About the service: Arbour Street is a residential care home which is registered to provide accommodation and personal care for three people with learning disabilities. Accommodation is provided over two floors. The home provides personalised care to meet the needs of people in their own home and the wider community. At the time of the inspection three people were living at Arbour Street.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

The service provided individualised care and support in accordance with best-practice. People’s experience of living at the home was positive. The people that we spoke with told us that they were happy with the care and support provided and did not want to change anything about the service.

People were cared for by staff who knew them well, understood their needs and provided effective care to keep them safe. Risk was subject to regular review and was effectively managed. People received their medicines as prescribed from trained staff. The home was clean and well-maintained.

Staff received regular training and support and were equipped to provide effective care. Care was provided in-line with best-practice guidance and legislation. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

People spoke positively about the staff and the way in which care was provided. Staff treated people with kindness and respect and supported their dignity in a sensitive manner. People were encouraged and supported to maintain their independence. They were actively involved in decision-making regarding their own care and developments within the wider home.

Care was personalised and met the needs of each individual. Care records captured important information regarding people’s histories, families and preferences. This information was used to tailor the provision of care to meet each person’s needs. There were no complaints recorded in the previous 12 months.

The registered manager, provider and staff promoted an open, positive culture with a focus on high-quality, person-centred care. The registered manager and provider made effective use of audits and other sources of information to review and improve practice. The home had forged links with other services and resources in the local community to support further development.

More information is provided in the full report.

Rating at last inspection: Good (report published 16 November 2016)

Why we inspected: This was a scheduled inspection based on the previous rating from the last comprehensive inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This was an unannounced inspection which took place 25 October 2016. The inspection was carried out by an adult social care inspector.

Arbour Street is a care home, providing care and support for up to three people with a learning disability. It is situated in a residential area of Southport. The house has two spacious lounges and separate dining room. The first floor has three bedrooms and a bathroom. The home is owned by Speciality Care [Rest Homes] Limited.

The service had 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 staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training and this was on-going.

We reviewed the way medication was managed. We saw there were systems in place to monitor medication so that people received their medicines safely.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We found recruitment to be well managed and thorough.

We found there were enough staff on duty each day to keep people safe and to be able to access the community.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

Arrangements were in place for checking the environment to ensure it was safe. We found the environment safe and well maintained.

Staff received a regular programme of training and support, through regular supervision and appraisals.

The principles of the Mental Capacity Act 2005 were followed for people who could not consent to care and treatment. We saw that an assessment of a person’s mental capacity was made and decisions made in a person’s best interest in consultation with health professionals and family members.

The registered manager had made appropriate referrals to the local authority applying for an authorisation to support a person who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

Care records showed that people’s health care needs were addressed and contact with external health care professionals was made when needed. We saw that the registered manager and staff liaised well with community services to support the person who lived in the home.

People’s dietary needs were managed with reference to individual preferences.

People living in the home took part in a range of activities of their choice. They were supported to develop and maintain relationships.

Care and support plans were formulated and were current to meet people’s needs. We saw that the people living in the home were involved in their care planning and decision making on a day to day basis.

Family members of people living at Arbour Street told us that staff had the skills and knowledge needed to ensure their relative received the right support. Relatives were satisfied with their family member living in the home and the quality of life they enjoyed.

We saw some examples in care planning documentation which showed evidence of people’s input. One person who lived in the home confirmed they had sat with the registered manager to update their person centred plan. The use of photographs in the document enabled the person to understand its content.

There was a complaints procedure in place and a record was made of any complaints and these had been respon

Our inspection was carried out unannounced. As part of the outcomes we followed up on two areas where the home needed to make improvements following our last inspection in June 2014. The inspection helped answer some of the five questions we ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We conducted a responsive follow up inspection and we did not look specifically at this outcome.

Is the service effective?

We looked at how the staff protected people’s rights and welfare in accordance with the Mental Capacity Act [2005]. The Mental Capacity Act [2005] is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. An assessment tool had been used to measure and record people’s mental capacity to make individual decisions about the care, treatment and support. A multi-disciplinary approach was used so that people who lived at the home were protected by effective assessment and consent procedures. This is of particular importance as the service provides support for people with a learning disability.

The Mental Capacity Act [2005] also includes further legislation called Deprivation of Liberty Safeguards [DoLS].These are legal requirements to ensure decisions to restrict the liberty of people who may lack capacity, are made in their best interests. The provider may find it useful that at the time of our inspection the service had yet to make an application under the DoLS for people who lived at the home. Following our inspection however we were informed by a senior manager that DoLS applications were being sent to the local authority. DoLS are in place to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

Is the service caring?

We conducted a responsive follow up inspection and we did not look specifically at this outcome.

Is the service responsive?

We conducted a responsive follow up inspection and we did not look specifically at this outcome.

Is the service well-led?

The service had a quality assurance system. This included both a number of audits [checks] by the manager and senior managers within the organisation. The audits showed us areas of good practice and also areas that needed improving. We saw actions plans to address these issues.

The manager was in new post and was in the process of applying to the Care Quality Commission [CQC] for the position of Registered Manager.

This was an unannounced inspection of Arbour Street care home. The inspection set out to answer our five questions:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with two people who lived at the home, staff providing support, the Regional Manager, looking at care records and records related to the management of the service.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The Mental Capacity Act (2005) is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. Staff informed us that nobody was subject to a Deprivation of Liberty Safeguards (DoLS) application or plan. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

At the inspection we found there was not a clear system in place to assess and record people’s mental capacity and agreement to treatment and care. Therefore this increased the risk that people's rights and welfare were not protected. We have asked the provider (owner) to tell us what they are going to do to meet the requirements of the law in relation to assessing people's capacity to make decisions.

Effective recruitment processes were established. Necessary checks were carried out as part of the recruitment process so that staff were suitable to work with vulnerable adults.

Safeguarding procedures ensured people at the home were protected from abuse. Staff received safeguarding training and were familiar with the safeguarding process they needed to follow should they witness an alleged incident.

Is the service effective?

People who lived at the home confirmed they were happy with the support they received. People's care/support plans recorded how they wish to be supported and information about their preferences and preferred routines. We saw some care documents had not been reviewed recently. However, discussions with staff and our observations showed that staff knew people well and were able to respond to their different communication methods. We observed staff had a good rapport with people at the home and made sure they were happy with day-to-day decisions made. People received support to live the lifestyle of their choice and spend their time as they chose, with appropriate staff support. A person confirmed with us they were very happy living at the home.

Is the service caring?

We observed people who lived in the home being supported by staff who were kind, caring and attentive. Staff did not rush people when supporting them and took the time to ask what they would like to do and to help them with their chosen activity. Staff were able to tell us about people's needs and how they wish to be supported.

Is the service responsive?

Discussions with staff and reviewing care documents showed people at the home received treatment from external health and social care professionals when they needed it. Staff were prompt in seeking advice to help monitor people's health and well-being.

People received support to maintain relationships with people important to them. We observed that staff spent time with people socially, as well as responding to their care and welfare needs.

We saw a complaint file and staff informed us no complaints had been received. The home had a complaints policy and procedure which was available in picture format for people at the home to see. This was not displayed at the time of our inspection and staff confirmed this would be rectified.

Is the service well-led?

We found that the overall monitoring arrangements were not as effective as they could be. A lack of auditing around assuring the service provision meant that issues noted during our inspection had not previously been picked up or acted upon in a timely manner. Examples of this were in respect of the 'on call' staffing arrangements for senior staff in the absence of the Registered Manager and also carrying out work to improve the home's environment for people to live in.

We have asked the provider (owner) to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of the service provision.

Some records were difficult to locate during the inspection however we saw the home was subject to a number of safety checks for equipment and services. This meant it was working effectively and safely.

A monitoring visit took place by senior management as part of assuring the service provision. The Regional Manager confirmed they would be working with the Registered Manager in respect of recommendations made from the latest report for May 2014 to help develop the service.

The manager held regular meetings for staff which ensured they were kept aware of their roles and responsibilities. 'Your Voice' meetings were also held with people at the home. This meant people were involved with the service and how they would like it to be run.

During our inspection we used a number of different methods to help us understand the experiences of people who lived at Arbour Street. This was because the people using the service communicated in different ways and we were not always able to directly ask them their views about their experiences. We spent time with two people who lived at the home. They told us they liked living at Arbour Street. We observed a positive rapport between people who lived at the home and the staff. There was a pleasant relaxed atmosphere and genuine understanding and consideration of people’s needs and how they wished to be supported.

We spoke with an acting manager and three members of the staff team. Staff were knowledgeable regarding people’s care needs and people’s care files recorded the information they needed to provide safe, effective care and support.

People who lived at the home received nutritious meals. A person we spoke with told us they liked helping to cook and choosing what they wanted to eat. We saw plenty of different foods and people had a choice of menu. This was in accordance with individual need and preference.

The home was subject to an on-going programme of decoration and refurbishment to ensure people lived in safe pleasant accommodation.

Sufficient numbers of skilled and experienced staff were available to provide support to people.

Due to the different ways that the people who lived at the home communicated we were not always able to directly ask them their views about their experiences. We however met with two people and spoke with the acting manager, three members of staff and relatives. We also looked at a number of care documents and observed the care and support people received. It was evident people received the care and support they needed in accordance with individual need. We observed good communication and understanding between the members of staff and the people who were receiving care and support from them.

We saw the staff supporting people with different activities throughout the day. Staff were seen to encourage people with daily life skills to promote their independence. There was a relaxed atmosphere in the home and people appeared at ease with the staff. A person told us they liked the home.

The home was decorated to a good standard and was well maintained. Areas seen were clean and infection control procedures were in place to ensure good standards of hygiene.

Staff received training and support, so they had the skills and knowledge to provide safe care to people

The home had a complaints policy and procedure (in picture format), so people who used the service had the information they needed should they wish to raise a concern. Regular meetings were held at the home to ensure people were able to give their views about the home.

We spoke to the registered manager, two staff members and two relatives during the inspection process. People living at this home have limited communication levels. This impacted on the amount of information we could gain about their experiences living there. We relied on initial observations between the staff and people using the service.

In addition to gaining the views and comments of people experiencing the service, we asked other external agencies including social services contracts team and the infection control practitioner. All reported the service was compliant to their standards and regulations.

People living at Arbour Street are encouraged to express their views in their own way and the manager on duty at the time supported this.

There were initially two staff on duty at the time of arrival, however due to the schedule they were not available in the home for discussion as the inspection progressed. Both staff members were supporting people who live there in activities in the community. We later followed this up by talking to two members of staff by telephone, in order to gain a more in-depth view of their experiences of working in this service. Comments included, "I haven't been here that long but I think its a good service to work in." Also, "We work well together as a team, which I think is important."

Two relatives we spoke to told us they were happy with the care their relatives receive. “I am satisfied my relative is getting all the care they need” also, “My relative has lived there for a long time, as have some of the others and they all seem to get on well."