This inspection site visit took place on 25 October 2018 and was announced.

Chosen Lives Co-operative Limited provides care and support to people living in a supported living’ setting, so that they can live as independently as possible. It provides personal care to adults with learning disabilities in one shared building. Up to eight people can receive a service.

The service is a co-operative which is run by its members. This includes the people who receive a service, the provider’s management team and independent advisors. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. There were five people using the service at the time of this inspection and one person was in receipt of the regulated activity personal care.

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.

At our last inspection in November 2016, the service was rated 'Requires Improvement'. This was because we identified improvement was required in two of the five key questions we inspect against. These were safe and well-led. We identified one breach in the Regulations associated with the Health and Social Care Act 2008. (Regulated) Regulations 2014. The breach was in relation to the service not being effectively monitored and assessed to improve the quality and safety of the service provided to people.

The provider sent us an action plan following that inspection which informed us the required improvements would be completed by 12 April 2017. During this inspection we checked and found the improvements had been made. This meant sufficient action had been taken in response to the breach in regulation. The rating has changed to good.

A requirement of the service's registration is that they have 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post.

People felt safe. Staff completed safeguarding training and procedures were in place to protect people from harm. Staff knew how to manage risks and risk management plans contained the information staff needed to provide care and support to people in the safest possible way. A system to record and monitor accidents and incidents that occurred was in place.

Staff were recruited safely and there were enough staff to provide the care and support required. Staff had received an induction when they had started work at the service. A programme of regular training helped staff to keep their skills and knowledge up to date.

Medicines were administered as prescribed by trained and competent staff. Medicine audits took place so if any errors were identified prompt action could be taken.

Staff understood their responsibilities in relation to infection control which protected people from the risks of infection. People’s nutritional needs were met. Staff worked in partnership other health professionals to support people to maintain their health and well-being.

People had opportunities to maintain relationships that were important to them. Staff spoke with people in a respectful way. People were supported to be independent. They were treated with dignity and their right to privacy was respected.

Detailed communication plans described the way people communicated and how staff should engage with them. Care records were up to date and showed the inclusion of the person whi

This inspection took place on 16 November 2016. The inspection was announced. We gave the provider 24 hours’ notice of our inspection. This was to make sure we could meet with people who used the service, the manager of the service and care workers on the day of our inspection.

Meriden Street Housing is a co-operative which supports adults with learning disabilities. The co-operative is operated by its members who include the people who live at the service and other independent advisors. People who live at the service are supported to live more independent lives by living within a shared address. They are supported by people employed to provide personal care and support to them in their own home.

Following the recent resignation of the committee board members the service had undergone significant changes. The registered manager had been a consistent support to people, relatives and staff whilst a new committee was formed. However the registered manager told us they had not felt supported by the previous committee and had been under considerable pressure to continue supporting people using the service whilst a new committee had been appointed. The new committee was formed in October 2016.

The provider did not continually assess, monitor and improve the quality and safety of the service.

However, the registered manager felt confident the new committee would support both the service and long term vision and aims of the Cooperative.

A requirement of the provider’s registration is that they have 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. At the time of our inspection there was a registered manager who had been in post at the service six years.

Relatives told us they felt people were safe using the service. The registered manager and staff understood how to protect people they supported from abuse. Most staff knew what procedures to follow to report any concerns they had. However the management and auditing of peoples finances was not robust enough. Shortly following our inspection visit we were notified of a safeguarding concern being reported to the Police and local safeguarding team.

Staff had a good understanding of risks associated with people’s care needs and how to support them.

There were enough staff available to support people safely and at the times they preferred. Recruitment procedures made sure staff were of a suitable character to care for people using the service. Agency staff working at the home were provided with an induction and information about the people they would be supporting.

Medicines were stored and administered safely, and people received their medicines as prescribed. Regular audits were completed to ensure medicines were managed in line with good practice guidelines.

People were supported to maintain their health and well-being. They attended appointments when they needed to and their nutritional needs were met. Staff were flexible to the needs of some people requiring hospital treatment.

Staff were kind and supportive to people’s needs and people’s privacy and dignity was respected. People were encouraged to be independent and assisted with household tasks and shopping.

The management and staff team understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), and supported people in line with these principles. People were supported to make everyday decisions themselves, which helped them to maintain their independence. Where people were not able to make decisions, relatives, social workers and healthcare professionals were consulted for their advice and input.

People were supported to pursue their hobbies and interests.

The focus of the inspection was to answer five key questions; Is the service safe, effective, caring, responsive and well-led?

Prior to our visit we reviewed all the information we had received from the provider. During the inspection we observed the care and support provided to six people cared for by the service. We spoke with three of the six people. We also spoke with the manager and three care staff. We looked at some of the records held by the service including the care files for six people.

The summary below describes what people using the service and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People's needs had been assessed and individual care plans drawn up to meet their needs. There were risk assessments in place to keep people safe. We found that people's capacity to make decisions had been assessed and incorporated into care planning.

There were arrangements in place to deal with foreseeable emergencies. We were told by staff members we spoke with that they were able to contact a manager when they needed to.

The provider employed sufficient staff to meet people’s needs. We found the provider had responded to people’s changing needs by making more staff available. People told us there were enough staff to meet their needs.

Is the service effective?

People told us they were happy with the care they had received and that their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff had received training to meet the needs of people.

We saw in care plans that risk assessments had been completed that promoted people's independence and protected their dignity. For example, risk assessments were in place for people to use local shops and other facilities independently. We found staff worked in accordance with these assessments. We found people had been supported to be involved in their local community.

Is the service caring?

We found that staff treated people with respect. People told us they liked the staff. One person told us, "The staff are here to help us and they do". At our visit we saw people being supported in a kind, considerate manner.

Is the service responsive?

We found that each person's needs were regularly reviewed and care plans had been updated when needed. Records showed that people were supported in line with these plans.

The provider had arranged for people to receive additional support from advocates and advisors where necessary.

Is the service well-led?

The provider had quality assurance processes in place. People's views had been obtained by the provider along with the views of visitors and staff. The provider used surveys and meetings to find out people's views. One person told us, "We say what we think at our meetings". The provider had taken action as a result.

We found that quality checks had been carried out by the manager and that the health and safety of people was monitored. At our visit we saw examples of the service taking action on health and safety concerns.

Staff and the manager consistently told us that their role was to provide care and support that maintained and developed people’s independence. People told us that being as independent as possible was important to them. One person told us, "The best thing is that I’m free”.

When we visited six people lived at the service who required personal care and assistance to help them live a more independent life. We spoke with three people who used the service and two members of staff. We also spoke to the current registered manager of the service Ms. Karen Little. We noted the previous registered manager had left the service and their registration was being changed to reflect this at the time of our visit.

Staff supported people in the communal areas and provided personal care to people in their own accommodation. Staff also supported people on activities outside the home including holidays.

All the people we spoke with said care staff were friendly and treated them well. One person told us "I like living here and choosing how to spend my time.”

We looked at three care files for people. All the files we looked at contained an assessment of need and an individualised care plan. Care plans had been signed by the people who used the service showing people had been involved in planning their own care. We saw that plans were in 'easy read' or large print formats so that people who used the service could access information. Plans were regularly reviewed, and reviews involved the input of people who used the service.

We looked at staff training records. These showed staff had completed the training required to work with people safely including the safeguarding of vulnerable people and whistleblowing.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We visited Meriden Street Housing Co-operative on 25 July 2012. No one knew we would be visiting. We spoke with one member of care staff, the manager and four of the tenants who used the service.

Meriden Street was a housing co-operative and all the tenants sat on the board of management. They were fully involved in the day to day running of the service. The overall impression was that tenants appreciated the way the service enabled them to maintain their independence whilst support was available when required. One tenant said, "It is independent living. We get support." The staff member told us, "It's all about promoting independence. Making sure people keep their skills."

Individual care plans were detailed and in a pictorial format which made them accessible to tenants.

Staff had received training in safeguarding and were aware of how to report any incidents or suspicions of abuse. There were procedures in place to support any tenants who were unhappy or wished to make a complaint.

Staff rotas were organised so there were sufficient numbers of staff to support tenants to attend appointments or to be involved in activities.

There were systems in place to monitor the quality of the service provided.

The staff member told us, "The service is exceptional. The tenants are not restricted in any way. All the time they are giving input to us."