This inspection took place on 6 June 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. 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 – 17 Norton Avenue 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.

17 Norton Avenue accommodates up to six people in one adapted building. At the time of this inspection there were four 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 well trained staff. Risks were assessed, identified and managed appropriately, with guidance for staff on how to mitigate risks. Premises and equipment were kept clean and tidy. 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 now managed safely, following improvements to the systems in place. The registered manager had systems in place to learn when things went wrong.

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 support this practice.

People were supported by well trained staff and received effective care in line with their support needs. Staff received regular supervision and appraisal which encouraged reflections on their practice with people and what they could do to further improve people’s experiences of receiving care and support. Staff had access to continuous training that was developed and delivered around people’s individual needs.

There was a good choice of food, which people enjoyed and they received support to meet their nutrition and hydration needs and to encourage independence. Staff were committed to supporting people to stay healthy and people achieved excellent outcomes resulting from staff’s commitment.

The environment was designed and adapted to support people effectively, including significant improvements being made to bathroom facilities to improve people’s choice, independence and comfort.

Healthcare professionals were consulted and staff worked collaboratively with them to help manage people’s complex health needs and to promote best practice. People were supported to access a wide range of healthcare services and were empowered to improve their quality of life and health. Innovative support was provided to encourage and support people to remain healthy. Links with health and social care professionals were excellent.

Staff were kind, caring and compassionate with people. People were supported to express their views and encouraged and supported to make their own choices with a range of communication aids. People were treated with dignity and r

We inspected this service on 27 January 2017. This was an unannounced inspection. At our previous inspection in August 2014, we found that the provider was meeting the required standards we inspected them against and the service was rated as ‘Good’.

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

The service had a registered manager. However, staff told us they had left the service in September 2016. 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. The newly appointed home manager told us they were applying to register with us.

At this inspection, we identified two Regulatory Breaches. You can see what action we told the provider to take at the back of the full version of the report.

The provider had not told us about the management changes at the home as required by law.

Risks to people’s health, safety and wellbeing were not always assessed and planned for to ensure people received care that was consistently safe.

People didn’t always receive their prescribed medicines as they were not always available to be administered.

People’s health needs were not always effectively monitored as planned, and advice from healthcare professionals was not always followed to promote people’s health, safety and wellbeing.

The information in people’s care records was not always accurate or up to date to protect them from the risks of receiving unsuitable and inconsistent care.

People’s dignity was not consistently promoted and, people were not always enabled to be involved in making choices about their everyday care. This was because appropriate communication tools were not always available.

People were supported to eat and drink, but this support was not always provided in a safe manner to protect people from the risk of choking.

The new management team had started to assess the quality of care. As a result of this areas for improvement had been identified and plans were being formulated to improve people’s care experiences. Staff spoke positively about changes the management team had introduced and they told us they had confidence in the new management team.

There were enough staff available to provide people with prompt care and staff were recruited in a manner that protected people from abuse.

Staff knew how to identify and report potential abuse and they received training to enable them to carry out their role of delivering care.

The requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards were followed. This ensured that decisions were made in people’s best interests when they were unable to make these decisions for themselves.

People were supported to be independent and people’s right to privacy was respected.

There was a formal complaints procedure in place that was followed when formal complaints were received.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced. This meant the provider did not know we were going to inspect. During the inspection we checked to see if improvements had been made since the last inspection carried out on 23 November 2014 where the service was found to be not meeting legal requirements relating to records.

Choices Housing Association-17 Norton Avenue provides accommodation and personal care for up to six people. At the time of our inspection there were six people living in the home. 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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

There were systems in place to provide safe care for people who used the service. We observed people receiving care and support that reflected what their care records said.

The service ensured staff were supported to develop the skills and knowledge to provide effective care and support for people who used the service. They were properly recruited because the service had robust systems for the selection and vetting of staff. We observed people who used the service where comfortable and happy with the staff who supported them.

There were six people living at the home on the day of our inspection. Five of the people who used the service had difficulty communicating verbally with us due to their complex health needs. We spoke with one person who used the service, observed the care and support people received and spoke with four members of staff. One person told us, “I like to go to the market and shops. The staff take me”.

We saw that staff understood people’s needs and they received support from staff in a caring, compassionate and professional manner. This was because people were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard. We saw that systems were in place to protect people from the risks associated with medicines.

We saw that people were not always protected from the risks of inappropriate care and treatment because accurate and appropriate records were not always maintained. Records were not always kept securely.

During the inspection we spoke with six people who used the service and also the three staff on duty. We checked six health records and three care plans.

We found that health records were well maintained by staff and that the people who used the service said they were involved with contents of their own care plans.

One person told us that the "Staff were their friends", another person told us "That they felt safe here". Staff told us that there was enough staff on duty to look after people properly.

The home was comfortable and felt relaxed, people were given choices of activities to do when we were there. We saw staff help people carry out activities such as sewing, cleaning and reading. Staff helped and assisted people to eat when they required it.

The people who lived in the home communicated in a positive way with the staff. Staff showed that they understood the people who they cared for because they talked and communicated in a way which prompted positive signals and responses from the persons' using the service.

We carried out this review to check on the care and welfare of people using this service as we had not visited for some time. We needed to assess whether the service had been meeting the essential standards of quality and safety.

Six people who have learning disability needs live in this detached house with good access to the Potteries towns.

One person was in hospital at the time of our visit but we saw and spoke with the five people at home. Two people had high dependency needs and need a high level of input from staff to meet their personal care needs.

We spoke also with staff on duty and observed interactions with people using the service. It was clear that staff understood people’s needs and that those needs had been met.

There is a very relaxed atmosphere and people were keen to tell us about life at Norton Avenue. Everyone had an individual activity programme with a range of internal and external activities. People told us they enjoy going out into the community to meet people, they went to social events and parties and had many friends they meet regularly.

We spoke with a visiting physiotherapy team who told us that staff worked closely with them, following established programmes and improving people’s mobility and daily life.