This inspection was unannounced and took place on 09 May 2018.

We last inspected the Thoughts of Others on 15 March 2016, when we rated it as ‘good.’ The home is registered to provide accommodation and personal care, for a maximum of four people young people (aged 13 – 18) and there were three young people living at the home on the day of the inspection. At this inspection we found overall the rating was still good, but the rating for well led is now 'requires improvement' as there were some areas in the way in which the service was managed that needed improving.

A registered manager was in place. A 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.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met.

People were supported by staff to take their medicines and records were completed by staff to record when medicines had been administered.

Staff were available to meet people’s individual needs promptly and demonstrated good knowledge about people living at the home. Staff told us training helped them meet the specific needs of the people they supported and they attended regular training to ensure they kept their knowledge updated.

People’s consent was appropriately obtained by staff when caring for them and people's rights were protected because key processes had been followed to ensure people were not unlawfully restricted.

People were involved in developing how they wanted to be supported and were encouraged to be as independent as possible. They were supported to access healthcare appointments and to maintain a healthy diet which reflected their choices and preferences.

People said staff were caring and we saw they were relaxed around the staff supporting them. We heard and saw positive communication throughout our inspection and saw people smiling and responding positively to staff. Staff showed us that they knew the interests, likes and dislikes of people and people were supported to enjoy various activities. We saw that staff ensured that they were respectful of people’s choices and decisions.

At the time of our inspection a copy of completed provider audits were not available to us, therefore we were not able to assess if these audits were effective in identifying areas for improvement and evidence of how required improvements were monitored for their effectiveness once they had been put into place.

A programme of regular checks where completed by the acting manager to review areas such as medication, care plans and equipment checks. However, we found that these audits had not been robust in findings some areas requiring improvement.

People and staff were positive about the service and the way it was managed for the people that lived there. The acting manager and the registered manager demonstrated clear leadership and staff were supported to carry out their roles and responsibilities effectively, so that people received care and support in-line with their needs and wishes.

This inspection took place on 15 March 2016. This was an unannounced inspection.

At the time of our last inspection in September 2013, Thoughts of Others was found to be meeting all of the essential standards relating to the quality and safety of care.

Thoughts of Others provide accommodation and personal care for up to four young adults who require support to live in the community. At the time of our inspection, there were three people living at the home.

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.

During our inspection we found that the service was safe because people were supported by staff who had been safely recruited and the provider had ensured that there were enough members of staff available to meet people’s needs. This meant that people received the care they required when they required it, including their prescribed medications.

People were protected from abuse and avoidable harm because staff had received adequate training and had the knowledge and skills they required to do their job effectively. Robust risk assessments and management plans were also in place to promote people’s safety within the home.

The service was effective because people received care and support with their consent, where possible, and people’s rights were protected because key processes had been followed to ensure people were not unlawfully restricted. People were supported to maintain good health because staff worked closely with other health and social care professionals when necessary and people’s nutritional needs were assessed and monitored and they had food they enjoyed.

The service was caring because people were supported by staff that were helpful and who took the time to get to know people and involved them in making decisions about the care they received. This meant that people received the care they wanted based upon their personal preferences, likes and dislikes.

People were cared for by staff who protected their privacy and dignity and people were encouraged to be as independent as possible. People were supported to express their views in all aspects of their lives, as far as reasonably possible and staff respected people as individuals including their choices relating to their equality and diversity.

People were supported and encouraged to engage in activities that were meaningful to them and to maintain positive relationships with people that were important to them.

The service was responsive because people felt involved in the planning and review of their care and were encouraged to offer feedback on the quality of the service; people knew how to and felt comfortable raising a complaint and felt that they would be listened to.

Staff felt supported and appreciated in their work and reported the management team to be approachable.

The management team had systems in place to assess and monitor the quality of the service and were compliant with the requirements of their registration.

There were three people living at the home on the day of our inspection. One of the three people was staying with their family. We spoke with one person who lived there, seven members of staff and the acting manager.

We saw good interactions between people who lived there and staff. We observed that people were at ease in the company of staff. One person told us, "I’m happy living here; I get on with the staff."

We saw that people's needs had been assessed by a range of health professionals and people's healthcare needs had been monitored and met.

People were encouraged to eat a healthy and nutritious diet. One person told us that staff helped them to plan their menus and they helped to prepare their meals and drinks.

Systems were in place to safely manage people's medicines to help meet their health needs.

We saw that the home was safe and comfortable for people to live in. Staff told us that repairs were completed promptly so the home was safe.

We saw that checks were made on staff before they started working there to ensure people's safety. Staff had the skills and knowledge to know how to safely support people who lived there to meet their needs.

People were asked for their views about the home and these were listened to. We saw that audits were completed and action was taken to make improvements where needed.

We found that the service operates in a person centred approach to all tasks. The provider has a system in place to gather daily information and use this to formulate weekly feedback sessions with the people who use the service. Obtaining feedback from individuals is done through weekly meetings and monthly multi-disciplinary. We spoke to two people who used the service and both were very happy with the quality of the support that they receive form the provider. The provider had taken all reasonable steps to ensure all staff have a high degree of knowledge in the safeguarding of vulnerable adults.

People who lived at 77 Shortheath Road told us that they liked living there.

“This is the best unit I’ve ever been in. There is so much help and support. It's like a family.”

“There are always staff around, it's really good. There is a nice atmosphere, relaxed; they help you move forward”.

“It's alright here”.