

The manager at the home is the registered provider. Registered providers 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 carried out this inspection to check whether the provider had made improvements to quality of care provided. We found that the provider had made some improvements. Staff training was up to date and in accordance with national training standards for staff working in health and social care services. Staff members were receiving regular supervision from a manager to ensure that they were supported in their roles. Improvements had been made to the environment of the home to ensure that people were safe. A range of quality monitoring processes had been put in place. However these had failed to identify and address some issues in relation to the quality of care and support to people living at the home.

At our previous inspection of the home in October 2016 we found that that the provider had failed to take action to ensure that people were always safe. The safety of the home environment had not been assessed and we found a number of trip hazards that had that had not been identified and remedied. Window restrictors did not meet the Health and Safety Executive's (HSE) guidance on window restrictors in care homes. A fire exit had not been alarmed or otherwise secured to ensure that staff members were alerted when a vulnerable person tried to leave the home.

During this inspection we found that a health and safety risk assessment had been put in place. Improvements to the home environment had been made. New flooring had been put in place to reduce the risk of trips and falls. New window restrictors had been put in place which met HSE guidance. The provider showed us a copy of a recent independent fire risk assessment. However, when we examined the fire exit we found that the locks had been changed but no alarm or other security system had been installed. This meant that people could still leave the home undetected by staff and therefore be put at risk.

At our inspection in October 2016 we found that two people did not have care plans or risk assessments in place. Other people’s care plans and risk assessments had not always been updated to reflect changes in their needs. During this inspection we saw that care plans and risk assessments were in place for all five people living at the home. However, these did not always contain any information for staff members about how they should provide care or manage risk to people. Actions to reduce risks in relation to likelihood of pressure ulcers were not always being followed or recorded.

Staff members supported people in a caring and respectful way. They were able to describe their roles and responsibilities in ensuring that the people whom they supported were safe from harm.

At our inspection of the home in October 2016 we had found that there were no formal records of recent safeguarding concerns and these had not been notified to CQC. During this

Our inspection of Towerhouse Residential Home took place on 20, 24 and 25 October 2016. At our last comprehensive inspection of the home on 30 November 2015 we found breaches of regulations in relation to safeguarding of people who lived at the home, training and supervision of staff and the provision of regulatory notifications to CQC. We undertook a focused inspection of the home during June 2016 and found that there remained concerns about training and supervision of staff. In addition, at our inspection in June we also found that the home was not meeting the requirements of the law in relation to safe management of medicines. We served two Warning Notices in relation to medicines and the training and supervision of staff.

We carried out this inspection to check the Warning Notices and also to respond to a serious incident at the home which had been reported to us by a local authority. At this inspection we found that the provider had taken action to address some of our concerns about medicines. However, we identified further issues and we found that staff members had not always received training and supervision.

Towerhouse Residential Home is a care home situated in Willesden which is registered to provide care to up to eight older people. At the time of our inspection there were eight people living at the home, the majority of whom were living with dementia.

The manager at the home is the registered provider. Registered providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection, although people told us that they felt safe, we identified parts of the home which were not safe. The provider had partially addressed concerns about medicines identified in our focused inspection in June 2016. However, we found that there was no internal monitoring of medicines. Medicines were not always given in accordance with the information contained in people’s prescriptions and some prescribed creams and laxatives were not recorded as given when we were told by the registered manager and staff that they had been.

The safety of the home environment had not been assessed and managed. Window restrictors had been put in place but these did not meet the Health and Safety Executive’s guidance on window restrictors in care homes. Actions had not been put in place to address risk to people living with dementia who were at risk of leaving the home. We also found that risk assessments and management plans were not in place in relation to refurbishment of a bathroom at the home and that people were at risk of trips and falls.

People living at the home told us that they were well cared for. However, we found that two people did not have care plans or risk assessments in place, despite the fact that risks associated with behaviour had been recorded in their care notes. Although care plans and risk assessments were in place for other people, they had not always been updated to reflect changes in their care and support needs.

Staff members supported people in a caring and respectful way. They were able to describe their roles and responsibilities in ensuring that the people whom they supported were safe from harm. However, we found that that there were no formal records of two recent safeguarding concerns and these had not been notified to CQC.

The majority of people at the home were living with dementia and were subject to the requirements of the Mental Capacity Act 2005 (MCA). We found that applications for authorisations under the Deprivation of Liberty Safeguards (DoLS) which are part of the MCA had not been made for three people who met the DoLS criteria of being under constant supervision and unable to leave the home unaccompanied.

Staff members told us that they were well supported by the provider/manager. However, a staff member who had been in post for more than a year had not received core mandatory trainin

We inspected Towerhouse Residential Home on 3 June 2016. This was an unannounced inspection. We made a further unannounced visit to the home on 10 June 2016 in order to complete the inspection.

During our previous comprehensive inspection of the home on 30 November 2015 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safeguarding service users from abuse and improper treatment and staffing. The provider had also breached Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.by not providing CQC with a notification in relation to a safeguarding concern. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection on 3 and 10 June 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements. We also looked at medicines at the home following a concern that the provider was not meeting requirements in relation to safe administration of medicines. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Towerhouse Residential Home on our website at www.cqc.org.uk.

Towerhouse Residential Home is a care home situated in Willesden which is registered to provide care to up to eight older people. At the time of our inspection there were seven people living at the home, most of whom were living with dementia..

The home is owned and managed by Mrs Mary Mundy who is registered with us as an individual provider. As she has taken on the role of manager in day to day charge of how the regulated activity accommodation and personal care is provided there is no requirement for a separate manager to be registered with us.

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During our focused inspection on 3 and 10 June we found a continuing breach of regulation in relation to staffing. The provider had failed to take action to improve the level of training and support that was provided to staff members. One staff member had not received training in essential skills including food hygiene, basic first aid, safeguarding and moving and handling. Staff members had not received regular periodic supervision from a manager. This meant that the provider was failing to ensure that all staff members received the training and support that they required to carry out their duties effectively.

There had been no safeguarding concerns at the home since our previous inspection on 30 November 2015. We saw, however, that a notification had been sent to CQC in relation to a minor injury that was sustained by a person that lived at the home.

The administration and disposal of medicines were not safely managed. At our visit on 3 June 2016 we found that medicines were not directly administered to people from the pharmacy-provided packs, but had been placed in unlabelled pots prior to the time when people were due to receive them. The medicines administration record (MAR) was not completed immediately each person had taken their medicines. The manager was about to give a person medicines from a packet that had been prescribed for another person, but did not do so when we intervened.

Medicines were only administered by the registered manager who came into the home when not otherwise working in order to undertake this task. There were no arrangements in place to ensure that people received their medicines if she was ill or otherwise away. Neither the registered manager nor other staff members had received up to date training in the safe administration of medicines.

Unused and out of date medicines were stored at the home. These had not been disposed of, and there was no record in relation to any previous disposals of medicines.

When we returned to the home on 10 June 2016 we saw that medicines were administered to people directly from their

Our inspection of Towerhouse Residential Home took place on 30 November 2015 and was unannounced. We last inspected this home on 17 April 2014 when we found that the service met the regulations that we assessed.

Towerhouse Residential Home is a care home situated in Willesden which is registered to provide care to up to eight older people. At the time of our inspection there were eight people living at the home, the majority of whom were living with dementia.

There was 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 registered manager at Towerhouse Residential Home is also the registered provider.

During our inspection, we found that feedback from people, our observations and most records we looked at demonstrated there were many positive aspects to the service including kind and supportive staff and experienced leadership.

People’s safety was compromised because there was limited evidence that actions were in place to ensure that they were safeguarded from risk or abuse. The staff training records that we looked at indicated that a number of staff members had not received safeguarding training. Although a staff member that we spoke with demonstrated an awareness of their role in keeping people safe, we could not be sure that this was the case for all staff.

The home had not provided a notification to the CQC in relation to a safeguarding concern that had been investigated by the local authority. Notifications of concerns such as safeguarding are a requirement of registration with CQC.

The home’s training records also showed that staff members had not received training in relation to the Mental Capacity Act 2005 (MCA).The home was otherwise meeting the requirements of the MCA. Information about people’s capacity to make choices and decisions was included in their care plans. Applications had been made to the local authority for Deprivation of Liberty Safeguard authorisations to ensure that people with limited capacity were not unduly restricted.

We saw that medicines at the home were well managed. People’s medicines were stored, managed and given to them appropriately. Records of medicines were well maintained.

Staff at the home supported people in a caring and respectful way, and responded promptly to meet their needs and requests. There were enough staff members on duty to meet the needs of people living at the home. People who remained in their rooms for part of the day were regularly checked on.

Staff who worked at the home were generally knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking. All staff members received regular supervision from a manager, and those whom we spoke with told us that they felt well supported. However, we saw that the training records for staff were limited and we could not always ascertain if they had received mandatory training. There was also limited evidence of regular management supervision of staff. This meant that we could not be sure that staff members received appropriate training and support to enable them to fulfil their roles.

People’s nutritional needs were well met by the home. Alternatives were offered where required, and drinks and snacks were offered to people throughout the day. Daily records were maintained of people’s nutritional and hydration intake. Monthly monitoring of weight showed that people maintained a consistent weight for their age and height.

We were able to see some positive examples of caring practice at the home and feedback from people about the care that they received was good. The care plans and risk assessments that we viewed were person centred and provided detailed guidance for care staff about how they should support people’s specific care and support needs and risks.

The home provided a range of individual and group activities for people to participate in throughout the week. We saw that staff members engaged people supportively in participation in activities. People’s cultural and religious needs were supported by the home.

The people that we spoke with knew how to complain if they had a problem and we saw that the home had addressed complaints in an appropriate way. A copy of the complaints procedure was displayed at the home.

Care documentation showed that people’s health needs were regularly reviewed. The home liaised with health professionals to ensure that people received the support that they needed.

There were systems in place at the home to review and monitor the quality of the service. However, the provider had not undertaken a workplace health and safety assessment since 2010.

We have made a recommendation about the need for an up to date health and safety assessment.

Policies and procedures were up to date and reflected regulatory requirements and good practice in care.

People who lived at the home and staff members spoke positively about the management of the home.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.