This inspection was completed on 2 and 3 November 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to ensure we would be able to meet with people where they were receiving the service.

There were six registered managers in post at the service, 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected in January 2014. At that inspection there were no breaches of the regulations. .

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment.

People were receiving effective care and support. Staff received training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS). Staff supervisions and appraisals were not always completed. The provider sent us an email after the inspection confirming every staff member will receive these by January 2017.

Staff told us there was an open culture and the environment was an enjoyable place to work. Staff were extremely passionate about their job roles and felt integral to the process of providing effective care to people. There were some mixed reviews from relatives regarding the management.

The service was caring. We observed staff supporting people in a caring and patient way. Staff knew the people they supported well and were able to describe what they like to do and how they like to be supported. People were supported sensitively with an emphasis on promoting their rights to privacy, dignity, choice and independence. People were supported to undertake meaningful activities, which reflected their interests.

The service was responsive to people’s needs. Care plans were person centred to provide consistent, high quality care and support. Daily records were detailed and contained sufficient information for staff to read and support people effectively.

The service was well led. Quality assurance checks and audits were occurring regularly and identified actions to improve the service. Some staff, relatives and other professionals spoke positively about the registered managers.

During this inspection we visited four houses and spoke with seven people who lived in those houses. In one of the houses we spoke with a visiting relative. We also looked at the care records for eight people, this included six of the people we spoke with and two others who were unable to communicate with us.

We also spoke with three registered managers at the agency’s office and eight staff who were on duty in the houses we visited. People we spoke with told us they were happy with the service they received and they were supported to participate in daily activities of their choosing. A relative told us, “Staff are kind and compassionate and have the person’s best interest at heart”.

Care plans were personalised to the individual and gave detailed step-by-step guidance for staff to follow to meet people’s care and support needs. Staff we spoke with showed that they had a clear understanding of involving people in day-to-day decisions about their care.

Appropriate arrangements were in place to support people to take their medication. There were enough qualified, skilled and experienced staff to meet people’s needs. The provider sought the views of people who used the service and used these comments to improve and develop the service.