About the service:

Aspirations provides care and support to people living in the community. At the time of our inspection 15 people were in receipt of the regulated activity ‘personal care’. People were living in supported living houses. Senior support workers managed the everyday running of the supported living houses and the registered manager had oversight of the service.

People’s experience of using this service:

Everyone we spoke with said they felt safe being supported by Aspirations. Staff were recruited safely, and risks to people’s health and safety were assessed. Medication was stored in people’s homes safely, and was only administered by staff who were trained to do so. Accidents and incidents were tracked, and the registered manager was in the process of implementing a new analysis tool. Staff were able to describe the course of action the would take to report safeguarding concerns.

There was a training programme in place and staff had completed all training courses deemed mandatory by the registered provider. The service was working within the principles of the Mental Capacity Act and people were fully involved regarding decisions about their care and support. Staff were required to engage in supervision and had an annual appraisal. People were supported to eat and drink in accordance with their needs.

People were involved in their care and support plans. We received positive comments about the staff in relation to the support they provided. Everyone said staff were kind and caring. Staff were able to describe how they ensured people's dignity was respected.

We observed, heard and read examples evidencing how people’s routines and choices were listened to and respected. There was a complaints procedure in place and we checked the status of complaints and how they had been responded to.

The service was managed well, and the ethos and culture of the service was well implemented with the staff team that provided the care. Staff all spoke well about the registered manager. Audits were in place which were effective in highlighting any areas for improvement. The registered manager was aware of their role with CQC and had notified us of all incidents as required.

Rating at last inspection:

Rated ‘Requires Improvement’ report published April 2018.

Why we inspected:

This inspection was conducted in line with our inspection schedule.

Follow up:

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection was prompted due to information shared with CQC about the potential concerns around the management of people's care needs, the management of risk and staffing, and management at the service. We decided to complete a focused inspection. This inspection examined those risks.

This inspection took place on 14 and 22 March 2018 and was unannounced.

This inspection was 'focused' in response to concerns in that we only looked at two domains; Safe and Well-led. The domains ‘Effective’, 'Caring' and 'Responsive' were not assessed at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Aspirations Northwest' website at www.cqc.org.uk.

This service 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. Some people chose to live together and did so in houses of multiple occupancy (HMO).

Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities.

At the time of our inspection the manager informed us that there were 14 people in receipt of the regulated activity of personal care. There were other people accessing support from this service, however they were not within receipt of this regulated activity, so we did not look at their documentation.

There was a manager, they were not registered. However they were in the process of starting their registration with us due to only taking up the post recently.

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.

We viewed risk assessments in place for people who used the service and found that risks were clearly described along with information for staff with regards to how to mitigate these risks. We found that some information was not detailed to include people's clinical needs. We have made a recommendation concerning this.

We saw the prior to our inspection safeguarding concerns had not always been reported and acted on appropriately. We discussed this at length with the new manager who acknowledged there were some issues they were currently investigating with regards to the reporting of safeguardings.

Prior to our inspection we received some information of concern relating to staff numbers at the services and a high use of agency staff who had not been properly introduced to people. We saw the service had used agency staff. However there was a clear emphasis on recruitment and the number and usage of agency staff had decreased in the last few weeks. We saw there was a handover for agency staff when they came on shift. However, there was no formal introduction of agency staff to people who used the service.

We checked some of the audits for the last few months. We saw that some audits had not highlighted when issue were brought to the attention of the service. This included services which were not clean, and issues relating to staffing concerns. We spoke to the manager at length who showed us new audits which had been implemented which highlighted and action planned these concerns.

We checked the cleanliness of some of the services people lived in. The manager was open and transparent and confirmed that some services could be described as 'dirty' however, audits had been completed in these services and there were now cleaning rotas in place to help staff support people with this.

Prior to the inspection we received information of concern tha

This inspection of Aspirations Northwest took place on 7, 8 & 11 September 2017.

We gave the provider 48 hours’ notice that we would be coming, as the organisation provides a domiciliary care service and we wanted to make sure that someone would be available.

Aspirations Northwest is registered with CQC to provide personal care to people in their own homes. Most of the people who used the service lived within a supported living setting. At the time of our inspection the registered manager informed us that there were twelve people in receipt of the regulated activity of personal care. There were other people accessing support from this service, however they were not within receipt of this regulated activity, so we did not look at their documentation.

This was the service’s first inspection at their new location.

The inspection was carried out by an adult social care inspector and an expert by experience who had expertise in care from this type of service. The expert by experience spoke to people who used the service and their families over the telephone.

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.

Everyone we spoke with told us they felt safe receiving care and support from Aspirations.

Staff were able to explain the course of action they would take to ensure actual or potential abuse was reported in line with the service’s polices.

Staff recruitment procedures were robust and we saw that staff were only offered positions within the company once all satisfactory checks had been completed on their character and suitability for the role.

Medication was managed safely. People were supported to store their medication in a safe place within their home. People who required support from staff to take their medication were supported only by staff who had been trained to do so. These staff also underwent regular competency checks to ensure they were still able to complete this task safely.

Risk assessments were regularly reviewed and contained information around how to manage the risk and keep the person safe.

There were adequate numbers of staff to keep people safe, however we saw that staff turnover over the last 12 months had been high. We enquired about this and found the registered manager and regional manager were honest and open about structural changes within the service and challenges they had to overcome which resulted in some staff choosing to leave employment.

The Mental Capacity Act and associated principles had been considered for some people who were found to lack capacity. Decisions were made in people’s best interests, and there was an open dialogue of conversation between Aspirations and the local Authority regarding a proposed deprivation of liberty safeguard referral for one person.

Staff had undergone a programme of training. As well as mandatory training, staff were also trained in areas to support their understanding of the people they supported and their individual diagnosis. New staff were required to complete an induction.

Staff supervisions took place regularly, and these were managed and checked by the registered manager. All staff received an annual appraisal.

People were supported to maintain a diet of their own choosing which took into account any specific dietary requirements they had. For example, people who required their food to liquidized had this done and presented to them in a which they chose. We also observed people doing their own cooking and choosing homemade meals which the staff supported them to make.

Care records demonstrated that people had access to medical professionals such as GP’s and district nurses when they required it. One