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Inspection carried out on 14 June 2019

During a routine inspection

About the service

Livability Wall Street is a residential care home in Hereford city centre providing personal care for up to 10 people in a purpose-built environment. It specialises in supporting older people with cerebral palsy, multiple sclerosis, acquired brain injury and stroke. At the time of our inspection, there were 9 people living at the home. The service also provides personal care to 10 people living in three 'supported living' settings and one person living in their own flat, all of whom live within Gloucestershire.

People’s experience of using this service and what we found

People were protected from abuse by staff who understood how to identify and report any abuse concerns. The risks to people’s health, safety and welfare had been assessed, recorded and plans put in place to reduce these. Staffing levels enabled people’s needs to be met safely, and ensured those receiving care in supported living settings or their own home received a consistent and reliable service. The provider and management team sought to learn from any accidents or incidents involving people. Steps had been taken to protect people from the risk of infections.

People’s individual needs and requirements were assessed with them before they started to use the service. Staff received an effective induction, followed by ongoing training and management support to enable them to work effectively. People had enough to eat and drink, and any risks associated with their eating or drinking were assessed and managed. Staff and management worked effectively with community health and social care professionals to ensure people’s health needs were met and to achieve positive outcomes for them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff adopted a friendly, caring and professional approach in their work and this gave people confidence to express their views about the care provided. People were treated with dignity and respect at all times and staff promoted their independence. Staff and management understood the need to promote equality and diversity and consider people’s protected characteristics.

People and their relatives’ involvement in decision-making about the care provided was encouraged by staff and management, and their views were listened to. People’s care plans supported a person-centred approach and were followed by staff. People had support to lead lifestyles of their choosing, access the local community and participate in recreational activities. People and their relatives understood how to raise any concerns or complaints about the service. People’s wishes and choices about their end of life care were explored with them.

The management team promoted a positive and inclusive culture within the service, based upon open communication with people, relatives, community professionals and staff. Staff told us the management team were approachable and felt their own work was valued. The provider’s had quality assurance systems and processes in place to enable them to monitor and improve the quality of people’s care.

Rating at last inspection

The last rating for this service was good (published 28 June 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 11 May 2016

During a routine inspection

The inspection took place on 11 and12 May 2016 and was unannounced.

Wall Street provides accommodation and personal care for up to 10 people with a physical disability. There were nine people living at the home when we visited. A registered manager was in post at the time of our 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 protected from harm and abuse because the provider had clear procedures for dealing with any concerns and staff understood these. The registered manager adopted a positive approach to risk and people were involved in risk assessment. Any accidents or incidents at the service were monitored on an ongoing to ensure lessons were learned. People’s medicines were stored, administered and disposed of safely.

There were enough staff to meet people’s needs and staff had the necessary skills and knowledge to support them effectively. Safe recruitment and selection procedures were followed at the service. The registered manager carried out pre-employment checks on all staff before they were allowed to start work. Staff received an effective induction upon joining the service and spoke positively about the ongoing training and one on one support sessions provided. The registered manager maintained up to date staff training records and adapted how training was delivered.

The people living at the service knew the registered manager and staff spoke positively about the overall management of the service. Staff were involved in the running of the home and able to question the way things were done. People and their representatives were involved in their assessment and care planning. People’s care plans detailed their care and support preferences and provided staff with guidance on how to support them. Staff understood people’s healthcare needs and provided support for people to attend routine health monitoring and check-up appointments.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 and how to apply it in their work. People were asked for their consent before staff carried out care tasks. People chose when they wanted to eat and drink during the day and received the support they needed with eating and drinking from staff. Risks to individuals associated with eating and drinking had been identified and assessed with appropriate specialist advice.

People were supported by staff who were kind and caring. People felt comfortable and relaxed in their home and were supported to pursue their hobbies and to participate in activities of their choosing. People were supported by staff who had a good understanding of their needs and preferences. . People were supported by staff in a way that maintained their dignity and respected their privacy.

People were supported to maintain relationships with families and those that mattered to them. People’s relatives could visit the home whenever their family members wanted and were made to feel welcome.

The provider and registered manager encouraged an open dialogue with the people who lived at the service. People were encouraged to give feedback and their views were valued.

The registered manager had a clear understanding of the responsibilities associated with their role and felt supported by the provider’s senior management team.

Inspection carried out on 12 August 2013

During a routine inspection

As well as being registered to provide a care service within Wall Street care home the service was also registered to provide personal care to people living in their own home. At the time of this inspection no one living in their own home was receiving a service so this regulated activity was not inspected.

We met four people who were living at the service. We talked to three in private about their experiences. People were very satisfied with the support they received which helped them be as independent as possible. One said, "The staff are pleasant� and �I get help with food shopping and preparation�. One person�s relative who was visiting said, �You can�t fault them it is really good care�.

We found that people had their support and health needs met by staff working in liaison with community health professionals. Care plans had not been fully developed for two new people but staff felt well informed about their needs and there was evidence that their needs were being met.

Overall suitable arrangements were in place to support people with their medication. There were some areas where the arrangements could be made safer and the manager took prompt action to make improvements.

The staff felt well supported and trained. Refresher training in some areas was overdue but a plan was in place.

There were effective leadership systems in place to manage the care service and monitor health and safety risks.

Inspection carried out on 13 September 2012

During a routine inspection

When we visited 14 Wall Street we spent four hours in the home. We met the registered manager and two staff. We talked to two of the eight people who lived there about their experiences. Both people gave us permission to look at their care records. They were very satisfied with the support they received which helped them be as independent as possible. One said, �I have lived in many places around the country and I have never known care this good�.

We found that people were supported in promoting their independence and community involvement. Their diversity, values and human rights were respected. People told us that staff took them seriously if they felt unwell and provided good care. They felt able to raise any concern they had.

We looked at staff training records and spoke to two staff on the telephone to get their views. The staff felt well supported and trained. Refresher training in some areas was overdue but a plan was in place.

People told us they liked the staff and felt they were competent and had the right skills and attitude. Comments included, �they are always helpful and welcoming to my visitors and they don�t rush me� and �there are enough staff so we don�t have to wait long for help�.

Reports under our old system of regulation (including those from before CQC was created)