Choices Housing Association Limited - 17 Norton Avenue

At the last inspection the service was rated as requires improvement. We found the provider was not meeting all the requirements of the law. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve to at least good. During this inspection we found that the provider had done what they said they would do and were no longer in breach of regulations.

Choices Housing Association Limited – 17 Norton Avenue is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

17 Norton Avenue accommodates up to six people in one adapted building. At the time of this inspection there were four people using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post at the time of the inspection. 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.

People were protected from avoidable abuse and harm by well trained staff. Risks were assessed, identified and managed appropriately, with guidance for staff on how to mitigate risks. Premises and equipment were kept clean and tidy. Staffing levels were sufficient to meet people's needs and staff had their suitability to work in a care setting checked before they began working with people. Medicines were now managed safely, following improvements to the systems in place. The registered manager had systems in place to learn when things went wrong.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported by well trained staff and received effective care in line with their support needs. Staff received regular supervision and appraisal which encouraged reflections on their practice with people and what they could do to further improve people’s experiences of receiving care and support. Staff had access to continuous training that was developed and delivered around people’s individual needs.

There was a good choice of food, which people enjoyed and they received support to meet their nutrition and hydration needs and to encourage independence. Staff were committed to supporting people to stay healthy and people achieved excellent outcomes resulting from staff’s commitment.

The environment was designed and adapted to support people effectively, including significant improvements being made to bathroom facilities to improve people’s choice, independence and comfort.

Healthcare professionals were consulted and staff worked collaboratively with them to help manage people’s complex health needs and to promote best practice. People were supported to access a wide range of healthcare services and were empowered to improve their quality of life and health. Innovative support was provided to encourage and support people to remain healthy. Links with health and social care professionals were excellent.

Staff were kind, caring and compassionate with people. People were supported to express their views and encouraged and supported to make their own choices with a range of communication aids. People were treated with dignity and respect by staff who knew them well.

Staff understood people and their needs and preferences were assessed and regularly reviewed. Activities were organised by staff and people were supported to participate in activities that they preferred. People's diverse needs were considered as part of the assessment and care planning process. Complaints were managed in line with the provider's policy. People were supported to consider their wishes about their end of life care.

A registered manager was in post and was freely available to people, relatives and staff. People, their relatives and staff were involved in the development of the service and they were given opportunities to provide feedback that was acted upon to improve the service. We found the registered manager and provider had systems in place to check on the quality of the service and use this to make improvements. Continual learning and improvements were encouraged.

The service is registered to provide accommodation and personal care for up to six people. People who use the service have learning and physical disabilities. At the time of our inspection six people were using the service.

The service had a registered manager. However, staff told us they had left the service in September 2016. 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 and associated Regulations about how the service is run. The newly appointed home manager told us they were applying to register with us.

At this inspection, we identified two Regulatory Breaches. You can see what action we told the provider to take at the back of the full version of the report.

The provider had not told us about the management changes at the home as required by law.

Risks to people’s health, safety and wellbeing were not always assessed and planned for to ensure people received care that was consistently safe.

People didn’t always receive their prescribed medicines as they were not always available to be administered.

People’s health needs were not always effectively monitored as planned, and advice from healthcare professionals was not always followed to promote people’s health, safety and wellbeing.

The information in people’s care records was not always accurate or up to date to protect them from the risks of receiving unsuitable and inconsistent care.

People’s dignity was not consistently promoted and, people were not always enabled to be involved in making choices about their everyday care. This was because appropriate communication tools were not always available.

People were supported to eat and drink, but this support was not always provided in a safe manner to protect people from the risk of choking.

The new management team had started to assess the quality of care. As a result of this areas for improvement had been identified and plans were being formulated to improve people’s care experiences. Staff spoke positively about changes the management team had introduced and they told us they had confidence in the new management team.

There were enough staff available to provide people with prompt care and staff were recruited in a manner that protected people from abuse.

Staff knew how to identify and report potential abuse and they received training to enable them to carry out their role of delivering care.

The requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards were followed. This ensured that decisions were made in people’s best interests when they were unable to make these decisions for themselves.

People were supported to be independent and people’s right to privacy was respected.

There was a formal complaints procedure in place that was followed when formal complaints were received.

We saw that staff understood people's needs and they received support from staff in a caring, compassionate and professional manner. This was because people were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard. We saw that systems were in place to protect people from the risks associated with medicines.

We saw that people were not always protected from the risks of inappropriate care and treatment because accurate and appropriate records were not always maintained. Records were not always kept securely.

We found that health records were well maintained by staff and that the people who used the service said they were involved with contents of their own care plans.

One person told us that the "Staff were their friends", another person told us "That they felt safe here". Staff told us that there was enough staff on duty to look after people properly.

The home was comfortable and felt relaxed, people were given choices of activities to do when we were there. We saw staff help people carry out activities such as sewing, cleaning and reading. Staff helped and assisted people to eat when they required it.

The people who lived in the home communicated in a positive way with the staff. Staff showed that they understood the people who they cared for because they talked and communicated in a way which prompted positive signals and responses from the persons' using the service.