Choices Housing Association Limited - 2 Cowley Way

People’s experience of using this service: The culture was welcoming and inclusive. People enjoyed living at 2 Cowley Way.

Staff, most of whom had been at the service for several years, cared passionately about their roles and people receiving good health and wellbeing outcomes.

The registered manager had confidence in their staff and the respect was mutual, with a good team spirit and shared understanding of how best to support people.

Feedback from people, their relatives and external professionals was positive regarding the continuity of care and the sensitive, dignified approach of staff. Staff turnover was extremely low and agency staff were not used.

There were sufficiently trained staff, suitably deployed, to meet people’s needs safely.

Healthy eating was encouraged, as was healthy living, notably through people being supported to use the gym.

People’s individual preferences, likes, dislikes and important information such as allergies and potential triggers to anxiety, were well known by staff.

Regular meetings were held with staff and people who used the service. These meetings were an opportunity to openly discuss a wide range of topics. People and staff confirmed they could raise queries or suggestions in a welcoming, inclusive atmosphere at these meetings.

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 supported this.

Good community links were in place and people felt a part of their community. People were encouraged to try new activities and make new friendships.

Records were accurate, up to date and person-centred. Clear systems were in place for the review and audit of all aspects of the service, with support in place from the area manager.

The registered manager had been in post for five months and demonstrated a good knowledge of the needs of people. People got on well with the registered manager and relatives confirmed they were approachable.

Turnover of staff remained low and staff morale was high.

The care service was managed in line with the values that underpin 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (report published December 2016).

Why we inspected: We inspected the service in line with our scheduled programme of inspections.

The service is registered to provide accommodation and personal care for up to eight people. People who used the service had a learning disability. At the time of our inspection there were eight people who used the service.

The service had 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 and associated Regulations about how the service is run. The registered manager was unavailable at the time of our inspection, but we were able to speak with the deputy manager.

People were kept safe because staff understood how to recognise possible signs of abuse and the actions they needed to take if people were at risk of harm. People’s risks were assessed in a way that kept them safe whilst promoting their independence.

People who used the service received their medicines safely. Systems were in place that ensured people were protected from risks associated with medicines management.

We found that there were enough suitably qualified staff available to meet people’s needs in a timely manner. The registered manager made changes to staffing levels when people’s needs changed or to accommodate support with accessing the community.

Staff were trained to carry out their role and the provider had safe recruitment procedures that ensured people were supported by suitable staff.

Staff had a good knowledge of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA and the DoLS set out the requirements that ensure where appropriate decisions are made in people’s best interests where they are unable to do this

for themselves. People’s capacity had been assessed and staff knew how to support people in a way that was in their best interests. We found that where people were able they consented to their care and treatment.

People were supported with their individual nutritional needs and were able to access other health services with support from staff.

People told us and we saw staff were kind and compassionate. Staff treated people with respect, gave choices and listened to what people wanted.

People’s preferences in care were recorded throughout the care plans and we saw that people were supported to be involved in hobbies and interests that were important to them.

The provider had a complaints procedure that was available to people in a format that they understood.

Staff told us that the registered manager was approachable and led the team well. Staff were enthusiastic about their role and what their support meant for people.

People, relatives and staff were encouraged to provide feedback on the service provided. The registered manager had systems in place to assess and monitor the quality of the service provided.

Is the service safe?

There was a system in place to make sure that the manager and staff learned from events such as accidents, incidents, complaints, concerns and investigations. We saw that lessons had been learned in some of these areas. This reduced the risks to people and helped the service to continually improve. The provider closely monitored the operation and safety of the service.

A safe system of medication was in place. Medication had been appropriately stored, recorded and administered. Staff received training and regular competency tests by the manager to ensure that medication was given correctly and safely.

We saw detailed care records outlining people's needs and the actions needed to ensure they were safe. Some people could become distressed and agitated, presenting a potential threat to themselves or others. Behaviour management plans were in place to manage these situations. Diversionary actions had been successful in avoiding an escalation of behaviours.

We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospitals and care homes. The service had procedures in place and the manager knew how to apply for this authorisation. A recent application had been made in relation to DoLS. The service were awaiting a decision from the best interests team of the local authority. No one at the time of our inspection was subject to DoLS.

Is the service effective?

People's health and care needs were assessed with them. They had been involved in care planning and establishing care and treatment plans. Goals had been set with people and reviewed quarterly. Monthly reviews had monitored progress and the actions needed to ensure people's goals and objectives had been met.

People told us that they were happy with the care they received and felt that their needs were being met. This confirmed what we had seen in care records. There was a relaxed and positive atmosphere. We observed good engagement and relationships between staff and all people using the service. A relative told us, "X was really ill last year and needed surgery. The staff were marvellous. They brought X through it. I can't praise them enough."

Is the service caring?

We found that people and staff treated each other with mutual respect. Staff gave us examples of how they ensured privacy and dignity for people. We saw in a person's care record that doors and curtains could be used to provide privacy and dignity.

People were listened to. We saw people approach staff in a relaxed way. Responses were positive and supportive. We saw people sitting with staff and having individual conversations. Some people sat in the office and chatted to staff, they did not need a reason to do this.

People who used the service completed an annual questionnaire. They recorded high scores for questions that included: Do you like the way staff treat you? Do staff listen when you have something to say? Do staff treat you like an equal?

Is the service responsive?

People undertook activities and had contacts with relatives and friends that were important to them. Staff supported them to maintain contact with people. People were encouraged to use public transport, taxis or the provider's transport to visit relatives and friends. A relative told us, "Every week X comes to visit me for the day. I then visit (them). The contact is important to us both."

People's health care needs had been monitored closely. When changes occurred external health care professionals had been contacted. We saw their advice and treatment plans in the records we examined. For example we saw daily exercises for a person that had been recommended by a physiotherapist. Staff had given daily encouragement to the person to exercise.

Is the service well-led?

People told us that the manager and staff were approachable and helpful. Staff told us they could approach managers at any time including out of hours contacts with on-call managers.

Systems were in place to monitor the quality of the service. Information from incidents and accidents had been analysed and used to identify changes and improvements to minimise the risk of them happening again. Action was taken to improve the quality of service, correct any shortfalls and act on concerns raised.

Regular staff meetings had been held. Staff told us they had been able to raise any concerns. They confirmed that regular supervision and appraisals were part of the support they received. We noted a commitment and pride in their work from the manager and staff we spoke with.

A relative who visited the home regularly told us that they had no concerns about people's safety or welfare. They told us that people were supported to enjoy life as much as possible. They said, 'I know he is happy and looked after.'

Every person had an individual plan of care, based on their learning disability and other health needs. During our inspection, everybody received unhurried care and support, at the time they needed it.

The home had a stable staff team, which ensured people were familiar with the staff supporting them. All the staff we spoke with were positive about working at the home. The training of staff ensured staff had the skills and knowledge to support people effectively and keep them safe. We found that adequate background checks had been completed as part of the recruitment of staff.

We found that important records about the care and support provided to people were complete and up to date.

We spoke with most of the people who lived there; two people showed us their rooms and spoke privately with us.

When we arrived at 10.30am people were involved in a range of personal activities. Playing on a games machine, cleaning the house, or just sitting listening to music. There was a relaxed homely atmosphere.

Details of the registered manager for this location do not appear in this report as the administrative process was still to be finalised. Miss Becky Whelan was in the process of registering but her details were not yet recorded on our system.