About the service: Choices Housing Association Limited - 40 Stafford Avenue is a residential care home providing personal and nursing care to five people with a learning disability at the time of the inspection.

Registering the Right Support has values which include choice, promotion of independence and inclusion. This is to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen. The home was meeting the principles of this policy.

People’s experience of using this service:

People were safe and received effective care. Staff had the skills to support people with meeting their needs. People were protected from the risk of abuse and risks to safety were assessed and managed.

People received support from kind and caring staff who knew them well and understood their preferences. People had their privacy and dignity respected and were encouraged to make decisions and choices for themselves.

People were supported to follow their interests and were involved in planning their care and support.

People had their views sought about the care they received and they were listened to. There were systems in place to monitor the quality of care and these were effective in identifying improvements.

The registered manager encouraged a positive culture and understood their responsibilities. Learning and partnership were encouraged and promoted to improve people’s quality of life.

The service met the characteristics of Good in all areas; more information is available in the full report below.

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

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 5 September 2017).

Why we inspected: This was a scheduled inspection based on previous rating.

We inspected this service on 26 July 2017. This was an unannounced inspection. At our previous inspection in August 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 five people. People who use the service have a learning disability. At the time of our inspection five men 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 were consistently protected from risks to their health, safety and wellbeing.

Improvements were also needed to ensure that the systems in place to assess and monitor the quality and safety of care were consistently effective.

People were protected from the risk of abuse because staff knew how to recognise and report potential abuse. People’s medicines were managed safely.

Safe staffing levels were maintained to promote people’s safety and to ensure people participated in activities of their choosing.

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.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

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. The registered manager understood the requirements of their registration with us and they notified us of reportable incidents as required.

This inspection took place on 11 August 2015 and was unannounced. Our last inspection took place in May 2014 and at that time we found that the provider was meeting the regulations that we inspected against.

40 Stafford Avenue is registered to provide care and accommodation for up to five people. People who use the service have a learning disability. At the time of our inspection, five 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. The registered manager was absent at the time of this inspection and the provider had arranged for a manager from another service to manage 40 Stafford Avenue until the registered manager returned.

People’s safety was maintained because people’s risks were assessed and plans were in place to minimise risks whilst also promoting people’s independence and freedom.

Systems were in place to ensure that people were protected from avoidable harm and abuse. Staff had been trained to understand different types of abuse and how to recognise signs of abuse. They were aware of the safeguarding adults procedures and how to report concerns so that people were protected, and we saw that this had been done when required.

There were sufficient numbers of staff to deliver safe care and support people who used the service. We saw that people were supported to attend appointments and access the community. Medicines were stored, managed and administered safely so that people got their medicines as prescribed.

Staff were supported to develop their knowledge and skills and training was provided to ensure they could support people effectively. Staff had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and the principles of the Act were being followed to make sure that people's rights were respected.

People’s health needs were met because they were encouraged to be involved in reviews of their needs and referrals to healthcare professionals were made promptly when needed. People had enough to eat and drink and were offered choice and flexibility about their food and drinks.

People were treated with kindness and compassion by staff who knew their preferences and goals. People were encouraged to be involved in making decisions about their care and support and staff communicated effectively with each individual to ensure their voice was heard.

People’s privacy and dignity was respected and they were encouraged to be independent and participate in the local community.

People received personalised care and were enabled to follow their hobbies and interests. Staff were proactive in supporting people to be involved in work and learning opportunities.

People knew how to complain and there was an accessible easy read complaints procedure available that people knew about. Staff listened to peoples comments and were aware of the complaints procedure.

There was a friendly and supportive atmosphere at the home and staff enjoyed working there. Staff felt supported by the managers and were involved in developing the service.

The manager completed quality monitoring and checks and acted upon any issues identified. The manager was aware of the conditions of their registration with us.

On this routine unannounced inspection we spoke with the five people living at Stafford Avenue, two relatives, two members of staff and the manager.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found:

• Is the service safe?

Robust safeguarding procedures were in place. Staff understood their role and were able to tell us how they would report any concerns regardless of how minor they may seem. Staff understood how to safeguard people from potential harm.

Restraint is sometimes necessary to protect people from harm. It is used only as a final option when other methods have failed. Incidents had been clearly recorded, reviewed by the manager and the provider. Checks ensured that restraint was lawful and not excessive.

Policies and procedures were in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). This applies where a person's liberty may be restricted, usually to protect themselves or others. No applications had needed to be submitted in relation to DoLS. Staff had been trained to understand when an application should be made to protect people.

The provider made all the appropriate checks on staff before their full employment commenced. This protected people from unsuitable staff and potential harm.

• Is the service effective?

People had been involved in establishing their personal plans of care. Plans had been reviewed regularly involving the person, their representative, staff and other professionals involved in their care. This meant people’s current needs were recorded and known to staff.

Each person had a health action plan to promote their health and wellbeing. We saw that a range of external health professionals had been involved in assessments and provided treatment plans to ensure people’s health care needs were met.

People had been asked to sign to confirm their consent to some aspects of care, however they had not signed their care plans giving consent to care, treatment and support. The provider is asked to note that people should give consent to all aspects of care, treatment and support before it is undertaken.

• Is the service caring?

Staff engaged in meaningful conversation with people and treated them with dignity and respect. We saw that people were responsive to this. We observed examples of staff successfully using diversionary methods to avoid potential difficult situations when people’s behaviours changed.

A relative we spoke with told us, “This is the best care that X has had. Staff are friendly and provide excellent care. X is strong-willed but staff know how to deal with this. X is settled and very happy”.

People’s preferences, choices, interests and aspirations had been recorded and were known to staff. Care and support had been provided in accordance with people’s wishes,

• Is the service responsive?

People had access to activities that were important to them and that they enjoyed. They had been supported to maintain relationships with their friends and relatives. A search for a former friend of a person without relatives had been pursued and contact established. This had been a positive factor in the life of the person.

We saw that minutes of staff meetings and residents meetings had been actioned to improve the quality of the service.

People using the service and relatives were aware how to make a complaint. There was a pictorial complaints procedure so that people understood the message. The procedures stated how complaints would be handled. No complaints had been received since our last inspection

• Is the service well-led?

Regular staff meetings had been held. Staff felt able to raise any concerns in meetings, supervision or on demand day-to-day. Staff told us that the manager or senior person was always available to them.

The provider has a quality assurance system in place. Records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they had a comprehensive training programme that equipped them well to meet people’s needs. They said that they were clear about their responsibilities and they had a good understanding of the ethos and values of the service.

Some of the people who used the service were unable to tell us if they were happy living at the home because their ability to communicate was limited. Through a process called 'pathway tracking' we looked at two people’s care records, observed the care those people received and spoke to the staff. We did this to see if people’s needs were being met.

Care records were personal to the individual, provided detailed information about their needs and were reviewed regularly. This meant that the risks associated with delivering care to people were reduced.

The environment was maintained to a good standard and facilities were appropriate for the people that used the service. Regular audits of the property ensured it was safe for people to use.

The staff we spoke with confirmed that they had received suitable induction and training to enable them to support people appropriately.

Records kept in the home were informative, accurate and regularly reviewed to ensure they provided an upto date account of people's needs.

We carried out this inspection as part of our planned schedule of visits. The inspection was unannounced which means the service did not know we were going to visit.

There were three people who used the service in the home when we arrived. We were not able to engage in discussion because people chose not to or were not available. We did however hold brief conversations with two people, observed interactions and spoke with three staff. Following our visit we spoke to a relative who commented, "My relative moved to Stafford Avenue approximately two years ago he was involved in making the decision to move there."

Through a process called 'pathway tracking' we looked at care plans, to establish the care people required and if it was being delivered according to the individual’s wishes.

The service had systems in place to ensure that staff understood their responsibilities in safeguarding (protecting vulnerable adults) and reported concerns appropriately.

Systems were in place to ensure people’s medication was managed and recorded appropriately.

Staff told us they were supported and had the opportunity to meet with the manager regularly. Staffing levels at times did not provide sufficient support to ensure people's safety.

We found systems were in place for auditing and monitoring the service. This meant there was ongoing quality monitoring of the service to ensure that people continued to receive effective and appropriate care.