Choices Housing Association Limited - 4 West Street

Choices 4 West Street is a care home, people in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Choices 4 West Street can accommodate four people in one adapted building. At the time of the inspection there were four people living in the care home.

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 supported by staff that understood how to protect them from harm and abuse. Risks were assessed and there was guidance for staff on how to support people to manage risks to their safety. The home was clean and all equipment was safely maintained. There were sufficient staff to support people and safe recruitment practices were in place. Medicines were administered safely and when things went wrong the registered manager made sure staff learnt from the incident.

People received support which was effective from trained staff. Staff were supervised and their competency was checked by the registered manager. 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 could choose for their meals and they enjoyed them. People were supported in an environment that was designed to meet their needs and had access to health professionals when they needed it.

People were supported by kind and caring staff. There were positive relationships in place and people felt they were supported to make their own decisions. Relatives and friends were able to visit when they wanted to and people had their privacy and dignity maintained.

People received personalised care and support. Staff understood people’s needs and preferences including their spiritual and cultural needs and were able to plan how they would wish to be supported at the end of their life. People were supported to maintain links in the community and undertake activities. There was a complaints policy in place which people understood and they were confident complaints would be addressed.

A registered manager was in post and was accessible to people, relatives and staff. People were actively involved in the service and shared their views about the quality. There were systems in place to check on the quality of the service and peoples care delivery. The registered manager took any required action to make improvements.

Further information is in the detailed findings below.

We used the information to answer the five questions we always ask:

Is the service safe?

Robust safeguarding procedures were in place. Staff were well-trained, understood their role and how to protect people from potential harm. People using the service told us what they would do if they were worried about anything. We saw that each person had watched a DVD with staff about the various forms of abuse and what they should do if they had concerns about their safety.

There were systems in place to identify, assess and monitor risks. Risk management strategies were in place to reduce risks. When control or restraint had been used to protect people, detailed records were kept and reviewed to ensure that restraint was used only as a final option when other methods had failed. People were protected against actions being unlawful or excessive.

We monitor the operation of the Deprivation of Liberty Safeguards 2009 (DoLS) that apply to care homes. Policies and procedures were in place but no applications had been needed or submitted. Staff had been trained to know when an application should be made and the service had previous experience of submitting applications.

We saw that people had been cared for in an environment that was safe, clean and hygienic.

Is the service effective?

Detailed plans of care had been compiled involving people who used the service. Risk assessments and risk management plans were in place outlining the actions to be taken to reduce risks. Care records, including risk assessments had been reviewed regularly with the person to ensure there was a current record of how care was delivered.

The three people we spoke with told us that they were happy with the care provided at the service. People were overwhelmingly positive and complimentary about the staff and we observed good open dialogue and interactions between staff and people using the service. A relative told us, 'We couldn't wish for a better place. Staff are excellent and keep us informed.'

An independent advocacy service was available if people needed support or advice about their care. This had been used previously to assist a person making a complex decision.

Is the service caring?

When speaking with staff and observing their interactions with people it was clear that they genuinely cared for the people they supported. We saw that a regular evening social event had been established by the service and was very successful. We saw that some staff continued to support the event when they were not working.

People made decisions about their lives. They told us they liked daily planned events in the community and that having contacts with their families was important to them. We saw that regular contacts with relatives and friends were built into activity programmes. People told us they liked this.

People's preferences, interests, aspirations and diverse needs had been recorded in care records. Staff were aware of people's individual needs and care and support had been provided in accordance with people's wishes and choices.

Is the service responsive?

People were aware how to make a complaint. There were clear procedures stating how complaints would be handled. Relatives told us that if they asked for information or made suggestions there was always a positive response.

We saw that minutes of staff meetings, house meetings and quality questionnaire responses had been action.This contributed to improvements to the service.

If people's health or psychological needs changed external health professionals had been contacted. Their advice had been recorded and treatment plans put into place. The contribution by health professionals was an integral part of the care and support that people were given.

We saw that the service had responded to information from people using the service, their representatives and staff. This improved the quality of the service

Is the service well-led?

Regular staff meetings had been held. Staff were able to raise any concerns they had. We saw that regular supervision and appraisals were part of the support staff received. Staff told us that they were listened to.

The service had a quality assurance system and records showed that identified problems and opportunities to change for the better had been addressed promptly. As a result the quality of the service was continuously improved.

We saw that people who used the service were treated with respect and dignity and were involved in activities which brought them into contact with the local community. One person told us, "I work at the office, I file and shred some of the papers and I get paid". Another told us, "I have a bus pass".

We saw people received the care and support that met their individual needs. People had care records that informed staff of how people wanted to be supported. People's personal records were stored appropriately and had been reviewed regularly.

Medication was administered, stored and recorded in line with good practice guidance and managed appropriately.

We saw records which showed that staff received training opportunities and were supported by the registered manager and the organisation. Staff we spoke with confirmed they met with the manager to discuss their practice and training needs.

People's concerns or complaints were listened to, recorded and acted upon to ensure that any concerns were resolved without delay. People who used the services and their relatives told us they knew who to complain to, if they needed to.

People we spoke with told us that they could make choices for themselves and there was evidence that their capacity to consent and to make decisions had been assessed. People said they felt that they were consulted about the things that happened and felt supported when they made day to day decisions. One person said, "I go to work and also go to Bingo every week".

We saw that people's personal and health care needs were assessed and plans were in place to ensure that staff had the information they needed to ensure people's needs could be met and risks reduced.

We saw that people knew how to make a complaint and how to report if they were unhappy or didn't feel safe. This meant that the service had ensured people had received information they needed to ensure their safety and welfare.

Following the inspection we spoke to two relative's and to a social care professional. They were positive about the service. We speak to other people who have an interest in services to establish their views of the quality of service provided.

We saw that regular monitoring and auditing of the service and systems was carried out regularly to identify deficits and to ensure that improvements were made.