We carried out this unannounced inspection on 25 January 2018 and 1 and 5 February 2018. At our last inspection we rated the service Good overall and Outstanding in Responsive. At this inspection we found the evidence continued to support and improve the rating to Outstanding overall.

Edward Gibbons House is a 35 bed supported living service that provides care and support for men with health issues linked to drugs or alcohol misuse. People's care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people's personal care and support. At the time of the inspection there were 29 people using the service.

People told us they felt safe and comfortable using the service. Staff attended safeguarding meetings and were skilled in recognising and reporting signs of abuse. Robust risk assessments were in place to mitigate the risks to people’s safety and risk management plans were co-produced with people. Policies and practices were reviewed when things went wrong to promote the safety of the people who used the service. Infection control guidelines were followed to minimise the risk to people’s health.

The provider continued to provide outstanding responsive care since the last inspection and had taken further steps to build on this. People were valued, appreciated and made to feel part of a community. Care plans were personalised to map people’s journey through recovery. The provider had developed tools to guide staff on how to provide person centred care to best support people with their lifestyles and circumstances. The provider worked with other provider’s to improve standards of care that were fundamental to enhance people’s lives. Discussions were held with people about their end of life needs. People knew how to make a complaint and these were acted on and resolved satisfactorily.

The service was exceptionally well-led. The provider fought for people’s rights despite the challenges they faced to influence policy and decision making. The provider created and implemented new pathways of care and adopted new ways of working to reduce the risk of homelessness. Staff were highly skilled and worked collaboratively as a team and successes were shared and celebrated. Surveys were undertaken to monitor and improve the delivery of care to benchmark best practice.

The registered provider was skilled in obtaining people’s consent to care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the provider had adapted their policies and systems in the service to support this practice and ensure people were fully supported to make their own decisions wherever possible.

Robust background checks were carried out before staff commenced employment and there was a sufficient number of staff to meet people’s needs. Specialised training was completed by staff to make certain they could meet people’s individual needs. Staff received the support they required and were supported with clinical supervision to discuss how they could effectively manage people’s needs.

People received sufficient food and drink to meet their dietary requirements. Medicines were given to people as prescribed and these were stored safely to maintain their effectiveness. People had access to a wide range of medical and social care professionals to offer advice and treatment to support their on-going health needs. Refurbishments were being made to the premises to include facilities that would be beneficial to people and the wider community.

People told us they were supported by a caring and compassionate staff team. People were involved in the decisions that affected them and staff were empathetic and knew their needs well. Positive relationships were encouraged and staff supported people to maintain these. Services were available so people could have thei

This inspection took place on 15 December 2015 and was announced. We gave the provider 48 hours’ notice of the inspection because we needed to be sure that someone would be available. At the last inspection on 5 January 2015 the provider had not met the regulations that covered risks to people who use the service when planning and delivering their care, safeguarding and consent.

Edward Gibbons House provides high level support for people who are alcohol dependent and have complex needs. At the time of the inspection 34 people were using the service. The service had a registered manager in place. 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 this inspection we found the provider had taken appropriate action to address the breaches previously identified. All statutory notifications were being reported to CQC as legally required. Risks to people were assessed and effectively managed to ensure people were protected. Staff took action in response to known risks to keep people safe. The provider had revised their policy and procedures to ensure that care and treatment of people was only provided with the consent of the relevant person.

People told us they felt safe and well supported and staff took appropriate action in response to significant incidents affecting the welfare of people, raising safeguarding alerts to the local authority where required to protect people and established procedures to record their actions. People were supported to maintain good health, and had access to healthcare services and ongoing healthcare support.

Staff were sufficient in skill-mix and numbers to support people who had complex needs. They had developed positive relationships with people based on trust which helped them to work effectively with people in working to achieve their aims. People who used the service held staff in high regard and said they were kind and caring and responded well to any issues they raised.

Staff helped to promote and encourage people to become more independent, to gain more control and enable them to make their own decisions about their care. Support plans were in the process of development and the new format was more detailed and personalised including people’s needs, wishes and how to meet these.

People received care and support in a way that enhanced their sense of wellbeing and quality of life. This resulted from a service that was highly personalised and tailored to their needs and delivered by staff who were skilled, experienced and committed to their work. There was an innovative approach to working with people with complex needs, enabling staff to have more successful engagement with people to work towards and achieve their recovery plan aims.

A complaints procedure was in place, however people said they had no current complaints. Previous complaints made had been promptly addressed.

People benefitted from using a service that was well managed and organised to ensure their needs were met. The registered manager understood their responsibilities and promoted a positive, open culture. Staff said they were happy with how the service was managed and received good training and ongoing management support. There were effective quality monitoring systems in place to check the quality of service and care delivered. A high percentage of people whose views were sought about the quality of care and service provided said they were highly satisfied with the service overall.

The inspection took place on 5 January 2015. Edward Gibbons House is a 24-hour supported housing project and recovery hub. It provides personal care, support and temporary accommodation for single homeless men with complex support needs linked to poor physical and mental health due to alcohol or drug misuse.

The project has 30 bedrooms and five bedsits and catering is provided. Referrals come from the London Borough of Tower Hamlets.

The service had a registered manager in post. 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.

Safeguarding allegations were not reported to the CQC as required. However, staff were able to explain the possible signs of abuse.

Risk assessments contained some detailed information on some known risks to people, but we saw one set of risk assessments was incomplete. Staff told us they had not received any guidance or training in how to handle the known risks to this person.

Staff received first aid training and were able to correctly explain how they would respond to a medical emergency. There were enough, safely recruited staff available to meet people’s needs. Staffing numbers were adjusted depending on people’s individual requirements.

Medicines were managed safely. Records were kept when medicines were administered, and appropriate checks were undertaken by staff. Records were clear and accurate and regular auditing of medicines was undertaken.

The service was not meeting the requirements of the Mental Capacity Act 2005 which is a law to protect people who do not have the capacity to make decisions for themselves. We did not see evidence of mental capacity assessments being completed for two people with fluctuating capacity.

Recruitment procedures ensured that only people who were deemed suitable worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with a range of ongoing training, but we noted that some training was out of date. Staff received regular supervision to support them to meet people’s needs. However, the registered manager confirmed they were delayed in conducting annual appraisals of staff performance to carry out their role.

People were supported to eat and drink a balanced diet that they enjoyed and appropriate advice regarding their nutritional needs had been obtained from their GP where required. People were supported effectively with their health needs and had access to a range of healthcare professionals. Healthcare professionals spoke positively about their working relationship with staff at the service.

People told us staff treated them in a caring and respectful way. People’s privacy and dignity was respected and we observed positive interactions between people and staff throughout our visit. Staff demonstrated a good understanding of people’s life histories and their individual preferences and choices.

Staff and people who used the service felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was an effective complaints policy and procedure in place. We found complaints were dealt with appropriately and in accordance with the policy.

The registered manager had not followed CQC reporting requirements in relation to safeguarding incidents and the completion of a Provider Information Return.

The service carried out regular audits to monitor the quality of the service and to plan improvements. Where concerns were identified action plans were put in place to rectify these. However we did not see evidence of care plan audits which could have identified the shortfalls we found in these records during our inspection.

Staff worked with other organisations to implement best practice. We saw evidence of multi- disciplinary team working and this was monitored to ensure best outcomes were achieved for people. The service also had good links with the local community. People told us they participated in activities at local recovery teams and that they enjoyed doing so.