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Inspection carried out on 15 March 2018

During a routine inspection

Angela House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Angela House is registered to provide care and accommodation for up to six adults with a learning disability or autistic spectrum disorder. At the time of this inspection there were four people living at the service, each with their own bedroom. The accommodation comprises a communal lounge, kitchen diner, a sensory room, a small rear courtyard, and communal bathrooms and toilets. The bedrooms do not have ensuite facilities. The house is located in a central part of Hammersmith close to a wide range of amenities, public transport and a large park. This 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.

This comprehensive inspection was conducted on 15 and 21 March, 5 April and 14 May 2018. The first day of the inspection was unannounced and we advised the manager of our plan to return on the second day. We visited the provider’s main office on 5 April 2018 in order to check staff recruitment files and also met with senior management staff at the main office on 14 May 2018, as they wished to discuss matters that had arisen about the service. During the inspection we received information of concern from an external source which alleged concerns regarding to the safety and welfare of people who used the service. There were specific allegations regarding the provider’s management of people’s finances. This information was also sent to the local authority, who met with the provider to discuss these allegations. The provider informed us that they asked the local authority to investigate these allegations through safeguarding procedures, so that an independent judgement could be reached. These safeguarding investigations were in progress at the time we concluded this inspection.

An immediate concern was also raised by the external source about the safety of a specialist bed and mattress allocated to a person living at the care home. This was addressed by a visit from a physiotherapist and occupational therapist employed by the local learning disability partnership. Following their visit, we received written confirmation from the professionals to confirm that the bed and mattress safely met the person’s needs. The external source has subsequently raised other issues to the local authority about the suitability of the bed and mattress.

At our previous comprehensive inspection on 30 January, 6 February and 16 March 2017 the service had an overall rating of Requires Improvement. We had rated effective, caring and responsive as Good, and safe and well-led were rated as Requires Improvement. A breach of legal requirements had been found in relation to staffing levels. Following the inspection the provider wrote to us to state what action they would take to meet the breach of legal requirement.

We undertook an unannounced focussed inspection on 13 October 2017 in order to check how the provider had met its action plan and report on our findings in relation to specific aspects of safe and well-led. We had also received information of concern from an external source prior to the inspection and these concerns were looked into as part of the inspection. Following the inspection visit we had received other information of concern from other external sources and returned unannounced to the service on 21 November 2017 to conduct a second day of this unannounced focussed inspection and look into the additional concerns which had been brought to our attention. We had found that although t

Inspection carried out on 13 October 2017

During an inspection to make sure that the improvements required had been made

We conducted a comprehensive inspection of this service on 30 January, 6 February and 16 March 2017. A breach of legal requirement was found in relation to staffing levels. Following the inspection the provider wrote to us to state what action they would take to meet the legal requirement in regards to the breach. This unannounced focussed inspection commenced on 13 October 2017 and was undertaken in order to check how the provider had met its action plan. We had also received information of concern from an external source prior to this inspection and these concerns were looked into as part of the inspection. Following this visit we received other information of concern from other external sources. We returned unannounced to the service on 21 November 2017 to conduct a second day of this inspection and look into the additional concerns which had been brought to our attention.

At our previous comprehensive inspection on 30 January, 6 February and 16 March 2017 the service had an overall rating of Requires Improvement. We had rated Safe and Well-led as Requires Improvement and Effective, Caring and Responsive were rated as Good. This report only covers our findings in relation to specific aspects of Safe and Well-led. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Angela House on our website at www.cqc.org.uk.

Angela House is registered to provide care and accommodation for up to a six adults with a learning disability or autistic spectrum disorder. At the time of this inspection there were five people living at the service, each with their own bedroom. The accommodation comprises a communal lounge, kitchen diner, a sensory room, a small rear courtyard, and communal bathrooms and toilets. The bedrooms do not have ensuite facilities. The house is located in a central part of Hammersmith close to a wide range of amenities, public transport and a large park.

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 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 time of the inspection the service was being managed by an experienced manager who had applied to the CQC for registered manager status.

At the previous inspection we had found that staffing levels did not demonstrate that sufficient staff were consistently deployed to ensure that people received their care and support in a timely manner. At this inspection we found that the staffing levels were now satisfactory. The staffing levels were planned in accordance with people’s needs and kept under review.

The systems for storing medicines needed to be improved. Although the provider was aware that the temperature of the room used for the storage of medicines was not suitable for this purpose, no actions had been taken to address the problem. Concerns about how the service decanted medicines to the relatives of a person who regularly took breaks away from the service with their relatives were shared with us by the relatives. Although the relatives were offered an alternative system that would have been safer, the relatives were not consulted with or provided with sufficient training about the new medicines system so that they could make an informed decision.

Although the health and safety records we checked were up to date, the cleanliness of the premises needed to be addressed. The structural damage at the service had resulted in the growth of mould in communal areas and we were informed after the inspection that this mould had spread to the bedroom of a person who uses the service.

Staff understood how to protect people from the risk of abuse and confirmed that they had received safeguarding training. Individual risk assessments had been developed in order to reduce identified

Inspection carried out on 30 January 2017

During a routine inspection

This inspection took place on 30 January, 6 February and 16 March 2017. The first day of the inspection was unannounced and we informed the interim manager of our intention to return on the second day. The third day of the inspection was unannounced and was scheduled in order to gather further evidence following our receipt of information of concern. At our previous inspection on 29 October and 3 November 2014 the service had an overall rating of Good. We rated Safe, Effective, Responsive and Well-Led as Good and Caring was rated as Outstanding.

Angela House is registered to provide care and accommodation for up to a six adults with a learning disability or autistic spectrum disorder. At the previous inspection the accommodation was organised so that four people had a single bedroom and two people shared a bedroom. At the time of this inspection there were five people living at the service, each with their own bedroom. The accommodation comprises a communal lounge, kitchen diner, a sensory room, a small rear courtyard, and communal bathrooms and toilets. The bedrooms do not have ensuite facilities. The house is located in a central part of Hammersmith close to a wide range of amenities, public transport and a large park.

The service had a registered manager, who had worked at Angela House for nearly 25 years. 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 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 time of the inspection the registered manager was on an authorised period of absence and had not been working at the service since May 2016. The service was being managed by an interim manager, who was an established manager from another local service operated by the provider.

Staffing levels did not demonstrate that sufficient staff were consistently deployed to ensure that people received their care and support in a timely manner. Observations during the inspection, discussions with different individuals and information sent to CQC signified that there was a distinct level of concern about the difficulties permanent staff encountered. This was due to the regular use of agency staff in an environment where people need consistency of care to meet their complex needs.

Staff were familiar with the provider’s safeguarding policy and procedure, and understood how to protect people from the risk of abuse. Individual assessments were in place to promote people’s independence and mitigate identified risks to their safety and welfare. Staff had been recruited in a detailed manner which ensured, that as far as possible, they were suitable to work with people who use the service. Records showed that staff had received medicines training and staff followed the provider’s policy to safely manage people’s prescribed medicines.

People were supported by staff, who had appropriate training to meet their needs. Newly appointed staff received induction training and their performance was formally monitored, in order to ensure they were suitable to permanently remain at the service. People’s legal rights were protected as staff had a satisfactory understanding of how the Mental Capacity Act 2005 (MCA) impacted on their role and responsibilities.

People were supported to make choices about their food and drinks, and their nutritional needs were monitored. Staff supported people to visit health care professionals, including GPs, psychologists, speech and language therapists and dietitians.

We observed that people had positive relationships with staff, who demonstrated their understanding of people’s individual and complex needs. Staff understood people’s likes and dislikes, and could explain people’s life histories. People were spoken with and treated by staff in a respectful and kind manner a

Inspection carried out on 29 October 2014

During a routine inspection

This inspection took place on 29 October and 3 November 2014. The first day of the inspection was unannounced and we told the registered manager we would return on the second day. At our previous inspection on 27 December 2013 we found the provider was meeting regulations in relation to the outcomes we inspected.

Angela House is a six bedded care home for adults with a learning disability or autistic spectrum disorder. Four of the bedrooms are used for single occupancy and there is one shared bedroom. At the time of this inspection there were no vacancies.

There was a registered manager in post, who had worked at the service for over 20 years. 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.

Staff had been trained about identifying and reporting signs of abuse and there were policies and procedures in place to protect people from harm or abuse. Care plans contained up-to-date, relevant risk assessments, including assessments to support people to safely access community facilities and to support people with behaviour that may challenge the service. We saw that there were sufficient staff to provide people with one-to-one support as required and to take people out. Medicines were stored, administered and disposed of safely, and records showed that staff had received training in regard to the safe handling and administration of medicines.

People received effective care from staff, who had appropriate training and supervision. People were supported to make choices about their food and drinks, and their nutritional needs were monitored. Staff supported people to visit health care professionals, including GP’s, psychologists, speech and language therapists and dietitians. Staff were aware of the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS), which care homes are required to meet.

We observed that people had positive relationships with staff, who demonstrated their understanding of people’s individual and complex needs. Staff understood people’s likes and dislikes, and could explain people’s life histories. People were spoken with and treated by staff in a respectful and kind manner and their privacy and dignity were promoted. For example, people were asked by staff if they were happy to show us their bedrooms and their wishes were respected.

Care plans were regularly reviewed, involving people, their relatives and health and social care professionals. Relatives told us they were asked for their views about the quality of the service and had an opportunity to do so, for example, through attending annual review meetings and completing surveys. There were opportunities for people to take part in a range of activities within the service, and to go out on local trips. During the inspection we saw that staff had enough time to respond to people’s needs in a timely way. Relatives knew how to make complaints and said they were confident that any complaints would be taken seriously.

The registered manager was described by relatives and professionals as being caring and competent. We saw the registered manager interacting well with people who used the service, staff and a visiting relative. The staff told us they felt well supported by the manager. They were supported through regular one-to-one and group meetings, and also used ‘handover’ meetings between shifts. This meant any concerns and important information could be shared with colleagues. There were systems in place to monitor the quality of the service and foster a culture of continuous improvement. There was evidence that learning took place from the results of audits and through seeking the views of relatives and professionals.

Inspection carried out on 27 December 2013

During a routine inspection

We were not able to talk with many of the people living at the home because they were not able to communicate easily but one person who did speak to us said that they liked living there.

On the day of our visit we spoke to four members of staff and looked at the files of four of the people living at the home. We spent time in the house observing the care provided to people. The house had a homely atmosphere and we saw that people were well looked after by staff who understood their needs. Staff were respectful and kind in the way they cared for people and took pride in supporting people to be as comfortable as possible.

We saw that some people needed considerable support with their personal and health care as well as support in managing their learning disability. We saw that care and support was provided safely because risks were identified and was action was taken to minimise these.

We saw that records about people was well organised and kept securely. Medicines were administered properly and stored safely. The provider had carried out the required checks on staff to ensure they were suitable to care for people living at the home.

Inspection carried out on 14 March 2013

During a routine inspection

On the day of the inspection some of the people using the service were not able to communicate verbally. We saw positive interactions between people who use the services and the staff and it was evident that staff knew and understood the needs of the people who use the service. There were health check records for all people who use the service with information showing where and when they had attended appointments. Staff were trained in safeguarding vulnerable adults and all staff were aware of the procedure to follow if an incident occurred. There was a policy and procedure in place for how to report any safeguarding concerns, including to the local authority. When staff started at the service they received an induction. Staff undertook mandatory training on an annual basis, including safeguarding and health and safety. There was a procedure in place for them to undergo annual appraisals where their performance would be discussed and targets set for the coming year. Staff at Angela House monitored the services provided to the people living there and conducted health and safety checks to make sure the environment was safe.

Inspection carried out on 19 May 2011

During a routine inspection

On this occasion it was not possible to speak to people who use the services about their experiences.

Reports under our old system of regulation (including those from before CQC was created)