We inspected this service on 11 November 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 that we checked them against.

Choices Housing Association Limited - 43 High Street is registered to provide accommodation and personal care for up to five men. People who use the service have a mental health condition and/or a learning disability. 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’s safety was maintained because risks were assessed and planned for and the staff understood how to keep people safe. People’s medicines were managed safely, which meant people received the medicines they needed when they needed them.

There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety. Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

People’s health and wellbeing needs were met and people were supported to attend health appointments as required. People could access suitable amounts of food and drink that met their individual preferences.

Staff showed they understood and applied the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This ensured decisions would be made in people’s best interests if they were unable to make decisions for themselves.

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

People were involved in the assessment and review of their care and staff supported and encouraged people to access the community and participate in activities that were important to them.

People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

There was a positive atmosphere at the home and people and staff were supported by the registered manager.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with us.

As part of this inspection we spoke with four of the five 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 records, daily care records, staff training records, serious incident reports, medication records, staff duty rosters and quality monitoring documents. We used the information to answer the five questions we always ask:

Is the service safe?

People's consent was sought before care and treatment was provided. Where people did not have capacity the provider had followed the principles of the Mental Capacity Act 2005 to ensure that decisions were made in the person's best interests.

There were systems in place to identify, assess and monitor risks. Strategies were in place to reduce risks. Where serious incidents had occurred detailed records had been completed and were reviewed by senior managers to ensure that methods used were appropriate to ensure people's safety. The reviews were used to see if alternative strategies could be used. The service learned from previous incidents.

The medication system in place was safe. All staff had received medication training and the provider's policies and procedures had been followed to ensure people were protected against the risks associated with medicines

We looked at staffing levels to check that people's needs were being met. None of the staff had any current concerns about staffing levels. We found that there had been sufficient numbers of suitably qualified, skilled and experienced staff on duty at all times to support people and keep them safe.

We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospitals and care homes. Staff had been trained to know when an application should be made. Correct procedures were in place but no applications had been needed or submitted since our last inspection.

Is the service effective?

Detailed plans of care had been compiled involving people who used the service, with risk assessments in place to protect people. Each person's care needs had been reviewed with them individually each month. Their comments had been recorded and changes made to care plans. This meant that there was a record of people's current care needs.

Where people were unable to make more complex decisions the principles of the Mental Capacity Act 2005 had been followed and decisions made in the person's best interests.

There was a quality monitoring system in place. We saw that changes had been made from comments and suggestions from people using the service, their relatives and staff. The provider sought the views of people to improve the quality of the service.

Is the service caring?

The four people we spoke with told us that they were happy with the care provided. They were positive about the staff and we observed close, warm and friendly interactions between them throughout our inspection. People gave us examples of how staff respected their privacy and dignity. One person told us, "The staff are good. I can talk to my key worker about anything."

A relative told us, "I am very pleased with how they manage X. Staff are very thorough in involving us about progress or when things go wrong. We are always informed."

People told us they made choices about their lives. One person told us, "I sometimes don't want to do certain things. I tell staff if that happens. They may not always agree but they don't press me to do things I don't want to do."

Is the service responsive?

People and their relatives were aware how to make a complaint. A relative told us that they would feel confident in making a complaint and that staff listened to them.

The service responded to suggestions from people who used the service. Meetings with key workers were recorded and we saw that changes had been made as a result of comments that people made. We also saw that actions had been taken where relatives had responded to quality questionnaires and also where comments and suggestions arose from staff meetings, supervision and appraisals. This improved the quality of the service.

Is the service well-led?

Staff were clear about their roles and responsibilities. They said they felt supported by managers and their views were actively sought, they enjoyed their work and felt part of the organisation.

The manager worked alongside other staff on the roster. This meant staff had the opportunity to raise any matters of concern with the manager at any time. We observed open discussions between the manager and staff during our inspection. We saw similar open dialogue that also involved people who used the service. Staff felt confident in their ability to meet people's needs. This ensured that people received a good quality service at all times.

The service has a quality assurance system and records showed that identified problems and opportunities for change were taken and used to continuously improve the service.

During our inspection we were able to talk to three of the five people who lived at the service and also the two members of staff who were on duty at the time. The people who lived there told us that they were happy at the service and that the staff were friendly and helpful.

We reviewed three care plans of people who lived at the service; the plans were up to date and maintained. They reflected people's individual needs. One person told us that they “Had monthly meetings to discuss their plan of care with their key worker".

Staff told us that they were "Supported by their manager and enjoyed working at the service". Two people who lived at the service said, “Staff were always able to help" and that “Staff answered their questions when they had any”.

The service had recently had new double glazed windows put in, one person who lived at the service told us that this happened because they had raised the issue of 'drafts' as a concern. The home manager acted upon this concern and subsequently windows were replaced with double glazing. The people who lived at the service were very happy about this.

One person told us that it was "Their home and that they had privacy", and it was "Better than other places they have lived at".

Staff were relaxed and engaged positively with the people who lived at the service.

Five men live in this large Victorian house. All have their own bedroom and share bathroom facilities. When we arrived at 9.00 a.m. one person had gone to work, two had had breakfast one was rising before going to visit family for the day and another person, who we were told likes to rise later, was still in bed.

During our visit we spoke with four of the five people living at Ellesmere. All had individual routines and needs and told us they liked living there. Most had been living there for a few years. We talked privately with each person as well as in a small group. They were very positive about Ellsmere and the staff. All people have low physical dependency needing only oversight from staff for personal care.

There was one member of staff on duty when we arrived and another staff member arrived at 9.30. The registered manager was on annual leave but we were given all the help and information we needed from the two staff on duty.

We spoke with two relatives of people living at Ellesmere. Both go home regularly and sometimes relatives visit the service. One relative told us “The staff are very friendly and easy to talk to. I can, and do, raise anything that I am concerned about and they always listen and follow things through if necessary.”

During our visit we observed positive exchanges between staff and people using the service. Staff joined in our conversations with people and it was clear there was an open dialogue with all parties feeling comfortable.

We spent time watching how care and support was provided and how staff communicated with people. Everyone received the same caring response from care staff and were included in the activities and conversations taking place. We saw a member of care staff responding to one person’s agitation sensitively and calmly, successfully helping them to calm and settle.

Every person had an individual plan of care, based on their learning disability and other health needs. People were supported to eat a balanced and healthy diet.

There were no set routines in the home and people were supported to have the freedom to live their life as they wanted to, even where some of their choices presented some risks to their safety and well-being. One person told us, “I know there are things I do that could make me poorly or get into trouble but I am learning and having a good time.”

The home had a stable staff team, which ensured people were familiar with the staff supporting them. All the staff we spoke with were positive about working at the home. We found that adequate background checks had been completed as part of the recruitment of staff.

The home provided a welcoming, comfortable and homely living environment. There were regular checks being completed to ensure that the premises were safe. One person told us, “It is alright here, we all get on. The staff are okay too.”

We found that important records about the care and support provided to people were complete and up to date.