We inspected this service on 11 May 2018.

At the last inspection of 57 Chestnut Street in 2015, we rated the service as 'Good'.

At this inspection we found that the service remained 'Good'.

57 Chestnut Street is a semi detached house in Southport situated close to the town centre and it’s amenities. It is part of Arden College that provides specialist further education for young people aged 16-25 years of age with learning disabilities. 57 Chestnut Street currently provides accommodation for three young adults aged over 18 who attend the college and there are support staff available 24 hours per day. Accommodation can be term time only and outside of term time if required.

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 time of our inspection three people were living at the home and attending the college.

There was a process for analysing incidents, accidents and near misses to determine what could be improved within the home. There was personal protective equipment (PPE) available within the home, such as gloves, aprons and hand sanitiser.

Medication was well managed and only administered by staff who had the correct training to enable them to do this. Medication was stored securely within the home.

There were enough staff to help people with their day to day support needs, such as accessing the community or support with their personal care. There was some agency use, however the same staff were often requested.

There were systems and processes in place to ensure that people who lived at the home were safeguarded from abuse. This included training for staff which highlighted the different types of abuse and how to raise concerns within the infrastructure of the organisation. Staff we spoke with confirmed they knew how to raise concerns.

Risk assessments were detailed and specific, and contained a good descriptive account for staff to follow to enable them to minimise the risk of harm occurring to people who lived at the home. We saw there were detailed protocols in place around people for when their behaviour escalated and placed them in harm’s way.

The service was operating in accordance with the principles of the Mental Capacity Act (MCA) and consent was sought in line with people’s best interests. People’s mental health needs were assessed appropriately, and people were treated with equality and diversity which was evidenced in the outcomes of their support. Appropriate referrals were made when people were required to be deprived of their liberty. Staff had the correct training to enable them to support people safely. Staff engaged in regular supervision with their line managers, and had annual appraisals. Consent was also sought and clearly documented in line with legislation and guidance.

Menus were varied, people told us they had input into the menus and often cooked their own meals. There was access to other medical professionals who often visited the home and were involved with people, and regular meetings with external healthcare professionals took place when needed. Staff said they were up-to-date with the training they were required by the organisation to undertake for the job and training records confirmed this.

People were treated as individuals, and their choices and preferences were respected by staff. This was evident throughout our observations around the home, and the information recorded in people’s support plans. Staff also described how the ensured they protected people’s dignity and choices when providing personal care. Staff spoke with people and about them with warmth and sensitivity. There were examples of accessible information for people who used the service. This was presented in

57 Chestnut Street is a semi-detached house in Southport situated close to the town centre and its amenities. It is part of Arden College that provides specialist further education for young people aged 16-25 years of age with learning disabilities. Chestnut Street can provide accommodation for three young adults aged over 18 who attend the college. There are support staff 24 hours per day. Accommodation can be term time only and outside of term time if required.

This was an announced inspection which took place on 5 November 2015. We announced our inspection so that key people could be present and people who lived at the home could make arrangements to be present if they wished to speak to us. The service was last inspected in September 2013 and was meeting standards at that time.

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. 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.

When we spoke with people living at 57 Chestnut St. they told us they were settled and felt safe at the home. We saw they were relaxed in the company of staff and there was a warm rapport.

To support up to three people being accommodated at the home at any one time we saw there was sufficient staff in place. We saw from the duty rota that staff numbers were consistently in place to provide safe care.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw checks had been made so that staff employed were ‘fit’ to work with vulnerable people.

We found the home were good at managing risks so that people could be as independent as possible. Both of the people living at the home at the time of our inspection were supported to attend Arden College. One of the people had been assessed as requiring one to one support to minimise assessed risks and promote as much independence as possible. We spoke with relatives of people being supported who told us staff managed people’s care needs well and this included ensuring their safety.

We saw there were good systems in place to monitor medication safety and that staff were trained to help ensure their competency so that people received their medicines safely.

The staff we spoke with clearly described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed on a regular basis where obvious hazards were identified. The home was undergoing planned development / maintenance at the time of the inspection and we saw this had been assessed and planned well so that people were living in a comfortable environment.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people as individuals. Staff were able to explain in detail each person’s care needs and how they communicated these needs. People we spoke with and their relatives were aware that staff had the skills and approach needed to ensure people were receiving the right care. The comments we received evidenced people received effective support.

We saw that the home was working within the legal framework of the Mental Capacity Act (2005) [MCA]. This is legislation to protect and empower people who may not be able to make their own decisions.

There was one person who was being supported on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the authorisation had recently been made and the appropriate referral to the Local Authority had been made and was being monitored by the manager of the home.

We were told that meal times were flexible. People being supported were encouraged to plan and prepare their own meals including shopping. We saw meal plans prepared with the support of staff. We also saw evidence that staff promoted healthy eating options and the collection of meal recipes we saw evidenced a wide variety of easy to prepare and cook meals.

We assessed whether people were treated with dignity, respect, kindness and compassion. We saw that there were various communication aids for people to use to show if they were distressed or unhappy. Relatives commented on the caring nature and philosophy in the home. We made observations when people returned from the day at college. The interactive skills displayed by the staff when engaged with people were warm and supportive and showed a personalised approach to help ensure people’s wellbeing.

We found that care plans and records included people’s preferences and reflected their identified needs from admission and during their stay. There was good evidence that care plans had been discussed with people on a regular basis so they felt involved in their care. One person said, “‘’I like the team I’m in. I do cooking and like it here.’’

Social activities were organised. These were both community activities and also some individualised activities and outings. The main focus of the day was centred on each person’s learning plan and attendance at Arden College.

Well-developed processes were in place to seek the views of people living at the home and their families. Managers were able to evidence a series of quality assurance processes and audits carried out. These were comprehensive and helped ensure standards of care were maintained consistently as well as providing feedback for ongoing development of the service.

At the time of our inspection, we were able to observe people with their support workers, going about their daily tasks. We were unable to speak with people directly about their care, due to communication difficulties. We spoke with support workers and senior management, as well as other professionals involved in their care.

When reviewing people's daily care and support needs, plans drawn up to meet those needs were detailed, regularly updated and consent to the care and support provided was asked for and recorded. We noted staff talked with people at the home in an inclusive way, for example explaining why a person would have to wait for a few minutes before they started a planned activity together. We heard one member of the support team explaining "we'll do that in just a minute [person's name], I'm just finishing this, I promise I'll be just five minutes." This demonstrated staff awareness of people's need for routines within their day and how any delay - however small - can prove quite a difficult concept for a person with a learning disability. We found staff were courteous, respectful and above all keen to empower the people they cared for.

We were able to speak to a community professional involved in a person's care at the home. They expressed how settled the person had been and how the staff and managers of the organisation had formulated and maintained a very individualised plan of support and care.

A healthy eating plan was in place that guided people in making choices on healthy eating and living. Whilst this was promoted, a person's right to choose was still respected, and this was evidenced in requested changes to menus.

We met with the two students living at the service. They were both positive about their experience and the documented evidence reflected this. One student was able to explain how she had changed accommodation at her own request and a member of staff had also transferred with her. We found that the students were comfortable and settled in their environment and interacted well with the care staff. The care staff supporting them had a good knowledge of how to meet their needs. All of the staff spoken with stated that they thought that a good service of support was provided for the students.