This inspection was unannounced and took place on 18 July 2017.

103 Heath Street provides accommodation and personal care for up to six people who have a learning disability. On the day of the inspection the home was fully occupied.

The home had a registered manager who was present on the day 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.

Practices did not always safeguard people from the risk of harm. However, staff were aware of their responsibility to share concerns of potential abuse with the registered manager. There were sufficient numbers of staff provided to meet people’s needs and they were supported to take their prescribed medicines.

People were cared for by staff who were skilled and supported in their role by the management team. People’s human rights were protected because staff had adopted the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards in their care practice.

People were supported by staff to eat and drink sufficient amounts to promote their health. People were assisted by staff to access relevant healthcare services when needed.

People were cared for and supported by staff who were kind and attentive to their needs and their rights to privacy and dignity was respected.

People were present when their care assessment was carried out and where appropriate their relatives were involved. People had access to a variety of social activities and stimulation. Formal systems were in place to manage complaints so people could be confident their concerns would be listened to and acted on.

People were unable to say how they would like the home to be run. However, people’s relatives had the opportunity to tell the provider about the quality of service provided to people. The home was run by a registered manager who was supported in their role by the compliance and performance manager. Staff were aware of the management team and felt supported in their role. The provider had formal systems in place to assess and monitor the quality of service provided to people.

We inspected this service on 6 May 2015. This was an unannounced inspection. Our last inspection took place in April 2013 and at that time we found the home was meeting the regulations we looked at.

The service is registered to provide accommodation and personal care for up to six people. People who use the service have a learning disability and/or a mental health needs. 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.

People were protected from the risks of abuse because staff understood what constituted abuse and took appropriate action when people were at risk of abuse. People’s care needs were reviewed to meet their changing needs. There were appropriate numbers of staff employed to meet people’s needs. People’s medicines were managed safely.

People were cared for by staff that knew them and understood their needs. Staff had completed training to enable them to provide safe and effective care. They received regular supervision to support them to carry out their roles and responsibilities effectively.

The Mental Capacity Act (MCA) is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The Deprivation of Liberty Safeguards is part of the MCA. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. People who used the service were unable to make certain decisions about their care. Legal requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) were followed to ensure that decisions were made in their best interest.

People were supported to eat and drink suitable amounts of food and drink of their choice. Advice given by professionals on what people on special diets had to eat and drink was followed. People’s health and wellbeing needs were monitored and people were supported to attend health appointments as required.

Care was tailored to meet people’s individual needs. Care plans detailed how people wished to be cared for and supported. People were supported to engage in activities which they enjoyed.

People were treated with kindness and respect. Care was not rushed and staff ensured that people’s comfort was maintained at all times. People’s dignity and privacy was respected.

The preferences and choices of people were respected. Staff understood people’s behaviours and communication styles and knew how to respond to behaviours in order to improve people’s experiences.

People were involved in assessments and planning of their care. The views of their families were obtained about their preferences and likes and dislikes. Staff supported and encouraged people to be as independent as possible and to access the local community.

There were systems in place to monitor and assess the quality of the service provided. The registered manager understood the requirements of their registration with us and they and the provider kept up to date with changes in health and social care regulation. There was a positive and open atmosphere within the service. Relatives and staff told us that the registered manager was approachable and supportive.

In this report the name of a registered manager, Jayne Ann Warrington appears. This manager was present during the inspection, but is no longer the registered manager at this location. The new manager was also present during our inspection. We are awaiting an application from this manager to become the registered manager for this service.

Most of the people who used the service were unable to tell us if they were happy living at the home due to their disabilities. Through a process called 'pathway tracking' we looked at three people’s care records, observed the care those people received and spoke to the staff and their representatives about the care. We did this to see if people’s needs were being met.

Relatives told us they were happy with the care being provided. One relative said, “I can’t fault the staff, they look after my relative brilliantly”. Another relative said, “It's 100% better than I thought it would be. The carers' and the manager are all brilliant”.

We saw that people were offered choices about their care and treatment and when people could not make choices for themselves, staff followed the legal requirements to act in their best interests.

People’s needs were met safely, because an effective recruitment process was in place to ensure that staff were suitable to work at the home.

Care records were informative and accurate, which meant that the risks associated with delivering care to people were reduced.

We spoke with two people using the service, two relatives and five members of staff. People using the service told us that they like living in the home. One person said, “I like everything about living here”. Relatives that we spoke with told us they were happy with the care provided. One relative said, “I am happy with the way that X has come on since living at Heath Street. X is more livelier now and I am happy that X is around people of their own age group”.

During our inspection we saw that people were encouraged to make day to day decisions. We saw that where people were unable to make decisions for themselves the provider did not always act in accordance with the legal requirements that ensure decisions are made in people's best interest's.

We saw that people were supported to engage in appropriate community activities and purposeful activities. People had access to health and social care professionals to ensure there health and well being needs were addressed.

We observed people receiving care and treatment by staff who had the required knowledge and skills to provide the level of care that people needed. Care records were accurate, up to date and were stored securely.

We saw that medicines were stored and disposed of safely, but appropriate arrangements were not in place in relation to the recording of medicine.

We saw that there was an effective complaints system in place to support people using and visiting the service.

People told us that they liked going out into the community. This included trips to Safari Park, Trentham Gardens, train journeys, shopping trips and community restaurants. One person told us that they walked to the nearby shop each day and had many friends, including a girl friend that they visit regularly.

We saw one person access a taxi by wheelchair to go for a GP appointment and told us that they regularly accessed taxis for visiting the community. Taxis are regularly accessed promoting independence and regular accesss to the community.

Three people were not able to communicate verbally but we saw from records, talking to staff and from observations that they were very positively engaging with staff on an angoing basis throughout the day in the home and had the same opportunities for visits and involvement in events outside the home, equal to those described and enjoyed by others.

We observed friendly, sensitive and caring interactions between staff and people using the service.