10 High Street is registered to provide accommodation and personal care for up to eight people with a learning disability and associated health needs. There were five people living there at the time of our inspection.

This inspection took place on 19 November 2016. At a previous inspection which took place in May 2014 we found the provider was meeting all of the requirements of the regulations we looked at.

There was a registered manager in post who was present throughout 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.

Due people’s complex needs people were limited in what they could tell us verbally about their experiences of living at 10 High Street. From our observations we saw staff members’ approach to people who use the service was kind and caring. We saw that positive praise and choices were offered and that communication was calm and respectful. People were encouraged to make their rooms at the home their own personal space.

People were protected from harm and abuse by staff who had received training in how to recognise, respond to and report poor practice and abuse. Relatives knew how to report any concerns they had about people’s safety and wellbeing and told us they felt comfortable doing so. The risks associated with individual’s care and support had been assessed and plans but in place to manage these. The registered manager had organised their staffing requirements to ensure people had their care and support needs met safely.

The provider had systems in place to ensure that medicines were administered and disposed of safely. Staff completed training in the safe administration of medicines and had their competency assessed All medicines were stored securely.

People were supported by staff who had the necessary skills and knowledge to meet their individual needs. Staff received effective training and supervision to support them in their roles. There were sufficient numbers of staff available to meet people’s care and support needs.

Staff were recruited safely. The provider and registered manager carried out all the required pre-employment checks to protect people from the employment of unsuitable staff.

People’s rights under the Mental Capacity Act 2005 were protected by the provider and staff team. People’s care plans evidenced specific decisions had been made in their best interest when they lacked the capacity to make these. Staff asked people’s permission before care was provided and gave people choices about their support.

People received care and support which was tailored to their individual needs and preferences. Staff knew people living in the home well and treated them with dignity and respect. People had a range of activities they could be involved in. People were able to choose what activities they took part in and suggest others they would like to try. People were supported to maintain relationships which were important to them.

People were provided with support to maintain good health and nutrition. We saw people had their preferred food and drink. Snacks and drinks were available in between meals throughout our inspection.

The registered manager demonstrated good management and leadership skills. The quality of the service was audited and action was taken where improvements were needed. There was good communication between the registered manager, relatives and staff. Relatives and staff said they were comfortable in making suggestions for improving people’s individual care and felt listened to.

At the time of our inspection there were six people living at 10 High Street.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found –

Is the service safe?

People were treated with respect and dignity by staff. We observed people were happy living at the home and that staff treated them well. People were cared for by staff that knew and understood how to support people in a consistent and safe way.

People’s safety was protected and promoted because the service obtained advice and support from other health and social care services that people required in order to meet their needs effectively.

Systems were in place to make sure that the manager and staff learn from events such as accidents and incidents and complaints. This reduced the risks to people and helped the service to continually improve.

Improvements had been made in the maintenance of the home so that people were protected against the risks of unsafe or unsuitable premises. Further work was being planned to make improvements to the environment.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Although no applications had needed to be submitted relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were kept safe from harm.

Is the service effective?

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people’s needs. People were involved throughout these processes. This ensured their needs were clearly identified and the support they received was meaningful and person centred.

Through our observations we saw that staff had built good relationships with people and that people were comfortable in the company of staff. Staff had received training to meet the needs of the people living in the home.

Is the service caring?

Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. Staff were knowledgeable about people's preferences and interests and encouraged people to be involved in meaningful activities.

There was a constant interaction between staff and people in the home; people were involved in conversations with the staff. We observed staff paid attention to people who needed additional support ensuring they were understood. People‘s communication was understood by staff and responded to in a timely way.

Is the service responsive?

People's needs were reviewed regularly and in response to any changing needs. We saw information in people’s records which indicated they had been consulted over the care they received. This meant that information about people’s preferences were gathered and used to plan care to meet their specific needs.

The service worked well with health and social care professionals and services to make sure people received their care in a joined up way.

People using the service, their relatives and staff completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

Is the service well led?

The service had a quality assurance system and records we saw showed that the registered manager monitored people's care needs and the care provided. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

At our last inspection on 12 February 2013 we issued a compliance action. We identified systems were not in place to ensure the quality of the service was regularly monitored. The provider did not have a system for seeking the views of people using the service or their representatives and members of staff.

The provider sent us an action plan which described how they planned to meet the compliance action. At this visit we saw improvements had been made. New systems had been developed to ensure the service was regularly monitored, detailing actions to be undertaken and when completed.

Where issues and concerns had been identified, measures had been put in place to enable them to be addressed.

We looked at the care plans of the seven people living at the service. We observed people being supported throughout the day. We saw that people's privacy, dignity and independence were respected. We also saw in people's care plans that supporting people to make choices had been planned for and people were supported in line with those plans. One person told us "I like it here".

There was evidence in people's care plans of people's needs being assessed, plans being drawn up, implemented and reviewed. We found that individual risks were assessed and plans drawn up to support people.

Staff told us of action they would take if abuse was suspected, witnessed or alleged. We saw staff were trained in safeguarding people. We saw that the provider had submitted one safeguarding referral. We reviewed the records of this referral and found it had been managed appropriately.

We found by looking at staff rotas and training records and speaking with the provider that there was sufficient qualified, skilled and experienced staff to provide care and support for people. We were told by staff that "staff care" and that "continuity is important".

We found the provider did not have a system in place to regularly assess and monitor the quality of service provided. We saw evidence and were told of views not being acted upon by the provider.

People were happy living at the service and were well supported by staff who knew them well. Members of staff understood people’s individual methods of communication. Staff engaged with people, included them in conversations and talked about what was about to happen or asked the person what they wanted to do next.

People were happy living at the service and were well supported by staff who knew them well. Members of staff understood people’s individual methods of communication. Staff engaged with people, included them in conversations and talked about what was about to happen or asked the person what they wanted to do next.