The inspection took place over two days, 4 and 8 October 2018. The first day was spent in the office of the organisation and on the second day we visited people using the service in a block of supported living flats. People using the service have learning difficulties.

This service is a domiciliary care agency. Some people using the service live in a ‘supported living’ setting, so that they can live in their own home as independently as possible. 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. Other people using the service lived at home with their family.

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.

There was a registered manager in place. 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.

The service was Outstanding in its responsiveness to people’s individual needs and preferences. Staff had in depth knowledge of the people they supported, enabling them to deliver a highly person centred service. Working with people’s particular communication needs and with understanding of their particular behaviours, staff supported people to manage their anxieties and related behaviours.

Staff were kind and caring and proud of the achievements of the people they supported. People were treated with dignity and respect and given privacy when they wanted it.

People using the service were safe. There were sufficient staff to meet people’s needs. Where there were gaps in rotas, these were covered by existing staff so that no agency staff were used. There was a positive approach to risk taking, which meant people didn’t experience necessary restrictions in their lives. For one person, staff had worked with the police and local shopkeeper to help make the local environment safe for them to go out independently. Support was given for those people who were prescribed medicines. When these were administered, it was recorded on a Medicine Administration Record (MAR) chart.

The service effectively met people’s health needs, working with healthcare professionals when necessary. People were supported nutritionally to maintain a healthy diet and weight. For some people this involved working with the community dietician. People’s rights were met in line with the Mental Capacity Act 2005 (MCA). We viewed records of Mental Capacity Assessments and Best Interests decisions.

Staff were well supported in their work, attending supervision regularly. They told us they felt able to raise issues and concerns and that senior staff were approachable. Staff were also positive about the training they received. They told us the training enabled them to meet the complex needs of people they supported. The provider demonstrated the importance they placed on training by sending staff on ‘train the trainer’ training for certain topics that were difficult to find courses for.

The service was well led. The registered manager and directors were involved at all levels of the organisation. There was a culture of continual improvement within the service and the provider had clear ideas about how they wanted to improve. There were systems in place to monitor the quality of the service provided.

We undertook an inspection of 3 Trees Community Support on 1 March 2016. The inspection was announced, which meant that the provider knew we would be visiting. This is because we wanted to ensure the provider, or someone who could act on their behalf, would be available to support the inspection. When the service was last inspected in October 2013 no breaches of the legal requirements were identified.

3 Trees Community Support provides personal care and support to people in their own homes in Bristol, South Gloucestershire and Bath and North East Somerset. 3 Trees supports people with a learning disability, Autism Spectrum Disorder (ASD), sensory and physical impairments and dementia. At the time of our inspection there were 27 people receiving personal care and support.

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.

The service ensured people were safe by having thorough recruitment procedures. A structured process sought to employ staff committed to the ethos of the organisation. New staff completed a full induction programme aligned with the Care Certificate. Ongoing training ensured staff were skilled and effective in their roles.

There was a positive approach to managing risk which promoted people’s independence. Care records were detailed and gave clear guidance and strategies on how people were effectively supported. People were encouraged and assisted to participate in a range of activities and be part of their local community.

The service was responsive to people’s needs as staff showed a positive understanding of working with individual strengths and preferences. This enabled people to work towards their own desired outcomes. People’s needs were fully assessed to ensure the service was able to meet them.

The service had engaged with people and staff to gain feedback. It had used this information to make positive changes in the systems it used and the way the organisation operated.

A range of systems were in place to enable the quality of the service to be effectively monitored. Regular meetings took place to ensure care was consistent and proactive. Comments received from relatives about the service were positive and consistently good.

The 15 people we spoke with by phone and in person gave positive feedback about the agency. Examples of the comments included “they help me to cook and “I can choose what I would like to do”.

Every person we spoke with had positive opinions about the staff who worked for the agency. People told us “they really are excellent” and “I would give them ten out of ten”.

We found that care plans showed how to meet people’s needs and had been regularly updated to reflect that people’s needs had changed.

There were systems in place to monitor the quality of the service. This included gaining feedback from people who received support from the agency.