The inspection took place on 13 April 2018 and it was unannounced. It was completed by one inspector. At the previous inspection on 7 December 2015 the service was rated good.

9 Victoria Street is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It is a care home registered to support 18 people with learning disabilities. This is a large service which was registered with us prior to the development and publication of Registering the Right Support and other best practice guidance. These state that the service should be designed and developed in line with the values of choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should live as ordinary a life as any citizen.

We found that the planning of the service did not always meet these principles. There were not always enough opportunities for people to plan and achieve their goals. They were not always included in the planning and managing of their home; for example, choosing when and what to eat. When they raised concerns they were not always satisfied with the outcome. Complaints were also not always managed in line with the provider’s policy. Some staff felt that the service was not as person centred as it could be and that when they raised those concerns they were not always listened to.

When people could not make some decisions for themselves these were not always assessed or legal safeguards applied for. This meant that people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.

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 understood their responsibilities to ensure that we were informed of events in line with their registration. They ensured that audits and quality checks were completed so that people received safe care and treatment.

Risk was assessed, reviewed and managed to keep people safe. They received their medicines as prescribed and they were stored and managed well. There were enough staff to meet people’s needs safely and they had been recruited to ensure they were safe to work with people. The risk of infection was also controlled.

People had enough to eat and drink and any specialist dietary needs were catered for. They were supported to attend health appointments and to monitor their health. When specialist support was needed this was sought so that staff provided care in line with national best practice guidelines. Staff knew people well and had caring relationships with them. They respected their privacy and encouraged their independence. Relationships with families and friends were encouraged and developed.

Staff received training and support to do their job well. They maintained care records on a daily basis which highlighted any changes to people’s support and this was communicated clearly.

The environment was being reviewed and modernised to meet people’s needs. Information was displayed in the home in an accessible way for people to understand. There was no one receiving end of life care and so we did not inspect this.

You can see what action we told the provider to take at the back of the full version of the report.

There were 14 people using the service at the time of this inspection. We spoke with 4 people, 3 staff and the manager.

People we spoke with were generally satisfied with the service. One person said, “It’s alright here. They do their best for us, the staff. We go out sometimes. We’ve been to the pub and to a nightclub.” Another person said they usually liked being at 9 Victoria Street, though did not like the behaviour of some other people using the service: “I don’t like it when they start kicking off. I don’t like all the noise and swearing.”

We found that the provider had taken action since our previous inspection to ensure that people were asked for their consent to care and treatment. Where people were unable to give consent, the provider acted in accordance with legal requirements. This ensured that decisions taken were in the best interests of people using the service.

We found that the provider had taken some action to increase the number of staff employed at the service. However, the staffing issues identified at our previous inspection had not yet been fully addressed. There were occasions when staffing had fallen below the planned levels. This meant that the safety of people may have been compromised and they may not have had the support planned for them.

We spoke with two of the people using the service about how they were supported there. We also spoke with three members of social care staff, the deputy unit manager in charge, the manager and the service manager. We read the care plans of three people, to find out more information on the quality of service provided at 9 Victoria Street.

The people we spoke with said that their privacy and dignity was respected at 9 Victoria Street. One person told us, “[Staff] treat me with respect.” They also told us that staff encouraged them to be as independent as possible.

People told us that staff talked things over with them before carrying out their care. However, from reading people’s care records, we found that where people were unable to make informed choices about important life decisions their best interests were not always being fully considered.

The people we spoke with told us that staff respected their personal preferences and they thought that their needs, apart from their social needs, were being met. People told us that the food provided was, “Lovely”, and, “We can get our drinks if we want.”

People gave us mixed views on whether staffing levels were adequate to meet their needs. However, the consistent message from staff was that staffing levels were not adequate.

People were asked for their views. One person told us, “Staff ask if I’m all right…they help me…I like it here.”

There were 12 people using the service at the time of this inspection. We spoke with four people to gain their views of the service. Some people were not able to give their views, but we were able to observe their mood, behaviour and how they interacted with staff. We also spoke with a relative of a person using the service.

People told us they were involved in making decisions about their care and they understood the choices available to them. One person said, “I can make choices what I like to do”. A relative we spoke with told us they were “fully involved” in making decisions about the person’s care. People said their privacy and dignity were respected and we saw evidence of this. We found that people did not always have appropriate support and opportunities to promote their independence and community involvement.

People's needs were assessed and their care was planned and delivered to meet their individual needs. One person said, "I have a care plan in the office. I sit with staff to help".

People using the service told us they felt safe. We found that people were protected from the risk of abuse by staff awareness and the policies in place.

People told us they were asked for their views about the service and we saw evidence of this. However, we found that there was no formal system for gathering and evaluating the views of people using the service, their representatives and staff.

There were 13 people using the service during our inspection visit. We spoke with seven people to gain their views of the service.

People told us they liked the staff at the service. They said “they talk to me ok” and “staff are nice”.

People told us they would like help to be able to live more independently. One person told us they had been at the service for several years. They said “It was for a bit but it’s been a long time”. Another person knew they were moving on soon and said they had been “waiting for years” for this to happen. They said they were not sure what was happening because they had not been involved in a plan.

People told us there was not enough for them to do and they were bored. One person told us ”We used to do things years ago here and then it all stopped”.

Most people said they would talk to staff if they felt unhappy about anything, although two people said they did not know who they would talk to.

9 Victoria Street Care Home provides accommodation for up to 18 people with a learning disability who require personal care.

This inspection took place on 7 and 8 December 2015. The first day was unannounced.

Our last inspection of January 2014 found the provider was not meeting one regulation. This was in relation to staffing. At this inspection we found that the actions we required had been met. There were sufficient staff available and they received appropriate guidance and training to ensure they could meet people’s needs.

There was a registered manager at the service. 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. However, they were absent from the post and an acting manager was responsible for the day to day running of the service, with support from the provider’s other registered managers.

The service was following the guidance in people’s risk assessments and care plans and the risk of unsafe care was reduced. People’s records were up to date and indicated that the required interventions had been undertaken. The records had also been updated to reflect changes in people’s care needs.

People were safeguarded from abuse because the provider had relevant guidance in place and staff were knowledgeable about how to reporting procedure.

Medicines were managed safely.

Consent to care and support had been sought and staff acted in accordance with people’s wishes and legal requirements.

People told us they enjoyed their food and we saw meals were nutritious.

People’s health needs were met. Referrals to external health professionals were made in a timely manner.

People told us the care staff were caring and kind and that their privacy and dignity was maintained when personal care was provided. They were involved in the planning of their care and support.

Complaints were well managed.

People were able to take part in hobbies and interests of their choice.

Systems to monitor the quality of the service Identified issues for improvement. These were resolved in a timely manner and the provider had obtained feedback about the quality of the service from people, their relatives and staff.