We inspected the service on 17 November 2016 and the visit was announced. We gave 48 hours’ notice of our inspection because we needed to be sure somebody would be available.

Choices Housing Association provides personal care and support for people in their own homes and for those living in supported living schemes or extra care housing. Supported living schemes enable people to be independent with support arranged to meet people’s individual requirements. Extra care schemes enable people to live in their own flats or apartments with support available on site should they require it. At the time of our inspection 102 people were receiving personal care and support.

There was a registered manager in place. It is a requirement that the service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 felt safe with the support offered from staff. Staff understood their responsibilities to protect them from abuse and avoidable harm. Risks to people’s health and well-being were assessed to give staff guidance about how to support people to reduce the likelihood of harm. Where an accident or incident did occur, the provider took action to prevent reoccurrences wherever possible. The provider had plans in place to support people to remain safe during emergencies such as a fire.

People and their relatives were satisfied with the number of staff available to offer them care and support. The number of staff the provider employed was enough to provide the care that was planned for each person. Prospective staff were suitably checked before they worked for the provider so that people were protected from those who should not work in the caring profession.

Where people required support to take their prescribed medicines, this was undertaken in a safe way by staff who had received guidance. Staff knew what to do should a mistake occur when assisting people with their medicines.

People received support from staff who had the necessary skills and knowledge. Staff received regular guidance and training relevant to their role. For example, staff received training in epilepsy. People’s food and drink was monitored where this was required to make sure they had enough. Staff knew people’s food and drink preferences. People had access to healthcare services to promote their well-being.

People were asked for their consent when care and support was offered and were supported to make decisions in line with the Mental Capacity Act 2005. Staff understood their responsibilities under the Act including what might constitute restrictions to people’s freedom.

People received support from staff who showed kindness. Their privacy and dignity was protected when receiving care and support. Staff knew the people they offered support to and they were supported to be as independent as they wanted to be. For example, staff encouraged people to do as much for themselves as they could.

People were involved and contributed to the planning and review of their support so that this was centred on them as individuals. The provider told us they were looking to improve the regularity of reviews of people’s support to check that people’s care and support continued to meet their requirements. Where people required additional support to make decisions, advocacy support had been made available to them.

People mostly received care and support from regular staff and at agreed times. The provider was reminding staff to contact people if they were running late. This was identified as an area of improvement when people had offered their feedback to the provider. Staff knew the people they were supporting including their preferences and routines that were impor

We spoke with three people using the service, a relative, four staff members and the registered manager. We used all the information to answer the five questions we always ask:

• Is it safe?

The provider had a system in place to monitor the quality of the service and ensure that people received safe care. Systems ensured that managers and staff learned from events such as accidents and incidents, complaints, concerns and investigations.

Risk assessments and risk management plans were in place to ensure people's safety. We saw that they had been followed. People made choices and remained in control of decisions about their care.

Changes had been made to staff rosters and people had greater continuity from a core of staff that they knew. This helped to ensure that people’s needs were always met.

There was a system in place to ensure that people’s medicines had been administered to them safely and appropriately.

• Is it effective?

People confirmed to us that they had been involved in assessments and creating their care plans. They had given written consent relating to some aspects of care such as medication, but they had not signed their plans. It is important that people sign care plans where they are able to confirm agreement with their care and treatment.

Reviews of care and support plans had been carried out after the service had been in place for six weeks and then every twelve months, although we were not able to see evidence of some reviews we were told had taken place.

Some people used an independent advocacy service to seek advice and to ensure that complex decisions were made in their best interests.

• Is the service caring?

People we visited at home told us that staff were helpful, caring and respectful towards them when providing personal care. One person confirmed that their privacy was respected at all times by visiting staff.

People using the service and their relatives completed an annual satisfaction survey. They had reported high levels of satisfaction with the service across a range of activity. Where shortfalls or concerns had been raised these were taken on board and dealt with.

People’s preferences, interests and diverse needs had been recorded in care records. Care and support had been provided in accordance with people’s wishes.

• Is the service responsive?

People knew how to make a complaint if they were unhappy. A copy of the provider’s complaints procedure was available in each person’s home. A person told us they had not made a formal complaint but raised some concerns that had been taken seriously and addressed by the service.

When people’s health care needs changed, health care professionals had been contacted. Their advice had been recorded and treatment plans had been put into place and followed.

• Is the service well-led?

Quality assurance systems were in place. The quality of the service had been monitored closely. We saw that there had been recent reviews and changes to the way the service had been delivered. A new staff structure had been put into place that would improve the service people received.

Staff were clear about their roles and responsibilities and felt supported with training and supervision by senior staff and the manager. Staff felt confident in their ability to meet people’s needs. This ensured that people received a good quality service at all times.

During our inspection we spoke with two people who used the service or their relatives, two members of staff, a social care professional, the registered manager and her deputy. Our inspection was announced because we needed to ensure that the manager was available.

People's relatives told us they were very happy with the care provided. One person said, “I have nothing but praise for the agency". Another said, "They understand my relative. I can tell they are happy with the staff team".

People's needs were assessed and care plans were in place to ensure that their needs were met, to their satisfaction.

People told us they received their planned care in a professional and unrushed manner. This was because there were enough suitably trained staff to meet people’s individual needs.

We saw that there were systems in place to support people who made a complaint. Complaints procedures provided people and staff with information about how complaints were managed and addressed.

Our inspection of Choices Housing Association Lifestyle service was unannounced. This means that they did not know we were going to visit.

We checked to see if people were able to be involved in making decisions and received the support they wanted.

We looked at care and support records and spoke to people who used the service or their relatives to establish their views on the quality of the service they received. One person told us, "I'm very satisfied, I have the same staff all the time", a relative said, "My relative has had been happy with the level of support they receive and I'm very grateful for the assistance provided".

We looked at the recruitment arrangements in the service to ensure that new staff were vetted to ensure they were suitable to work with vulnerable adults. We also checked to see if staff received the support and training they needed. We saw that suitable arrangements were in place.

We saw that there was an effective complaints system in place to support people using the service. People we spoke with confirmed that they had received information about how to make a complaint.

We carried out this inspection visit because we had not visited for sometime and we did not have recent information about the service. We needed to assess whether the service was meeting the essential standards of quality and safety.

A person receiving care and support in their own home told us that they were very satisfied with the service they received. We were told: “I have a rota at the beginning of the week telling me which staff will visit me each day. If there are any changes, they tell me in advance. If they are running late I have a telephone call to say so. It is an excellent service”

A person using the service said that they had two previous care providers before switching to Choices Lifestyles and “This is the best agency by far”.

A relative told us that "The service is fantastic. Staff are friendly, but professional, they listen to my (relative) if complaining of pain and find the reason. They are always on time, even with the recent snow I went along to be sure, but staff were already there. We have been having the service for a year and there is not one negative comment we can make".

The local authority commissioning the service told us that they had no concerns about how the agency operated and felt that a good service was offered to people.

We spoke with four members of staff who said unanimously that the provider was a good employer, they had good induction and follow-on training with regular support from managers both face to face and by telephone. They told us they used the 24 hour manager on-call system and always had access to advice or information.