This inspection took place on 28 and 30 November 2017 and was unannounced. At the last inspection completed on 23 September 2015 we rated the service as good. At this inspection we found the service remained good.

Choices 4 West Street is a care home, people in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Choices 4 West Street can accommodate four people in one adapted building. At the time of the inspection there were four people living in the care home.

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 supported by staff that understood how to protect them from harm and abuse. Risks were assessed and there was guidance for staff on how to support people to manage risks to their safety. The home was clean and all equipment was safely maintained. There were sufficient staff to support people and safe recruitment practices were in place. Medicines were administered safely and when things went wrong the registered manager made sure staff learnt from the incident.

People received support which was effective from trained staff. Staff were supervised and their competency was checked by the registered manager. 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 could choose for their meals and they enjoyed them. People were supported in an environment that was designed to meet their needs and had access to health professionals when they needed it.

People were supported by kind and caring staff. There were positive relationships in place and people felt they were supported to make their own decisions. Relatives and friends were able to visit when they wanted to and people had their privacy and dignity maintained.

People received personalised care and support. Staff understood people’s needs and preferences including their spiritual and cultural needs and were able to plan how they would wish to be supported at the end of their life. People were supported to maintain links in the community and undertake activities. There was a complaints policy in place which people understood and they were confident complaints would be addressed.

A registered manager was in post and was accessible to people, relatives and staff. People were actively involved in the service and shared their views about the quality. There were systems in place to check on the quality of the service and peoples care delivery. The registered manager took any required action to make improvements.

Further information is in the detailed findings below.

We inspected this service on 23 September 2015. This was an unannounced inspection. Our last inspection took place in June 2014 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 four people. People who use the service have a learning disability and/or mental health needs. At the time of our inspection four 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 told us they felt safe and protected from harm. People’s relatives told us that they felt that their relatives were safe in the home. . Staff we spoke with knew what safeguarding was and explained to us what actions they would take if they felt that a person who used the service was at risk of abuse. There was guidance on display for people who used the service and staff on how to raise safeguarding concerns. The provider took appropriate action when abuse was suspected.

People had risk assessments and management plans and there were enough staff on duty to meet their needs. People told us they did not have to wait long when they needed assistance and we observed this. People’s medicines were managed safely.

People told us that staff knew them well and understood their needs. Staff demonstrated a good understanding of people’s care needs and how to provide them care. They had had completed training to enable them to provide safe and effective care.

Legal requirements were followed when people were unable to make certain decisions for themselves. Legal requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) were followed when people were unable to make certain decisions about their care. MCA is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. MCA enables staff to make decisions in people’s best interest. The DoLS 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 were supported to eat and drink suitable amounts of food and drink of their choice. Advice given by professionals was followed in respect of special diets. People were supported to attend health appointments as required.

People were treated with kindness, compassion 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.

Care was provided to meet people’s individual needs and preferences. Care plans detailed how people wished to be cared for and supported. People were involved in assessments and planning of their care. The views of their families were obtained about their preferences and likes and dislikes.

People were supported to engage in activities and hobbies they enjoyed. Staff supported and encouraged people to be as independent as possible and to access the local community.

People were supported to raise concerns and make complaints if they wished to. The provider had systems in place to deal with and monitor complaints made about the service.

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. The registered manager was approachable.

At the time of our inspection there were two people at the service. Two other people were away from the service on a pre planned break. In order to make our judgements we spoke with both people who were available, a member of staff and the registered manager. Following the inspection we spoke with two relatives and two other staff.

We saw that people who used the service were treated with respect and dignity and were involved in activities which brought them into contact with the local community. One person told us, "I work at the office, I file and shred some of the papers and I get paid". Another told us, "I have a bus pass".

We saw people received the care and support that met their individual needs. People had care records that informed staff of how people wanted to be supported. People's personal records were stored appropriately and had been reviewed regularly.

Medication was administered, stored and recorded in line with good practice guidance and managed appropriately.

We saw records which showed that staff received training opportunities and were supported by the registered manager and the organisation. Staff we spoke with confirmed they met with the manager to discuss their practice and training needs.

People's concerns or complaints were listened to, recorded and acted upon to ensure that any concerns were resolved without delay. People who used the services and their relatives told us they knew who to complain to, if they needed to.

As part of this inspection we spoke with two people who used the service, two relatives, three staff members and the registered manager. We also reviewed records relating to the management of the home which included three care plans, daily care records, three staff files, staff training records, serious incident reports and quality monitoring documents.

We used the information to answer the five questions we always ask:

Is the service safe?

Robust safeguarding procedures were in place. Staff were well-trained, understood their role and how to protect people from potential harm. People using the service told us what they would do if they were worried about anything. We saw that each person had watched a DVD with staff about the various forms of abuse and what they should do if they had concerns about their safety.

There were systems in place to identify, assess and monitor risks. Risk management strategies were in place to reduce risks. When control or restraint had been used to protect people, detailed records were kept and reviewed to ensure that restraint was used only as a final option when other methods had failed. People were protected against actions being unlawful or excessive.

We monitor the operation of the Deprivation of Liberty Safeguards 2009 (DoLS) that apply to care homes. Policies and procedures were in place but no applications had been needed or submitted. Staff had been trained to know when an application should be made and the service had previous experience of submitting applications.

We saw that people had been cared for in an environment that was safe, clean and hygienic.

Is the service effective?

Detailed plans of care had been compiled involving people who used the service. Risk assessments and risk management plans were in place outlining the actions to be taken to reduce risks. Care records, including risk assessments had been reviewed regularly with the person to ensure there was a current record of how care was delivered.

The three people we spoke with told us that they were happy with the care provided at the service. People were overwhelmingly positive and complimentary about the staff and we observed good open dialogue and interactions between staff and people using the service. A relative told us, “We couldn’t wish for a better place. Staff are excellent and keep us informed.”

An independent advocacy service was available if people needed support or advice about their care. This had been used previously to assist a person making a complex decision.

Is the service caring?

When speaking with staff and observing their interactions with people it was clear that they genuinely cared for the people they supported. We saw that a regular evening social event had been established by the service and was very successful. We saw that some staff continued to support the event when they were not working.

People made decisions about their lives. They told us they liked daily planned events in the community and that having contacts with their families was important to them. We saw that regular contacts with relatives and friends were built into activity programmes. People told us they liked this.

People’s preferences, interests, aspirations and diverse needs had been recorded in care records. Staff were aware of people’s individual needs and care and support had been provided in accordance with people’s wishes and choices.

Is the service responsive?

People were aware how to make a complaint. There were clear procedures stating how complaints would be handled. Relatives told us that if they asked for information or made suggestions there was always a positive response.

We saw that minutes of staff meetings, house meetings and quality questionnaire responses had been action.This contributed to improvements to the service.

If people’s health or psychological needs changed external health professionals had been contacted. Their advice had been recorded and treatment plans put into place. The contribution by health professionals was an integral part of the care and support that people were given.

We saw that the service had responded to information from people using the service, their representatives and staff. This improved the quality of the service

Is the service well-led?

Regular staff meetings had been held. Staff were able to raise any concerns they had. We saw that regular supervision and appraisals were part of the support staff received. Staff told us that they were listened to.

The service had a quality assurance system and records showed that identified problems and opportunities to change for the better had been addressed promptly. As a result the quality of the service was continuously improved.