We carried out an unannounced comprehensive inspection of this service on 6 and 10 April 2017. Chosen Court provides accommodation and personal care for up to 11 people with a learning disability. 11 people were living in the home at the time of our inspection.

A registered manager was in place as required by their conditions of registration. 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.

At our previous inspection on 25 and 26 November 2016, the provider did not meet the legal requirement in relation to the records of people’s mental capacity assessments and consent to care. Following that inspection, the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made. We found that improvements had been made in obtaining consent to care and mental capacity assessments for significant decisions had been completed with the assistance of external professionals.

We discussed requirements for mental capacity assessments when people when unable to consent to aspects of their everyday care needs with the registered manager. We were satisfied staff recognised when people had capacity to consent and people’s rights were upheld. People were encouraged to be independent with the aspects of the care they could manage for themselves and supported with everyday living skills, including budgeting, when they were unable to do this for themselves. During the inspection the registered manager completed a mental capacity assessment and booked themselves on further training in these assessments. We were assured that documentation of capacity assessments would be prioritised following the inspection.

People living at Chosen Court benefitted from staff who prioritised their needs and wishes and understood them well. Risks were identified and carefully managed with appropriate help from external health and social care professionals. Staff knew how to protect people from harm and were skilled in meeting people’s support needs. There were enough staff so that people could be supported flexibly and in response to their changing needs. Medicines were managed safely.

Staff felt supported in their roles and were encouraged to obtain relevant qualifications and skills. When people had specific dietary or religious needs, these were well documented and care plans were followed by staff to ensure people’s needs were met. People were supported to access community based services, activity groups, preventative and specialist healthcare.

The atmosphere at the home was open and relaxed, where everyone was valued, respected and cared for as an individual. People spoke freely about what they wanted or any issues they were experiencing and they were supported to enjoy their private family lives.

Systems were in place to monitor the quality of the service and improvements were being made to the home in response to feedback and quality audits.

This inspection took place on 6 February 2015 and was unannounced. Chosen Court provides accommodation and personal care for up to 11 people with a learning disability. 11 people were living in the home at the time of our inspection.

A registered manager was in place as required by their conditions of registration. 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.

At our previous inspection on 9 September 2014, the provider did not meet all the legal requirements in relation to the people’s records and records that helped to monitor the service. Following this inspection, the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made. We found that improvements had been made in updating polices and people’s care records. However the records of people’s mental capacity assessments to make specific decisions had not been fully understood and recorded by the registered manager.

People’s personal support needs and risks had been assessed and discussed with them. Staff were given guidance on how to best support people when they were upset or at risk of harm.

Staff and the registered manager understood their role and responsibilities to protect people from harm and abuse. People and staff could raise any concerns or issues with the team and registered manager.

People were supported by staff who had been suitably trained and recruited to carry out their role. There were sufficient numbers of skilled staff to meet the needs of the people they supported. People told us that staff were caring and gave them the support they needed.

People’s medicines were ordered, stored and administered in an effective way. Their health, emotional and social needs were assessed and reviewed. Their care was focused around their needs and wishes. People were supported to eat and drink sufficient amounts and maintain a balanced diet. Their dietary needs and preferences were considered when planning the weekly menu. Alternative food was available if people did not like the meal options.

People were supported and encouraged to make day to day decisions. Staff were caring and compassionate towards the people who lived at Chosen Court. People were relaxed and empowered around staff and were encouraged to make suggestions about their day.

People were given information about their daily activities so they could make choices. People carried out activities in the community and around the home. They told us that any day to day concerns which they had raised were always dealt with immediately.

The registered manager provided the staff with good leadership and led by example. People spoke highly of the staff and the registered manager. The provider had regularly visited and monitored the home. Monitoring systems were in place to ensure the quality of the service. Internal and external audits were carried out to continually monitor the service provided.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

The inspection team who carried out this inspection consisted of two adult social care inspectors. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with five people who use the service, the registered manager, and four staff. We also observed how people were being cared for. We reviewed records relating to the management of the service which included, three care plans, daily care records, quality assurance systems and staff records. Concerns had been raised with us about the safety and wellbeing of people living in the home. We looked at how the provider had responded to these concerns as part of this inspection.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was not safe because the service had not managed the maintenance and upkeep of records appropriately. Some records did not evidence the strategies in place to reduce risks to people. Accident and incident audits did not provide evidence of the action which had been taken to prevent accidents reoccurring. Some policies and procedures did not provide correct or sufficient information. People were not protected against the risks of inappropriate or unsafe care and support because their records and those required for the management of the service had not been kept accurately. We have asked the provider to tell us what improvements that will make in relation to ensuring an accurate record is kept in respect of each person living in the home and as required for the management of the service.

People were safe because staff used both formal and informal methods to share information on risks associated with their care, treatment and support. Hazards were minimised and procedures were in place to keep people safe. When people were anxious or upset staff understood how to support them using distraction to help them to become calm. Physical intervention was not used. Safeguarding concerns had been raised with the service and the appropriate action had been taken to keep people safe from harm. There were sufficient levels of staff supporting people with the appropriate skills, knowledge and qualifications to meet their individual needs. When unsafe practice had been identified disciplinary procedures had been followed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Relevant staff had been trained to understand when an application should be made and how to submit one. Applications had been submitted to the relevant authorities for people restricted of their liberty. This was in response to recent developments (March 2014) in the case law around DoLS.

Is the service effective?

People received an effective service because their individual needs, choices and preferences were reflected in their care plans. People’s likes, dislikes and routines important to them had been discussed with them. Staff spoken with had a good understanding of people’s needs. People’s health was regularly monitored to identify any changes that might require additional support or intervention. Referrals were made to health care professionals when people’s needs changed. Staff received support and access to the training to make sure their skills and knowledge were maintained and kept up to date.

Is the service caring?

People received a caring service because staff had a good understanding of the people they supported which included their preferences for the care and support they received. They also knew about people’s personal histories and supported them to maintain links with people important to them. We observed staff listening to people and respecting the choices and decisions they made. One person told us, “Of course staff listen to me.” People’s care and support was discussed with them. Their views were reflected in their care records and the way in which their care was provided. People were supported to be independent and make decisions about the way they wished to live. People had access to advocates to help them express their wishes and aspirations. People’s end of life wishes had been discussed with them and plans put in place to reflect these.

Is the service responsive?

The service was responsive because people had their individual needs regularly assessed. Staff understood the care and support needs of people. People, their relatives and friends were encouraged to provide feedback. People and their relatives were given information about how to make a complaint. They were encouraged to discuss any issues or concerns with staff as they arose. People were observed discussing concerns with the registered manager and being listened to and offer the appropriate reassurance. We observed people being offered choice about their daily activities and staff respecting the decisions they made. People’s needs were assessed and they planned annual reviews of their care with staff.

Is the service well led?

The service was well led. Feedback from people who live in the home, their relatives and staff was encouraged. Action had been taken in response to their feedback. Quality assurance processes were in place to check on the experience of people living in the home. Residents’ meetings and annual surveys sent to people living in the home and their visitors gave the opportunity to feedback views on the quality of service provided. Systems were in place to monitor accidents and incidents. The necessary action had been taken to prevent these from happening again. The service had worked co-operatively with other authorities and safeguarding teams to reflect on how people were being kept safe.

During our visit we spoke with five people living in the home. People we spoke with told us they were happy living in the home and could make choices about their daily living. On the day of our visit everyone went out to take part in an activity of their choosing. People told us “I like going out”, “it’s not bad, I like living here” and “the food is good”.

The provider assessed people’s capacity to make day-to-day decisions and what type of decisions may need to be made in their ‘best interest’. Where people had capacity they were asked to give consent to their care and their wishes were acted upon. We saw that staff had a good understanding of people’s needs and used this knowledge to enable people to make their own day-to-day decisions about their care.

Care plans were personalised to each individual's needs and detailed how staff should work with people to meet those needs. Risk assessments had been completed where necessary and all care records were reviewed monthly.

Appropriate arrangements were in place in relation to the recording and storage of medicine. There were effective recruitment and selection processes in place. The provider sought the views of people who used the service and used these comments to improve and develop the service.

The service had a new manager who we were advised would soon be submitting their applicant to become the registered manager of this location.

During our visit we spoke with everyone living in the home, spending time with people in the communal areas. On the day of the visit everyone went out to an activity of their choice. Some people went swimming, others went to social skill classes and others went to a local pub for a drink. We saw a craft activity taking place in the home and people were making decorations for Halloween.

Everyone we spoke with told us they were happy living in the home. People were encouraged to help around the home, tidying their rooms and helping in the kitchen. One person told us “I like cooking and cutting up the fruit” and another person told us “I like living here”.

Staff we spoke with and observed showed that they had good knowledge of the people they supported. They were seen responding to each person respectfully, with good humour and in a manner appropriate to each individual’s needs.

The home regularly asked people who used the service, their representatives and other professionals for their views about the care and support the home provided. When feedback was given by people the home acted on it and used these comments to improve the service.

People said they made choices about the care and support they received. They said their care plans reflected these and their key workers helped them to record the way they wished to live their lives. They said they made choices about meals, parties, holidays and activities. People were observed being supported to participate in their local community such as going to the shops. They said they go to the local church and library.

People said they choose the meals for the monthly menu at house meetings. They liked to help prepare meals which were mostly freshly prepared.

People said they have appointments with health care professionals. They also confirmed they had annual reviews.

People were confident talking to staff about any concerns they may have either individually or at house meetings. They said they liked the staff and they told us about their key workers.

People said they had chosen how to decorate their rooms with the help of staff. They said they helped to clean and polish their rooms.