About the service:

6A Clock Tower Mews provides a domiciliary care service to people living in the community and to people living in a supported living setting. Currently there were eight people in total and these were adults with a learning disability. The agency planned to develop their community support further and provide support to people for end of life care when they had recruited sufficient staff with the necessary skills.

People’s experience of using this service:

We found that developments had taken place and people were now provided with good outcomes throughout.

• People who use 6A Clock Tower Mews are supported by sufficient staff who are appropriately recruited, well trained and know how best to support people living with a learning disability. People were able to lead a lifestyle that they chose. They had plenty of opportunities to develop life skills and increase their independence and become part of their community.

• People were supported to have a healthy lifestyle, access healthcare support and were provided with staff who promoted good overall wellbeing through developing relationships that were based upon mutual respect and a desire to empower people.

• Management of the service had developed systems to monitor how the service was doing. This included feedback from people and using complaints to drive improvements for the benefit of people who used the service.

Rating at last inspection: On 11 October 2017 we rated this service as requires improvement.

Why we inspected: Previously we had rated this service as requires improvement and therefore have been back to check that it had improved to good. We had received an action plan telling us what the service managers would do to become compliant and therefore we checked this action had been taken.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated good.

This inspection took place on the 29 August 2017 and was unannounced.

6A Clock Tower Mews is registered to provide personal care to people living in the community. They also provide care to people with a learning disability living within a supported housing environment. At the time of our inspection there were five people using the service. Two people were living within a supported living environment with staff who were providing 24 hour care support and three people were living independently in the community within Suffolk and Cambridgeshire.

It was evident during our inspection that the service was not always being managed on a day to day basis from the registered office, 6A Clock Tower Mews in Newmarket. The supported living service was provided and managed from a house in Littleport where the scheme manager and staff were based. This was the location, which was the point of contact for people who used the service.

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. The registered provider was the director of the company and was the registered manager responsible for the day to day management of the service.

Relationships between staff and people were relaxed and supportive of their needs, wishes and preferences. People were actively involved in making decisions about their daily care and support. Staff sought the consent of people in the planning and delivery of their care. Staff promoted and supported people's independence and enabled them to have access to the local community. Where risks to people had been identified, there were plans in place to manage them effectively.

Staff had completed training in safeguarding adults from the risk of abuse. Staff demonstrated how they would recognise and report safeguarding concerns to the relevant authorities. However, the risk of abuse to people was not always considered because there were ineffective systems in place for the recruitment and selection of staff.

People were generally satisfied with the service apart from occasional shortages of staff, which prevented them from receiving their planned care. We were unable to determine how hours commissioned by the local authority to provide one to one staff support to people both within the supported living service and to those people living in the community had been allocated. This meant we could not be assured people were receiving their care as commissioned.

Systems were in place to ensure that people received their prescribed medicines. Medicines were administered by staff who were trained to do this safely.

The provider did not have a clear overview of what training staff required. Staff had not been provided with all the training they needed to equip them for the roles they were employed to perform. For example, in meeting the needs of people living with dementia and those with complex needs who presented with distressed behaviours towards themselves and others. Staff had also not been provided with training in understanding their roles and responsibilities with regards to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff and the registered provider did not demonstrate a full understanding of their legal roles and responsibilities with regards to the Mental Capacity Act 2005.

People’s healthcare needs had been identified. However, further work was needed to ensure that planning for future appointments and annual health reviews for people living within the supported living service were clearly documented within their care plans.

Staff promoted a healthy diet and provided people with choice and opportunities to develop skills in the preparation and coo