The inspection took place on 17 July 2018 and was unannounced. Choices Housing Association Limited - 535 High Lane 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. It can accommodate up to eight people in one adapted building, split into two floors. There were eight people using the service at the time of our inspection.

At the last inspection in January 2016 the service was rated as Good. At this inspection we found the service remained Good.

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.

People gave us positive feedback. They told us they were happy, liked the staff and were supported to partake in activities and trips that they enjoyed.

We have made a recommendation about the provider considering best practice guidance in relation to their Statement of Purpose and achieving outcomes for people.

People were kept safe by the systems the home had in place. There were sufficient amounts of safely recruited staff to support people and staff understood their responsibilities to recognise potential abuse and to report their concerns.

There were detailed risk assessments and plans in place and staff were following these. Medicines were managed safely and action had been taken if things had gone wrong and learning put in place to reduce the likelihood of incidents reoccurring. People were protected from the risk of infection as the home was clean and tidy and checks were made in relation to infection control.

People were protected under the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to have food they liked and people were kept safe if they were at risk whilst eating. People had access to other health professionals when necessary and people’s health conditions were monitored and there were care plans were in place to guide staff.

Staff knew people well and people had personalised plans in place. People were supported to partake in a range of activities and trips. People had differing ways of communicating and these were planned for and staff knew how to communicate with people. People were supported to make plans for the end of their life and people’s preferences were recorded. People were able to complain and a suitable policy was in place.

Systems were in place to monitor of the service and to try and improve people’s experience of care. There were regular resident and staff meetings to discuss people’s feelings and people’s changing needs. People liked the registered manager and staff felt supported. The last CQC rating was on display and notifications were submitted as required by law.

We inspected this service on 20 November 2015. This was an unannounced inspection. Our last inspection took place in July 2014 and at that time we found the home was meeting the regulations that we checked them against.

Choices Housing Association Limited - 535 High Lane is registered to provide accommodation and personal care for up to eight people. People who use the service have a learning disability and/or a mental health condition. At the time of our inspection seven people were using the service.

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 and associated Regulations about how the service is run.

People’s safety was maintained because risks were assessed and planned for and the staff understood how to keep people safe. People’s medicines were managed safely, which meant people received the medicines they needed when they needed them.

There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety. Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

People’s health and wellbeing needs were met and people were supported to attend health appointments as required. People could access suitable amounts of food and drink that met their individual preferences.

Staff showed they understood and applied the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This ensured decisions would be made in people’s best interests if they were unable to make decisions for themselves.

People were treated with kindness, compassion and respect and staff promoted people’s independence and right to privacy.

People were involved in the assessment and review of their care and staff supported and encouraged people to access the community and participate in activities that were important to them.

People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

There was a positive atmosphere at the home and people and staff were supported by the registered manager.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with us.

This inspection was carried out by a CQC inspector. We spoke with five people who used the service, three relatives, three members of staff and the registered manager. We also reviewed records relating to the management of the home which included four care records, daily care records, medication records, staff files and training records and minutes of meetings. We used the information to answer the five questions we always ask:

Is the service safe?

Care records had been reviewed and re-written since our last inspection. This included risk assessments. This ensured that there was a current profile of risk for each person and staff had the necessary information to keep people safe.

People received effective and safe support to take medicines they had been prescribed because detailed and accurate records had been kept and evaluated by senior staff. Staff had regular assessments of their competency to administer medicines. This meant that people were protected against the unsafe use and management of medicines.

An effective staff recruitment and selection process was in place. Appropriate references and checks had been undertaken to ensure that staff were suitable to carry out their work. Staff had appropriate induction and training to ensure they had the skills and competencies to care for people safely.

A relative told us, "X has had several previous placements that were unsatisfactory. But we are very pleased with the care they now receive. We feel that X is safe now."

The service had made changes for people who may present risks to themselves or others. Incidents had been scrutinised and changes made to risk management plans with alternative strategies to de-escalate potentially serious incidents. Staff told us and records showed that the number of incidents requiring physical interventions or medication to manage serious incidents had significantly reduced. This meant the risks to people had been reduced.

We monitor the operation of the Deprivation of Liberty Safeguards 2009 (DoLS) that apply to hospitals and care homes. One person had been made subject to a restriction under DoLS since our last inspection to ensure their health and safety. The service had made other applications under DoLS procedures and were awaiting replies from the best interests team of the local authority in relation to the applications.

Is the service effective?

People's health and care needs had been assessed, records reflected the correct level of support people needed. Care records had been reviewed monthly and any changes to individual needs had been reflected in care records and risk assessments.

Each person had a health action plan to record their health needs and to ensure their continued good health and wellbeing. A range of health care professionals had been involved to meet people's needs. The service had established a regular dialogue with the GP surgery and health professionals. Care and treatment plans had been established and followed. We saw that the service had been pro-active in pursuing health issues. This ensured that people had the necessary care and treatment to meet their health care needs.

Annual reviews recorded people's goals and objectives. These had been reviewed subsequently at three monthly and also monthly reviews. Monthly audits by the provider's quality manager had included checks on the objectives set at the person's annual review meeting.

Is the service caring?

We observed natural and relaxed conversations and interactions between staff and people who used the service. People responded well to staff, who were sensitive and caring in the support they provided. We saw that staff had a good understanding of how people were feeling and were able to respond to what they needed.

We spoke with five people and asked their opinions about staff and the support they received. Feedback was positive. One person told us, "I really like the staff they are good to me they are friendly and helpful. I am happy with everything, I like living here."

Staff were able to give us examples of the good practices they used to ensure that people's privacy and dignity were respected. We saw that staff treated people with care and compassion. People were listened to, their views were sought and their wishes respected. People could be confident that their needs would be met.

Is the service responsive?

When people's health care needs changed external health professionals were contacted. Their actions and recommendations had been recorded and acted upon.

Regular weekly meetings had been held with people using the service. We saw from minutes of the meetings that people's views had been sought about a range of matters including activities, menu planning or any changes they wished to make about daily routines. We saw from a summary of the annual questionnaires completed by people who used the service and relatives that suggestions made had been acted upon to change and improve the service to people.

We saw that suggestions made by staff in team meetings had been acted upon.

Is the service well-led?

People told us the manager and staff were approachable and helpful. A relative told us, "Staff keep us informed about any developments relating to X. We have the same positive response whichever staff are on duty. We know we can speak with the manager at any time."

Staff told us they were involved in discussions about the service and were asked for their views. They felt listened to. Staff told us they felt that they were valued and any suggestions they made were considered. We noted a commitment and pride in their work and being part of the positive changes that had been made over the past year to improve aspects of the service.

The provider had a quality assurance system of checks and audits in place to monitor the quality of the service. We saw that opportunities to change things for the better had been addressed positively. As a result the quality of the service was continuously improving.

During our inspection we spoke with six people who used the service, three care staff and two visiting professionals. People told us they were happy with their care. One person told us, “The staff make me happy. They talk to me and listen to me”. Another person said, "Staff are nice to me. I miss my mum and dad but I talk to the staff and feel better”. A third person told us, “I am happy here”.

People told us they could make choices about their care. We saw that people’s choices were respected and staff were responsive to people’s individual choices and needs.

We saw that staff understood people’s needs and people 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.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

When we carried out our unannounced inspection we spoke with four people living at the home and four staff. We reviewed care records and other documents, and observed how people were supported to make decisions and choices about how they were cared for.

People living at the home told us that they were happy there and satisfied with the care that they received. One person using the service told us, “Staff look after me. I love the staff like my own family”. Another person told us, “I like living here, I can do what I want here and feel safe”. We observed that people were cared for in a sensitive and warm way and the care they received was as described in their care plans.

People we spoke with told us they felt safe living at the home and care staff that we spoke with had a good understanding of how to keep people safe. We observed that there were enough qualified and experienced staff and staffing levels were reviewed to reflect the needs of the people living at the home.

We saw that the provider had effective monitoring systems in place to ensure that people living at the home received a good quality service. We observed however, that records were not kept securely and were not always updated when they should have been.

We carried out this inspection visit to assess whether the service was compliant with outcome four of the essential standards of quality and safety, that all services have to meet. The standard relates to the care and welfare needs of people using the service.

This is a very large modern house where eight people live together. The two floors accommodate four people each with self-contained facilities and separate lounge, dining and bathroom areas, but we saw people moving between the two areas throughout our visit. One person told us that they had asked to move to the first floor and we saw that a stair-lift had been installed for ease of access for this person.

People told us that they liked living at High Lane and talked about the many interests they had and their daily access to the community. We also spoke with the manager and staff on duty, a family carer and two people from the local authority who monitor the service.

A family member told us that their relative is dropped off at their home each week for four hours where they have contact with several family members. The family told us that they had been very happy with the the care their relative received at High Lane. A relative told us that (the person) was "Very happy there and the staff are great". They had no concerns at all about the person's care and staff understood the importance of family contact as an important part of care.