The inspection took place on the 18, 24 and 25 May 2018 and was announced. At the last comprehensive inspection in February 2016 improvements were needed in relation to staff supervision. This was because the service was not always supervising staff in accordance with the provider’s own policy. At this inspection we found improvements had been made. Staff were now consistently supervised and properly supported in their work.

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.

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.

There were nine registered managers for the service. Each registered manager was known as locality manager. They also managed between two and three other locations run by the organisation. 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.

People continued to be protected because the risks they may face of abuse were minimised. This was due to the provider having suitable systems in place to keep people safe. Staff were trained to understand what abuse was. The staff also knew how to report any concerns if they ever had them.

People were protected from unsuitable staff by recruitment procedures in place that were robust. These aimed to ensure that people who used the service were kept safe from the unsuitable staff being employed.

Staff had a good understanding of their roles and responsibilities. They knew these included seeking people’s consent before care was offered.

When people did not have capacity to consent to their care or make decisions about some aspects of their care, this had been managed in line with the requirements of the Mental Capacity Act 2005 (MCA).

People told us they were supported by caring, friendly and kind staff. People were also well supported to make choices about how they lived their lives.

People's health and wellbeing needs were promoted, and they were supported to use other health and social care services when needed. People's needs had been assessed, and care plans took account of their individual needs, preferences, and choices.

People told us they enjoyed varied and fulfilled lives. They also said they were given opportunities to pursue their hobbies and interests.

People’s views were heard because the provider had a formal process for handling complaints and receiving feedback. Staff encouraged feedback from people who used the service and their relatives. They acted on the comments received to improve the quality of the service.

The provider's quality monitoring processes had been used effectively to drive continuous improvement. For example changes in the deployment of staff to support people, as well as changes to support plans were put in place after recent quality audits.

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Brandon Trust Supported Living – Bristol and North Somerset provides personal care and support to people with a learning disability living in their own homes which are supported living services.

At the last inspection on 3 March 2016, the service was rated Good.

This focused announced inspection on 20 March 2017 was prompted in part by a notification of an incident following which a person using the service died. This incident is subject to a HM Coroner investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with Care Quality Commission about the incident indicated potential concerns about the management of the risk of choking. This inspection examined those risks and other risks people might potentially face.

There were 14 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Each manager was responsible for a number of services.

At this inspection we found the service remained Good.

People’s care and support considered risks to their safety, and systems had been put in place to manage these. We saw that updates and changes were made when needed and these were communicated to staff members. Accident and incident records monitored events and action had been taken to respond to these in way that reduced future risks, but whilst still maintaining people’s independence. Staff had regular training and supervision to ensure they could support people safely. Regular audits were undertaken to ensure the service was safe.

Further information is in the detailed findings below.

Our inspection visit took place on 3 March 2016 and was announced. We gave the registered manager 48 hours’ notice of our intention to undertake an inspection. We did this to ensure we would be able to meet with people in their own homes.

Brandon Trust Supported Living Bristol and North Somerset is a domiciliary care service providing care and support to people in their own homes which are supported living services. When we visited 80 people were using the service at 20 separate addresses. Support is provided by a team of on-site staff who provide 24 hour support, seven days per week.

At the last inspection of the service in 8 April 2014 we found the service was meeting the regulations.

There were 14 registered managers in post at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run. Each manager was responsible for a number of services.

We found that some staff had not received consistent training relevant to their roles to enable them to meet the needs of the people they supported Staff have not received supervision and appraisals as required by the providers policy. People who used the service told us they were happy with the service and staff treated them well. Staff had undertaken key training courses relating to the needs of people with learning difficulties at the service. For example, staff working at the service had received training about supporting people with behaviours which may challenge.

People who used the service told us they felt staff using the service were caring to them. There were sufficient numbers of staff to meet people’s needs and keep people safe. Discussion with staff and the registered managers demonstrated that they were aware of local safeguarding procedures and had the necessary knowledge to ensure that vulnerable adults were safeguarded from abuse. There were regular health and safety checks to make sure people, staff who cared for the, relatives and visitors were safe.

People were involved in a range of day to day decisions and we noted that the staff adapted their communication to meet the needs of the person they were supporting.

Staff and the registered managers were up to date with current guidance to support people to make decisions. Any restrictions placed up on people were made in people’s best interest using appropriate safeguards.

People’s needs were met, responded to any changes in people’s healthcare needs were recorded. Staff were aware of people’s differing nutritional needs and were

able to explain how they safely assisted people to eat and drink.

People were positive about the staff who supported them. For example, one person said, “The staff are kind to me.” We saw lots of positive interactions between people and staff throughout our inspection. Staff had a clear understanding of how people expressed their needs. People’s support plans contained comprehensive, person centred information about people’s individual health and support needs.

People were supported to access meaningful activities to meet their differing needs and interests. People’s support plans provided information about the activities people enjoyed to do, such as horse riding going to a local farm and going on the trains.

People spoken with during our inspection had no complaints. An advocacy service was in place to support people to raise any issues and/or make a complaint.

People’s support pans contained information about how to make a complaint and the support they may require to do so.

Staff were positive about their managers and the way in which they and the team leaders led the service. A system was in place to continually audit the quality of care provided. This involved a range of weekly and mont

The inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people were treated with respect and dignity by the staff who supported them. People told us they felt safe and well cared for. Some of the people we spoke with told us, “the staff are very nice”, and “the manager is excellent he gets 10 out of 10”.

The risk that people may experience abuse was minimised because the provider had suitable systems in place. Staff were trained to recognise what abuse was. They also knew how they could report any concerns if they had them.

The provider had recruitment procedures in place that were robust. This helped to ensure that people who used the service were protected from the risks of unsuitable staff being recruited.

Is the service effective?

People’s needs were effectively met and they were being well supported by staff to gain independence in activities of daily living. Care records set out clearly how people’s needs were met. They had been regularly updated to ensure they reflected people’s current range of needs.

People who used the service told us they were aware of the content of their care plans and told us they had helped to write them. Care records clearly set out their each person’s preferences, interests and diverse needs in their daily life. We saw that people received support from the staff in accordance with their wishes in their care records.

Staff told us about and had a good understanding of the philosophy of the service. They told us one of its key aims was to support people so that they could gain more independence and confidence in the home and the community.

Is the service caring?

People who used the service told us "the manager is excellent ", "I would give the staff 12 out of ten I like them ", "the staff are not too bad, they are ok", “I love it here” and "I can do what I like it’s my home".

We saw that the staff had a caring and attentive manner when they supported people with their needs. We saw people being effectively supported in their home and in the community. We saw people were assisted to prepare a meal. They were also supported by staff so that they could go for lunch in the community to a café of their choosing.

People who used the service were supported to meet their needs by staff who were caring and friendly in their approach. When we visited people in their own homes, we observed they were relaxed in the company of the staff and approached them to engage them in social conversation. Every person we spoke with told us the staff were caring and nice to them.

Is the service responsive?

People who used the service, their relatives, friends and other professionals involved with the service were consulted on a regular basis to find out what they thought of the support that they received. This information was acted upon and was analysed by the provider. If there were shortfalls or concerns raised these were addressed promptly by them.

Care was planned for each person based on their individual needs and preferences. People were well supported to take part in activities of their choosing both in and out of the home. People were well supported so that they could make choices in their life. Acceptable risk taking was supported. People were properly supported to go out to social events in the evening if that as what they wanted to do.

The people who used the service and the staff we spoke with told us they felt they could raise any concerns about the service being provided if they had any.

Is the service well-led?

The people who used the service who we spoke with had positive views about the senior staff and managers of the service and the houses where they lived. We observed that the managers had positive relationships with people who used the service. We saw that people approached the managers we had met to engage them in conversation.

The service had an effective system in place to monitor the overall quality of service that people received. Where there were shortfalls in the services we saw that action was taken to address them promptly. This meant that the provider ensured that the quality of the service people received was improving and developing.