This was an unannounced inspection and took place on 21 June 2017.

The home provides permanent personal care and support for up to two adults with learning disabilities and respite care for up to three adults with learning disabilities. The service is managed by United Response and the building is owned by Thames Valley Housing Association. The home is in Whitton, Middlesex.

At the time of our inspection the home 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 and associated Regulations about how the service is run.

At the last inspection on 3 March 2015 the home met all the key questions and was rated good in each with an overall good rating.

As people using the service had limited verbal communication one relative spoke on their behalf, although we have included some of one person’s comments. We also based our findings on observation of care provided and people’s response to it. The relative we spoke with said that staff treated people with respect, responded to their needs well and that people enjoyed living at Powder Mill Lane. People were supported by staff to choose their activities and in the case of people receiving respite care to continue to attend activities in the community that they would normally attend. There was a variety of activities provided at home, within other homes in the organisation, at an activity hub run by the organisation in Teddington and in the community. People had risk assessments so that they were safe living at the home and doing activities within the community. The home had a warm, friendly and welcoming atmosphere and there was a lot of positive interaction between people using the service and staff during our visit.

The home’s records were up to date, accessible and covered all aspects of the care and support people received, including their choices, activities and safety. The person living at the home permanently had a fully completed care plan that was regularly reviewed and there was appropriate information regarding the two people receiving respite care. This enabled staff to perform their duties in an efficient and professional manner. People’s health needs were addressed and people using the service had access to GP’s and other community based health professionals, as required. The staff team helped people to choose healthy meal options and maintain balanced diets whilst meeting their likes, dislikes and preferences. This enabled them to be protected from nutrition and hydration associated risks. Our observations showed that people liked the choice and quality of their meals.

People using the service were well supported and enjoyed the way staff delivered their care. Skilled staff provided care and support in a friendly and professional way that was person centred. The staff were well trained and readily available to people using the service. Staff said they liked working at the home and had received good training, but would like a little more support from the management team after they had encountered episodes of difficult behaviour by people using the service.

The management team at the home, were approachable, responsive, encouraged feedback from people and consistently monitored and assessed the quality of the service provided. A relative said the management team was approachable, responsive and listened to them.

This was an unannounced inspection that took place on 3 March 2015.

The home provides personal care and support for up to five adults who have a physical and/or learning disability. The service is managed by United Response. The home is in Whitton, Middlesex.

The home 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 and associated Regulations about how the service is run.

In May 2013, our inspection found that the service met the regulations we inspected against. At this inspection the home met the regulations.

People said the home provided a good service and they enjoyed living there. People chose the activities they wished to do. These were group and individual based. The staff team provided the care and support they needed to do them.

We saw that the home had an inclusive, warm and enabling atmosphere. People were enjoying themselves during our visit. The home was well maintained, furnished, clean and provided a safe environment for people to live and work in.

The records were comprehensive and kept up to date. The care plans contained clearly recorded, fully completed, and regularly reviewed information. This enabled staff to perform their duties well.

The staff we spoke with was very knowledgeable about the people they worked with and field they worked in. They had appropriate skills, training and were focussed on providing individualised care and support in a professional, friendly and supportive way. They were trained and skilled in challenging behaviour and de-escalation techniques that they were required to use during our visit. They were well trained, knowledgeable, professional and accessible to people using the service and their relatives. Staff said they had access to good training, support and career advancement.

People were protected from nutrition and hydration associated risks with balanced diets that also met their likes, dislikes and preferences. They were positive about the choice and quality of food available. People were encouraged to discuss health needs with staff and people had access to community based health professionals, as required. Staff knew when people were experiencing discomfort and made them comfortable.

The management team at the home, were approachable, responsive, encouraged feedback from people and consistently monitored and assessed the quality of the service provided.

Our inspection of the 4th October 2012 found that some people were at risk of receiving unsafe care, treatment, support and attention because there was insufficient staff to meet people's needs and because records were not being fully maintained. People who use the service were not being fully protected from the risk of abuse, injury and harm. The provider wrote to us and told us they would make changes within three months by reviewing staff levels, provide staff training and review and maintain records. We found improvements had been made.

During our inspection we asked staff to explain how they provided choice and involved people living at Powder Mill Lane. Staff we spoke with gave examples of helping people choose their clothes and the places they wanted to visit. We spoke with one person who used the service. They told us "I like going to the shops, swimming and the cafe".

Some people living at the home displayed challenging behaviour and two staff had attended an advanced training course to address challenging behaviour, further staff were expected to attend. We talked with several relatives who felt that staff levels were adequate. One person said "I think the staff do a valued job". Another relative commented "staff are fairly consistent".

We spoke with two staff who told us that a lot of work had been done to improve the record management systems in the home. One staff said "everything is more clearly laid out and information has been reviewed".

People living at Powder Mill Lane told us about their favourite activities and special events and the things they enjoyed being part of.

They told us about the visits to local facilities and shops and what they enjoyed about these visits. People told us about the friends they had made at the home.

We spoke with relatives of two people living at Powder Mill Lane who complimented the staff and manager on the support and care they provided to people at the home. They told us that they had seen improvements in their family members overall health and wellbeing.

The provider may wish to note that relatives of people living at the home did not always feel that they were involved or that their feedback was gathered about life at the home and commented that communication was difficult at times. They felt that messages were not always passed on to the manager and said that both involvement and communication could be improved at the home.

Relatives of people living at the home felt that on occasions communication presented difficulties and they could not be sure that information was cascaded or passed to the manager according to their wishes.

Relatives of people living at the home also felt that staffing levels were not always sufficient to secure the safety of all the people living or working at the home. They told us that on occasions people living at Powder Mill Lane had few activities to engage them, apart from watching the television and that arranging health related appointments for people could be difficult.

We met all of the people living at the home. One person told us that they were happy there. People looked comfortable and relaxed. The staff were kind and attentive. We spoke to the local authority quality monitoring team. They told us that they felt the service gave good support to people who live there and that people were well cared for.

We carried out this inspection to see what improvements the service had made in supporting people to meet their needs, safeguarding people and supporting staff. We inspected the home in September 2011 and found that improvements were needed. The manager provided us with an action plan. He has kept us informed about how the service has improved and we have spoken to other stakeholders. We felt that improvements had been made when we visited in February 2012 and that people received the care and support they needed.

During our visit we met one person who lives at the home. They were not able to tell us about their experiences. We spoke to a relative of another person. They told us that they felt the home was well run and that people who live there were happy and well cared for.

However, we found that people at the home were not always being kept safe.