Harrow Council - Bedford House

Since the service's last inspection, they had undergone renovation work and had changed one unit. This unit previously provided respite care and had been renovated to provide care to people with autism. Relatives we spoke with told us that these changes had gone well and people had settled well.

There was a registered manager in post at the time of our inspection. 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 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.

During the inspection we observed care support staff treated people with respect, kindness and compassion. Positive caring relationships had developed between people who used the service and care support staff and people appeared at ease in the presence of care support staff. Relatives we spoke with told us that people were treated with respect and they were well looked after at the service.

There were appropriate systems in place to keep people safe. Staff had received training on how to identify abuse and understood their responsibilities in relation to safeguarding people, including reporting concerns relating to people's safety and well-being. Risks to people had been assessed, updated and regularly reviewed to ensure people were safe and risks to people in relation to treatment or care were minimised.

Appropriate arrangements were in place in relation to the recording, disposal and administration of medicines at the home. We found that medicines were managed safely in the service.

We found that there were enough staff to meet people's individual care needs. On the day of the inspection we observed that staff did not appear to be rushed and were able to complete their tasks. We discussed staffing levels with the registered manager and he explained that there was flexibility in respect of staffing and staffing levels were regularly reviewed depending on people's needs and occupancy levels.

On the day of the inspection we found the premises were clean and tidy. Relatives we spoke with told us that the service was clean and they raised no concerns in respect of this. There was a record of essential inspections and maintenance carried out. The service had an infection control policy and measures were in place for infection control.

Staff demonstrated that they had the knowledge and skills they needed to perform their roles. Staff confirmed that they received regular supervision sessions and appraisals to discuss their individual progress and development. Staff spoke positively about the training they had received and we saw evidence that staff had completed training which included safeguarding, medicine administration, first aid awareness and health and safety,

People's health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented as well as their likes and dislikes. Care plans were reviewed monthly and were updated when people's needs changed.

Staff we spoke with had a basic understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. The home had made applications for DoLS and we saw evidence that authorisations had been granted.

There were suitable arrangements in place to ensure that the nutritional needs of people were met. People's nutritional needs had been assessed and there was guidance for them and for staff on the dietary needs of people and how to promote healthy eating. The service had a five-week menu and we saw that there was a variety of different foods for people to choose from. The registered manager and chef explained that people always had had alternatives to choose from if they did not wish to eat what was on the menu.

We found the home had a management structure in place with a team of care support staff, team leaders, domestic staff and the registered manager. Staff told us that the morale within the home was good and that staff worked well with one another. They told us management was approachable and there was an open and transparent culture within the home and they did not hesitate about bringing any concerns to management.

Management monitored the quality of the service and we saw evidence that regular audits and checks had been carried out to improve the service. Checks had been carried out in relation to audits and checks had been carried at regular intervals in areas such as care documentation, health and safety, equipment, cleanliness of the home, medicines and staff training.

The five questions we ask about services and what we found