The inspection took place on 16 November 2016 and was announced.

At our previous inspection in March 2014 we found the provider was meeting the regulations.

Avenue Road is a supported living service that can accommodate up to nine people with mild to moderate learning disabilities, diagnosis of mental health and challenging behaviours and other associated health or communication needs. Supported living services enable people live in their own home and receive care and/or support in order to promote their independence. People who use this service had their own flat with separate tenancy agreement and received 24 hour support. In supported living services personal care is regulated by the Care Quality Commission (CQC) but the accommodation is not. People using this service liked to be addressed as tenants.

The service had a registered manager. 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.

Tenants and their relatives spoke of the excellent support received and how this impacted positively on their progress and wellbeing. Staff were providing new opportunities and experiences for people, they supported them to participate in education and training and develop skills. People felt totally empowered, they had education and developed skills that enabled them take up employment.

People felt safe and were able to express themselves or raise concerns without fear of recrimination. The manager and staff had an excellent understanding of managing risks and successfully supported people to reach their full potential. Positive risk taking was driven throughout the service, balancing the potential benefits and risks of taking particular actions over others, in order to support people to live fulfilling lives. In delivering this consistent approach people were supported to try new things and make positive changes in their lives.

Staff encouraged people to respect each other; there was a ‘no blame’ culture. Support plans were developed to provide guidance for staff in the positive management of behaviours that challenged the service and others. This was based on least restrictive best practice guidance to support people’s safety. The guidance and training supported staff to provide a consistent approach to situations that may be presented.

Every tenant’s voice was heard. The staff team empowered the tenants to communicate their thoughts wishes and aspirations by using creative ways of communication – pictures, social stories, and ‘books without words’. A family member said, “We value the efforts made by staff to push for people to be as independent as possible.”

People were supported by staff that were compassionate and treated them with dignity and respect. Interactions both verbal and non-verbal between staff and people who used the service were caring and respectful with staff showing patience, kindness and compassion. One of the great strengths in the service was reflected in how people were supported and developed the confidence to speak up for themselves. The manager and staff knew and understood the people they cared for and ensured people were provided with choices in all aspects of daily life by way of discussion.

Staffing provision was responsive to people’s changing needs and preferences and enabled people to lead fulfilling lives, the utilisation of resources demonstrated the service’s commitment to the culture of inclusion and participation for people using the service. Two tenants had been successfully supported to apply and attain paid employment as gardeners in response to their desire for increasing independence and contributing to the wider community. Both received training and were supplied with necessary safety equipment by

This inspection took place on 13 March 2015 and was unannounced.

Avenue Road is a supported living service that can accommodate up to nine people with mild to moderate learning disabilities, diagnosis of mental health and challenging behaviours and other associated health or communication needs. People who use this service receive care and/or support in order to promote their independence. They live in their own flat with a tenancy agreement and receive 24 hour support. People using the service liked to be addressed as tenants.

We last inspected this service in May 2013. At that inspection the service was meeting all the regulations that we assessed.

The provider appointed a new manager for the service in October 2014; the manager had submitted an application to register with CQC and was waiting for a date to have the interview and assessment. 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 told us they felt safe in their homes because of the staff support they received; it was tailored according to their needs and abilities. Family members told us they felt confident in the fact their relatives were developing more independent living skills; they were well supported and cared for.

Risk assessments considered individual needs, strengths and areas where support was required. The service encouraged and empowered people develop independent living skills, promoted positive risk taking and did not restrict people’s interests and encouraged them to try new things.

Recruitment processes were robust and only suitably vetted staff were employed. People using the service were fully involved in recruiting and selecting their team of support staff.

Staff told us they received essential training but also training specific to the people they were supporting. We saw that external professionals were regularly involved where needed and staff followed their advice and recommendations. Staff had undertaken relevant training on the Mental Capacity Act 2005 so that they understood the issues faced by people who may find it to make informed choices about their care.

The service had systems in place to safely support people who may behave in a way that put themselves or others at risk of being physically harmed.

Staff supported people to fulfil individual passions. The service worked with people to arrange and support them to try new things. Activities and opportunities were varied and regular. Staff supported people to achieve personal goals such as managing their finances better and in using public transport independently.

People were engaging in voluntary employment and being supported by staff to find employment to further increase their independence.

People using the service found staff respected their privacy and dignity, they had their own keys and the staff would only enter their flat in an emergency, if it was pre-arranged or if they were invited.

The provider had quality assurance processes in place that drove improvement in the service. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented.

The reader should note that the term ‘tenant’ has been used in this report and refers to people using the service.

We met with three of the nine people using the service during the course of our visit. We also spoke with four members of staff and the registered manager.

All the people we spoke with were pleased with the service. They told us they liked their living accommodation and were involved in their care and support. Comments included, “I like it here”; “the staff are nice” and “I go out a lot with my keyworker”.

Care records provided accurate information about people's needs which meant that staff understood how to support each person and provide consistent care. One staff member said the service was good because of its “person centeredness.”

There were robust arrangements in place to protect people from the risk of abuse. People told us they would talk to staff if they had any worries or concerns. Staff were supported to deliver care as they received ongoing training in a range of topics and regular management supervision. One staff member told us, “the manager knows how to get the best out of staff”.

The provider used effective quality monitoring systems and feedback from people using the service was used to improve the support they received.