Sefton Street

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People we spoke with told us that staff supported them when they needed it. We saw through people's body language and chatter between them and staff that they were comfortable with the staff.

There were robust measures in place to ensure people were safe. Staff had received training in safeguarding adults from abuse and knew what to do if they saw or suspected abuse. Risk assessments were in place specific to their individual needs and any behaviour they may present. They included detailed guidance for staff so people could be supported appropriately.

There was sufficient staff on duty to meet people's needs. Some people required staff support to access the community and take part in activities. Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. We found that staff had the skills, knowledge and experience to support people effectively and safely. Staff were supported by the manager through regular supervisions and regular training. Staff meetings were held regularly.

Medicines were managed safely and people received their medicines as prescribed. Staff had been trained to administer medicines in order to ensure errors were kept to a minimum.

We found the home clean with no odours. The home was well maintained and in good decorative order. People's bedrooms were personalised.

Regular checks and tests, such as gas, electricity, water safety and for fire safety were completed to maintain safety in the home.

People's needs were assessed and reviewed regularly to reflect people's current health and support needs. Appointments were made regularly with, for example, the GP, dentist and practice nurse, to help to maintain good health. People were supported to achieve their outcomes to maintain and increase their independence with activities of daily living, including personal care, meal preparation, shopping, laundry and travelling.

People were supported to eat and drink enough to maintain a balanced diet. We saw that people were encouraged to eat healthily and adopt an active lifestyle.

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 practice. People made decisions and choices in relation to their care, support received, daily routines and any activities they wished to take part in. Staff knew the people well and how they communicated their needs and choices, including their preferred daily routine.

People were supported to maintain regular contact and spent time with their families.

People received personalised care that was responsive to their needs. Care plans were written for the individual and informed staff of their preferences and wishes. We found they contained detailed information that enabled staff to meet people's needs. Support plans were completed to show the goals people wanted to achieve. Clear records of people's daily routines helped to ensure staff supported people according to their preference. The use of a 'visual planner' provided reassurance for which staff were supporting a person each day.

People enjoyed a range of activities, with staff support. They accessed their local community to enjoy amenities such as pub lunches, shopping, the gym, museums, and the theatre. The location of the home afforded easy access to local shops, the town promenade and beach.

There was a complaints policy in place. A complaint had been received and had been investigated according to the providers procedure, with a satisfactory outcome.

There was a person-centred and open culture in the home. Staff showed a commitment to provide support which achieved good outcomes for the people living in the home.

Quality assurance audits were completed by support staff and the registered manager which included, medication and health and safety checks.

There was a process completed annually where relatives had the opportunity to voice their opinions about the service. Feedback we saw was positive and complimentary.

There was a registered manager in the home. They were supported by support workers and an area manager. The registered manager and registered provider met their legal requirements with the Care Quality Commission (CQC). They had submitted notifications and the ratings from the last inspection were clearly

displayed in the home.

Further information is in the detailed findings below.

132 Sefton Street provides accommodation and support for up to three adults who have autism. The house is a large detached property situated on a quiet road not too far from the centre of Southport. The service is provided by Autism Initiatives UK, a national charity specializing in the support of people with autism. The property is owned and maintained by Liverpool Housing Trust.

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 and relatives of people living at the home told us they felt safe living at the home.

There were appropriate safeguarding procedures in place to protect people from harm. These included thorough staff recruitment, staff training and systems for protecting people against the risks of abuse.

There were procedures in place for managing, storing, checking and administering medicines.

We observed caring and warm interactions between staff and the people who lived at the home. Staff were able to explain how they ensured people’s dignity, privacy and choice was upheld.

Assessments had been made and reviewed regarding people’s individual capacity to make specific care decisions. Where people did not have capacity, decisions were taken in ‘their best interest’ with the involvement of family members where appropriate and relevant health care professionals. This showed the provider was adhering to the Mental Capacity Act 2005. This is legislation to protect and empower people who may not be able to make their own decisions.

The provider was meeting their requirements set out in the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. At the time of this inspection, there was one application which had been authorized under DoLS for people’s freedoms and liberties to be restricted. We checked records and saw the process had been carried out correctly.

People’s health and social care needs had been appropriately assessed. Care plans provided detailed information for staff to help them provide the individual care people required. Identified risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to the person.

People were encouraged to partake in activities and we could see people accessed the community often.

There were effective systems in place to monitor and improve the quality of service through feedback from people who used the service and their families, staff meetings and a programme of audits and checks.

Relatives of people at Sefton Street told us the care and support of their family member was "good". We were told that staff kept families informed of any changes, for example, if somebody's permanent support worker would be changing and the name of the new support worker. When appropriate, family members were involved in decisions on how care could be delivered to meet a person's specific needs. We found the provider had safeguarding policies and procedures in place that protected people from the risk of abuse. All staff had received safeguarding training.

Although people enjoyed activities in the community, we found leisure activities further afield, were not explored. For example, some people enjoyed rambling and walks in the countryside. Unfortunately this was not an activity supported by the provider and people only enjoyed this activity when visiting family and friends.

We spent time talking to a person who lived at the home, who told us about their interests. We found the use of regular bank staff, who provided cover when a person's permanent support worker was on leave, worked well in practice. The bank staff we spoke with were familiar to the people of Sefton Street and demonstrated a good understanding of their individual needs.

We found maintenance work was required to some areas of the home. Responsibility for this work sat with the landlord of the property. The provider had reported this and was waiting for work to commence.