This inspection took place on 29 and 30 November 2016 and was unannounced. Our last inspection took place on 26 July 2014 when we gave an overall rating of the service as 'Requires Improvement'. We found two breaches of the legal requirements in relation to safety and suitability of premises and records. At this inspection we found improvements had been made.

Norton Street is registered to provide personal care and accommodation for 20 adults with enduring mental health needs. Accommodation is provided in six terraced houses in the Old Trafford area of South Manchester. The service is situated close to local shops and transport networks into Manchester and surrounding areas. At the time of our inspection there were 18 people residing at Norton Street.

At the time of our inspection there was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law, as does the registered provider.

There was a manager at the service who had recently been promoted within the service and was in the process of applying to CQC to be the registered manager. However, we noted no application to register the manager had yet been received. We will continue to monitor this.

The manager and staff understood their obligations under the Mental Capacity Act 2005 and Mental Health Act 1983 and worked within these legislative frameworks. Staff had received training in both subjects and were fully informed of any changes at team meetings to ensure they continued to provide care within the law.

At the last inspection we saw two properties that were in need of redecoration, refurbishment and repair. At this inspection we found improvements had been made to all six properties, ensuring they were at a satisfactory standard for people.

Staff were extremely caring and always ensured they treated people with dignity and respect. They had an excellent understanding of the care and support needs of every person receiving a service at Norton Street. People had developed very positive relationships with staff and there was a friendly and relaxed atmosphere.

We found that medication arrangements were safe. Some people told us they managed their own medication and these were securely stored in their bedrooms. Support plans included an assessment of the person’s needs for support with any medicines they were prescribed.

Support plans showed that people had access to their GP and other health and social care professionals such as psychiatrists, a dietician, district nurses, social workers and community psychiatric nurses (CPN). This showed us that people were supported by staff to maintain their health and wellbeing.

The support staff we spoke with demonstrated an excellent knowledge of people's care needs, and significant events in their lives, and their daily routines and preferences.

Staff had received a range of training, which covered key courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who had mental health disorders and the use of Mental Health Act 1983 (amended 2007).

People and the staff we spoke with told us that there were enough staff on duty. We found that on the whole there were sufficient staff on duty to meet people's needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. This meant staff hired were suitable to work with vulnerable people.

The manager also completed a monthly manager's audit. This audit looked at the following areas: care planning, recovery, key workers, activities, meetings, medication, environment, food menus, and training. We found these audits were detailed, comprehensive and followed up on any actions identified. This meant the provider had adequate oversight of the care and support provided to ensu

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

The inspection was unannounced and took place on 29 and 30 July 2014. The inspection was carried out by a lead inspector, an expert by experience and a specialist advisor. Experts by Experience are people who have personal experience of using or caring for someone who use this type of care service. Specialist advisors have up-to date knowledge and experience in their specialist area.

The last inspection was carried out on 22 August 2013. At that inspection no regulatory breaches were identified.

Norton Street is registered to provide personal care and accommodation for 30 adults with enduring mental ill health. Accommodation is provided in 7 terraced houses in the Old Trafford area of South Manchester. The service is situated close to local shops and transport networks into Manchester and surrounding areas. At the time of our inspection there were 17 people residing at Norton Street supported during the day by four support workers, the deputy manager and the registered manager. Overnight people were supported by two members of staff on duty at the home and they were supported by a manager who was on call if required.

At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The registered manager was aware of their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards aim to make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom.

We saw properties that were in need of redecoration, refurbishment and repair. The registered manager told us there was an ongoing programme of re-decoration and refurbishment of the seven houses. Works had not been prioritised by risk or suitability and cleanliness. The issues we identified breached Regulation 15 (Safety and suitability of premises); of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This is because the provider had failed to ensure adequate maintenance of the premises where people were accommodated. You can see what action we have told the provider to take at the back of the full version of the report.

We spoke with health professionals who visited the home on a regular basis and received positive comments. One health professional told us: “Requests for visits are appropriate and made in a timely manner.”

We spoke with people who lived at the home who told us: “They (staff) are nice.” “I think the staff are really good they have helped me a lot.” “I can do whatever I like, if I want to go for a walk I can do. I prefer to stay where I am.”

We saw the provider had taken action to raise staff awareness of safeguarding issues by providing training. The training plan showed staff had received training relating to safeguarding vulnerable adults.

We found that medication arrangements were safe. Some people told us they managed their own medication and these were securely stored in their bedrooms. Support plans included an assessment of the person’s needs for support with any medicines they were prescribed.

Support plans showed that people had access to their GP and other health and social care professionals such as; psychiatrists, a dietician, district nurses, social workers and community psychiatric nurses (CPN). This showed us that people were supported by staff to maintain their health and wellbeing. People gave mixed opinions about the level of involvement they had with their support plans.

We found support plans provided information about the persons’ mental ill health diagnosis but medical conditions such as diabetes were not clearly recorded. These concerns are a breach of Regulation 20 HSCA 2008 (Regulated Activities) Regulations 2010 Records. The provider did not keep an accurate record in relation to the care and treatment of each service user. Regulation 20 (1) (a). You can see what action we have asked the provider to take at the back of the full version of the report.

We looked at a sample of two staff recruitment files. We saw security checks were carried out before staff were employed at the home. This included; written references from previous employers and a disclosure and barring service (DBS) check. This was to ensure staff were safe to work with vulnerable people.

We spent time observing staff interactions with people who lived at the home. We saw staff were respectful and understanding. Staff supported people to take part in activities in the local community.

We spoke with four members of staff who told us they felt they received enough training. Staff told us: “There is plenty of training, we get a training matrix sent out that is open to all staff.”

All the support plans we looked at had been signed by the person to whom they belonged. The registered manager told us support plans were reviewed monthly or more frequently if the person’s needs changed. Health and social care professionals we spoke with told us they were involved in the review process for their client.

The registered manager was sending statutory notifications to CQC, which is a regulatory requirement.

We spoke to four people living at Norton Street throughout the day, they told us: “The house is OK, kept clean, staff are quite good they help me with reading and writing, sit and watch telly with me.” and “It’s okay, nothing I would change.” and “Staff are nice and friendly, pleasant. People I live with are nice. I’m happy here.” and “Everyone is understanding and friendly.”

We looked at the care records for three people living at Norton Street. Within the three care records we found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. . Although care plans and risk assessments were in place they were not consistently being reviewed.

We saw in all the care records we looked at, people had nutrition care plans and risk assessments in place.

The four houses we visited, we noted the environment was clean, however the décor was dated particularly the bathrooms and kitchen areas. Furniture in the lounge of one house was dated.

The manager provided us with an action plan following our last inspection which outlined the quality monitoring systems they planned to implement. As part of our inspection the manager provided us with a copy of a recent audit of care plans.

The Operations and HR director provided us with a copy of the action plan they planned to implement at Norton Street to ensure work planned to improve the environment was completed.

People using this service had their rights to privacy and dignity respected. They were encouraged and supported to make their own decisions and to participate in activities that were designed to develop their independence. One person told us, "Staff help me to do the things that interest me.”

The eight people we spoke with told us that they liked the staff that provided their support. They said that staff listened to their views and took action when it was needed. The people we spoke with were confident that staff would take action if they had any concerns about their personal safety. A system was in place to identify and report allegations or suspicions of abuse and staff had been trained in this area.

Care plans provided evidence that risks to the safe delivery of care had generally been assessed and managed well. However, one person who was at risk of weight loss, did not have a nutritional risk assessment for the prevention of unintentional weight loss.

Although the provider had a system in place to monitor, review and improve the service provided, it had not been effective in ensuring that living environments were maintained to an appropriate standard. Hazards in the environment potentially placed people using the service at risk of burns from hot water pipes and trips from frayed carpets on stairways. Further improvements were needed to the decor of people's living environments.