About the service:

Aspects 2 Supported Living Service provides care and support to people living in a ‘supported living’ setting so that they can live in their own homes as independently as possible. The service was supporting 17 people at the time of our inspection who received personal care and support in seven ‘supported living’ settings.

People’s experience of using this service:

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The principles and values of Registering the Right Support and other best practice guidance were seen to be met in the following ways:

¿ People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

¿ Staff understood how to communicate with people effectively to ascertain and respect their wishes. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

¿ People were protected from abuse and discrimination

¿ People were supported to access their local community and supported to prevent becoming socially isolated.

¿ Systems for monitoring the quality and risks in the service had improved. Some time was needed for the provider to complete and evaluate some of their recently introduced improvements.

¿ People told us they were happy living where they did and that care staff were good.

¿ Improvements had been made to care and support plans, staff morale, quality monitoring, managing complaints and medicine management.

¿ Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents and concerns.

¿ The service assessed risks to people’s safety and plans were in place to minimise those risks.

¿ We received positive feedback from people, their relatives and health and social care professionals and were told things had improved since our last inspection.

¿ The provider had recruited a new manager who was in the process of registering with CQC and a quality manager who was responsible for monitoring the quality of the service. A service improvement and action plan was in place.

¿ The new manager had sent out surveys to relatives and was due to send out to people supported by the service soon to get their views, seek feedback and make improvements where appropriate.

¿ People were supported by staff who had received the training and support they needed to provide effective care.

Rating at last inspection: At the last inspection on 27 and 30 July and 1 August 2018 the service was rated as Requires Improvement. (This report was published on 25 September 2018).

Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions, 'Is the service safe, effective, caring responsive and well led'? to at least Good.

In September 2018 and March 2019 the provider told us they had changed the management structure and had employed a quality manager to ensure regular audits were completed. An on-going service improvement plan had also been implemented.

Why we inspected: We inspected this service as part of our on-going Adult Social Care inspection programme. This was a planned inspection based on the previous Requires Improvement rating. We also followed up on progress against agreed action plans to address the two breaches in regulation found at our inspection in July and August 2018. Previous CQC ratings a

This inspection took place on 27 and 28 July and 1 and August 2018. We previously inspected the service on 21 May 2016 and it was rated ‘Good’ overall. At this inspection we found the provider did not meet all the requirements of the regulations and we rated the service ‘Requires Improvement’ overall.

Aspects 2 supported living provides care and support to people living in ‘supported living’ settings, 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.

Not everyone living at Aspects 2 receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating.

This is the first time the service has been rated as ‘Requires Improvement’.

People using the service lived in different supported living households across Gloucestershire. At the time of our inspection there were 18 people receiving personal care in different households. As part of our inspection we visited four households.

There was no 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 and associated Regulations about how the service is run.

In February 2018 Aspects 2 supported living changed provider. In June 2018 the registered manager unexpectedly left the service, alongside 13 other staff members. A new manager commenced employment in July 2018 and they were planning to register with the CQC.

We spoke with a representative of the provider and the new manager on the second day of our inspection. They gave us reassurances that plans would be put in place to improve areas identified as requiring improvement during our inspection. The provider had been slow in assessing the quality of the service and putting safeguards in place to mitigate the risk of people receiving unsafe care for example, in relation to the induction of agency staff. Records and information relating to the management of the service was not readily available to ensure evidence how the provider was ensuring the service met the requirements of the regulations. A letter had been sent out to families, staff and people supported by the service on 16 July 2018 stating who would be the new registered manager.

At one of the households, medicines were not always safely managed because some documentation in relation to medicine administration practice was not in place.

The service had suitable systems for identifying and responding to allegations of abuse. Recruitment processes ensured that new staff were of good character and suitable to work with people.

Training records confirmed that all staff had received the provider’s required training to support people effectively. The Care Certificate had been introduced and newer members of staff were completing this as part of their induction.

The service worked in line with the principles of the Mental Capacity Act 2005 in terms of people’s consent to care and acting in their best interests where appropriate.

People experienced good services in some respects. People were supported to maintain good health and eat healthily. The advice of community healthcare professionals was appropriately sought and acted upon.

Permanent staff members knew people well and people relied on these staff to support them to make day to day choices about their care and daily routines. Some people living at Aspects 2 supported living had very limited vocabulary and found it difficult to make decisions about their care without support. We did not find accessible means of written communication used throughout the ser

This inspection took place on 5, 6 and 11 April 2016 and was announced. Aspects 2 provides care to people with a learning disability, physical and/or sensory disability and/or mental health needs living in their own homes in Gloucestershire. Some people lived alone in their homes and others lived together in a house they rented, receiving shared care from Aspects 2. At the time of our inspection 23 people were receiving personal care. The provider was also responsible for supporting people to take part in social activities, education and employment opportunities as well as maintaining relationships with people important to them.

There was a registered manager in post, who was also one of two directors of the company. 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 and associated Regulations about how the service is run. The registered manager was unavailable at the start of the inspection but was present on the final day.

People received highly individualised and personalised care which reflected their needs, likes, dislikes and aspirations. They were involved in planning and reviewing their care, talking with staff and managers about their experiences and how they wished to be supported. Their care records described their individual needs providing clear and specific guidance for staff. People were supported to be as independent as they could be; making choices about their day to day lives or being supported in their best interests if this was needed. People were supported by staff who knew them well and understood their needs. People liked to have the same staff helping them and this was achieved by allocating staff teams to work with people on a regular basis.

People were kept safe by staff who understood how to uphold their human rights. People’s diversity was respected and people were treated with dignity and sensitivity. Staff were kind, good humoured and reassuring. People were supported to stay well and healthy. Staff understood how to support people when anxious or upset.

People benefitted from innovative and imaginative staff who created opportunities for them to try out new activities or explore new ways of living. People said “It’s amazing” and “its cool” about their lifestyles. They enjoyed meaningful activities in their local communities such as going to day centres, college, voluntary work or helping in a school. They liked to socialise going to pubs, bowling, cinema and the theatre. They kept in touch with family and friends.

Creative systems had been introduced to help people to understand information. Some people had their care plans produced in an electronic format which they could engage with. People had taken part in films to explain to people how to make a complaint or to help to understand their tenancy agreements. Easy to read information had been produced to make information more accessible to them. People use technology to remind them to take tablets or as alarms in their homes to keep them safe.

People were supported by staff who had been robustly recruited to make sure they had the aptitude and values looked for by the provider. They had access to training to equip them with the skills and knowledge they needed to support people. Staff felt supported in their roles and had access to managers through face to face meetings as well as over the telephone. Staff said managers were open and accessible and always there for them if needed. Staff said there was some flexibility in the way they were allocated to make sure people’s needs were met.

Quality assurance processes enabled people and staff to voice their views and opinions. They were confident they would be listened to and action would be taken in response. Managers closely monitored and audited people’s experience of