About the service: Crosby Women's Service provides supported living accommodation for women with mental health needs who had usually spent a long time previously living in a secure service. The service consists of six individual flats with shared communal living areas. At the time of the inspection six people were being supported.

People’s experience of using this service:

Crosby Women's Service was exceptionally responsive to the needs of the people living in the service and promoted a calm and relaxed therapeutic environment for people adjusting to living back in the community from long term inpatient mental health services. Facilities included a therapy room which could be accessed for a variety of treatments by a trained person and communal living areas to encourage people to form social relationships and reduce the risk of feeling isolated. There was also a respite room maintained by the people supported which was available for people planning to move into the service as well as people who had moved on but may need to access extra support.

People living at the service gave us examples of the positive impact the support offered had made on their lives including one person feeling they had ‘got their life back’ and other people told us how they had been able to develop new friendships and had a sense of purpose through voluntary work opportunities.

People received care and support from staff who were caring and respectful. People's needs had been fully assessed with a significant emphasis to develop trusting relationships with people. The service worked in close partnership with other agencies to achieve this.

There was a strong person centred culture. Support plans were extremely person centred and people were fully involved in the planning and review of their care. Promotion of independence was at the heart of the service as well as supporting people to develop their confidence and ordinary living skills following long periods living in hospital.

Privacy and dignity was respected at all times and people spoke extremely positively about the staff and management team. We were told by one person, “Staff are great, very approachable. The manager is great, the team leader is great. Staff are always here on time and friendly. I can’t fault the service”.

The registered provider complied with the principles of the Mental Capacity Act (MCA) 2005. Staff understood and respected people's right to make their own decisions where possible and encouraged people to make decisions about the care they received. Consent had been sought before any care had been delivered in line with legal requirements. Where people had conditions under the Mental Health Act 1983, staff were knowledgeable and they were clear in support plans.

People knew how to make a complaint and they were confident about raising concerns should they need to.

The manager worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

Safe recruitment practices were in place and people were supported by staff that had undertaken a thorough induction process and training relevant to their roles. Enough staff were employed to meet the needs of the people using the service. Staff were supported through regular supervision, team meetings de-briefs and reflective practice sessions. Staff felt well supported by the current manager.

People were protected from the risk of harm and abuse. Staff had received training and felt confident to raise any concerns they had.

Medicines were administered by trained and competent staff and people were supported to be as independent as possible.

Staff had access to personal protective equipment (PPE) to prevent and control the spread of infection.

There were robust governance systems in place to ensure that the quality of the service was monitored.

Rating at last inspection: The service was rated good at the previous inspection (published 28 November 2016).

This inspection visit took place at Crosby Womens Service on 18 October 2016 and was announced. We told the manager before our visit that we would be coming. We did this to ensure we had access to the main office and the management team were available.

Crosby Women's Service provides accommodation for women with mental health needs who had usually spent a long time living in a secure service. The aim of the project is to support women to develop their own potential and to self manage their own mental health and wellbeing. The building

resides in a residential area in Liverpool consisting of six self contained flats. Public transport links to Liverpool city centre are within easy reach. A variety of amenities are within a short distance,such as, shops, pubs, a bank and churches.

There was no registered manager in place at the time of the inspection. The previous manager only recently left. We saw evidence a candidate who was the current manager had been through the application process and was waiting to confirm they had been successful. 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.

At the last inspection in February 2014 the service was meeting the requirements of the regulations that were inspected at that time.

We found the service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to provide safe care for people.

There were appropriate numbers of skilled staff deployed to meet the needs of women who lived independently within the building. Staff had been safely recruited to ensure people would be supported by suitable employees.

Thorough risk assessments had been developed to minimise the potential risk of harm to people whilst out in the community and within the service. These had been kept under review and had been reviewed with the individual at the centre of decision making. One staff member said, “It is important to mitigate any risks and each woman is involved in that risk management strategy.”

Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. However all women self medicated and had control of their medicines with staff oversight. One woman supported by the service said, “I look after my own medication and if I need any advice or support it is here.”

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

People were supported by caring staff who were supportive, caring and respectful. One woman said, “What jumps out is how caring and kind all the staff are.”

Staff knew people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported whilst promoting independence. Women were involved in making decisions about the support and guidance they required. Records looked at and women we spoke with confirmed this.

People were provided with support and guidance to meet their aims and goals. For example staff provided guidance and support for people who wished to achieve education or gain employment.

People who received a service told us they were comfortable raising any issues, concerns or complaints with their staff and the registered manager. The service had arrangements in place to deal with these appropriately.

We found a number of audits were in place to monitor quality assurance. The organisation and manager had systems in place to obtain the

We saw that the 'recovery star' was used to help people to improve their life skills. The recovery star is a tool to enable staff to support individuals in understanding their recovery and plotting their progress. It assesses areas such as self-care, identity and self-esteem, managing mental health and addictive behaviour. One service user told us she wouldn’t be able to be as independent if it wasn’t for the constant support of the staff.

We spoke to four staff all of whom were very confident about the process of reporting signs of abuse.

All medication sheets were clear and consistent, evidencing good record keeping and safe administration. All medicines were appropriately prescribed by GPs/ psychiatric consultants. We saw evidence that anti-psychotic medicines were reviewed on a monthly basis.

One staff member told us “it’s just not like coming to work...”. Staff told us they had a good rapport amongst themselves and felt the manager was also “very efficient”.

We looked at four staff folders of people who worked at the home all of which contained the correct documentation for recruitment.

You can see our judgements on the front page of this report.