This inspection took place on 17 October 2018 and was unannounced.

At the last inspection the service was rated as requires improvement. We found the provider was not meeting all the requirements of the law by ensuring people were safeguarded from potential abuse and notifying us of changes at the service which are required by law. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve to at least good. During this inspection we found that the provider had done what they said they would do and were no longer in breach of regulations.

Choices Housing Association Limited – 1 William 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.

1 William Street accommodates up to six people, who may have learning disabilities in one adapted building. At the time of this inspection there were five people using the service.

The 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.

There was a registered manager in post at the time of the 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 were protected from avoidable abuse and harm by trained staff. Staffing levels were sufficient to meet people's needs and staff had their suitability to work in a care setting checked before they began working with people. Medicines were managed safely, so that people received their medicines as prescribed. Risks were assessed, identified and managed appropriately, with guidance for staff on how to mitigate risks. Premises and equipment were kept clean and tidy. The registered manager had systems in place to learn when things went wrong.

People’s needs and choices were effectively assessed. People were supported by trained staff and received effective care in line with their support needs. Staff received regular supervision and had access to continuous training. People had a choice of food which they enjoyed and they received support to meet their nutrition and hydration needs. The environment was designed and adapted to support people effectively. Healthcare professionals were consulted as needed and people had access to a wide range of healthcare services. 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.

Staff were kind, caring and compassionate with people. People were supported to express their views and encouraged to make their own choices, as staff met their individual communication needs. People were treated with dignity and respect by staff who knew them well.

Staff understood people and their needs and preferences were assessed and regularly reviewed. People were supported to participate in activities that they preferred. People and their relatives were involved in the planning and review of their care. People's diverse needs were considered as part of the assessment and care planning process. People felt confident to raise any concerns or complaints and there was an accessible complaints policy and procedure in place. People were supported to consider their wishes about their end of life care.

A registered manager was in post and was freely available

We inspected this service on 31 August 2017. This was an unannounced inspection. At our previous inspection in September 2015, we found that the service met the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service is registered to provide accommodation and personal care for up to six people. People who use the service have a learning disability. At the time of our inspection six people were using the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

We found that improvements were needed to ensure that people consistently received safe care. This was because; local and national safeguarding guidance was not followed to ensure people were protected from the risk of abuse and neglect. Concerns were also identified in regards to the recording of medicines administration, night time staffing levels and access to on call management cover.

Improvements were also needed to ensure that the systems in place to assess and monitor the quality and safety of care were consistently effective and notifiable incidents were not always reported to us.

We found that staff were recruited safely and they received regular training that provided them with the knowledge and skills to meet people’s needs.

People’s health and wellbeing needs were monitored and people were supported to access health and social care professionals as required. People could eat meals that met their individual preferences.

Staff supported people to make decisions about their care and when people were unable to make these decisions for themselves, the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed to ensure people’s rights were protected.

People were treated with care, kindness and respect and staff promoted people’s independence and right to privacy.

People were supported and enabled to make choices about their care and the choices people made were respected by the staff.

People were involved in the assessment and review of their care and staff supported people to access the community and participate in activities that met their individual preferences.

Staff sought and listened to people’s views about the care and action was taken to make improvements to their care. People understood how to complain about their care and a suitable complaints procedure was in place.

People and staff told us that the registered manager was supportive and approachable.

We inspected 1 William Street on 9 September 2015, and it was unannounced.

The service is registered to provide accommodation and personal care for up to six people. People who use the service predominately had a learning disability. At the time of our inspection there were five people who used the service.

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 and associated Regulations about how the service is run.

People’s risks were assessed in a way that kept them safe whilst promoting their independence. People were kept safe because staff understood people’s individual risks and provided support whilst taking action to lower the possible risk of harm to people.

People who used the service received their medicines safely. Systems were in place that ensured people were protected from risks associated with medicines management.

We found that there were enough suitably qualified staff available who were trained to carry out their role. The registered manager made changes to staffing when people’s needs changed.

Staff had a good knowledge of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA and the DoLS set out the requirements that ensure where appropriate decisions are made in people’s best interests where they are unable to do this for themselves. People’s capacity had been assessed and staff knew how to support people in a way that was in their best interests.

People were supported to remain healthy and had access to health professionals when they needed to.

People told us and we saw staff were kind and compassionate with people. We saw staff treated people with respect, gave choices and listened to what people wanted.

People’s preferences in care were recorded throughout the care plans and we saw that people were supported to be involved in hobbies and interests that were important to them.

People knew how to complain and the provider had a complaints procedure that was available to people in a format that they understood.

Staff told us that the registered manager was approachable and supportive. The registered manager and staff all had clear values and were enthusiastic about their role and what their support meant for people.

People, relatives and staff were encouraged to be involved in the improvement of the service and action was taken to make improvements from feedback received. The registered manager had systems in place to assess and monitor the quality of the service provided.

On this routine unannounced inspection we spoke with all five people living at William Street, two relatives, four members of staff and the manager.

We considered all the evidence we had gathered under the outcomes we inspected. This is a summary of what we found:

Is the service safe?

A person using the service told us that they felt safe in their home. A relative told us, "Staff are well trained and know what X needs. They are spot-on about safeguarding." The relative told us about a safeguarding issue the service had identified in the past. Safeguarding is protecting people's wellbeing and human rights, enabling them to live free from harm, abuse or neglect.

Each person had a health action plan that outlined the actions to be taken to promote and maintain good health. Referrals had been made to health professionals and their advice and treatment plans had been recorded.

Risk assessments were in place to identify and reduce risks in relation to people's health and daily living needs. The assessments had been reviewed regularly.

Systems were in place to learn from accidents, incidents, complaints and investigations. This improved the quality of the service.

The design and layout of the service provided spacious accommodation that was safe and well maintained. Security systems ensured the building was safe at all times and plans were in place for foreseeable emergencies.

We monitor the operation of the Deprivation of Liberty Safeguards 2009 (DoLS) which apply to care homes. Correct policies and procedures were in place and staff knew how to make applications. No DoLS were in place at the time of our inspection. One application had been made to restrict access to the kitchen for one person to ensure their safety. The local authority, that determine the applications, decided that the matter was being dealt with appropriately by the service to manage the risk and a DoLS restriction had not therefore been needed.

Is the service effective?

People's needs were assessed prior to moving to live at William Street. Care plans were reviewed regularly to ensure people's needs continued to be met

People were involved in planning their care. If they did not have capacity, relatives were involved to ensure their best interests were followed.

The design and layout of the building provides suitable and safe surroundings. The building has been adapted to support people with physical impairments. Ongoing maintenance and upgrading of the facilities means that people's physical needs could be met appropriately and safely.

There were effective staff recruitment procedures in place with checks to ensure that people were protected from potential harm by unsuitable staff.

Disciplinary action had been taken in relation to members of staff when practice had fallen below acceptable levels. .

Is the service caring?

Some people with complex needs were unable to share with us their views of the service. We observed that staff engaged well with people who responded positively expressing their views by non-verbal means. People seemed happy and comfortable with staff who involved them in our inspection. Staff were able to confirm written information we had seen detailing people's personal preferences about the way they wished to be supported.

A relative told us, "X has settled well and loves it here. Staff listen to concerns and take action". Another relative told us, "We are immensely happy with the way X is cared for. Staff are well trained and know what X needs."

Is the service responsive?

A person living at William Street and a relative we spoke with were aware of the complaints procedure. A relative told us that the service had responded to issues they raised.

When people's health care needs changed external health professionals were contacted. Their actions and recommendations had been recorded and acted upon.

Minutes of residents and staff meetings showed that actions had been taken to make changes to the service when needed. Staff told us that they felt confident in raising any concerns they had about the service.

Is the service well-led?

Systems were in place to monitor the quality of the service. We saw that shortfalls had been identified and addressed. This ensured the provider was able to protect people against the risks of inappropriate or unsafe care.

Regular staff meetings were held. Staff told us that they felt listened to and could raise any areas of concern.

Staff were clear about their roles and responsibilities. They felt supported with training and supervision and told us they could speak to the manager at any time.

One person we spoke with said, "I like it here, it's where I live". Not everybody was able to tell us about their experiences because some people using the service had complex needs which meant they were not able to tell us what they thought. We used a number of different methods to help us understand the experiences of people using the service. We spoke to the relative of one person, who told us, "I am very confident that my son has the best care". We spoke with staff and observed care practices and how people's needs were met.

We observed that people were treated with dignity and respect. Staff were courteous and respectful when talking to people who used the service and it was clear from the interactions we observed that people were comfortable in their environment.

We checked how people's care needs were assessed and met. Information in the care records was centred around the person and individualised to their personal circumstances. There were clear and detailed plans of care in place that had been reviewed with the person and their supporters/relatives.

We looked to see if there were systems in place to maintain good standards of hygiene and infection control. Information available showed how regular audits of the environment and equipment meant that people were cared for in a clean, hygienic environment.

We checked that medication was managed and stored safely to ensure that any associated risks were reduced, and we checked that staff were supported.

We carried out this inspection as part of our schedule of inspections to check on the care and welfare of people who used this service. The visit was unannounced, which meant that the registered provider and the staff did not know we were visiting. During our inspection we spoke to three of the people who used the service and to three staff. We observed interactions and looked at records including two care records.

People we spoke with told us that they could make choices for themselves and there was evidence that their capacity to consent and to make decisions had been assessed. People said they felt that they were consulted about the things that happened and felt supported when they made day to day decisions.

We saw that people’s personal and health care needs were assessed and plans were in place to ensure that staff had the information they needed to meet people’s needs and potential risks were reduced.

We saw that people knew how to make a complaint and how to report if they were unhappy or didn't feel safe. This meant that the service had ensured people had received information they needed to ensure their safety and welfare.

During and following the inspection we spoke to three relatives. They were positive about all aspects of the service.

People using the service spoke to us throughout the visit, they made positive comments about their care experiences and of the staff team supporting them.

Family and friends could visit the home whenever they wanted, and confirmed that they were welcomed in the home.

People were happy with the meals provided and told us, “The food is alright.” We observed that people were able to choose their food and help to prepare and make their meals.

People knew how to make a complaint and told us they did not have any concerns about the home, but would talk to staff if they did. People who use the service and their carers were asked for their views on the quality of care in the home.

One person said, ‘I like my key worker and like my room.’ We observed that the home was clean and well maintained.

We saw that staffing numbers were sufficient to meet people’s needs and observed positive interactions between people using the service and the staff supporting them.