Bridge House is a domiciliary care service offering support to people within their own homes and also within supported living accommodation. The service supports 26 people in the Chester and Ellesmere Port area.

This inspection took place on the 26 and 30 October 2017. The first day was unannounced and the second day was announced to allow time for appointments to be made for visits to be undertaken to people's own homes and supported living services. The previous inspection took place on 11 and 15 December 2014 and the service was rated overall good.

The service remained good.

There were sufficient staff to support people's needs. People were involved in the safe recruitment of staff and were happy with their regular and consistent support. Staff had the appropriate skills and knowledge to support people with their individual needs.

Medicines were managed safely and robust systems were in place for the safe storage, ordering and administration of these.

Staff had all received training in all key topics required to ensure they could knowledgeably fulfil their roles. Training refreshers took place regularly.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People fully participated in the preparation of their care plans and risk assessments. They attended regular reviews and invited people of their choice to attend these meetings.

The registered provider had introduced two community enterprises with the full participation of the people supported since our last inspection. People were fully involved in the running of the community shop and café.

People had the opportunity to participate in activities of their choice. These activities included social events, volunteering opportunities and holidays.

People's dietary needs were assessed and fully met. Relatives told us people's health needs were well supported.

The management team had robust systems in place to continually monitor the service and this information was used to drive up improvements.

The registered provider offered accessible documents to meet the individual needs of people.

We spoke with two people who used the service, an advocate and one relative. We found that people were able to express their views and were involved in making decisions about the care and support provided.

People told us they were happy with the service and had no concerns with the care provided. Comments included; "I love it living here. I am very happy", "The staff are lovely. They really look after me" and "The staff are all good".

Staff knew what action to take if they recognised signs of abuse and were aware of the whistle blowing process should they have any concerns. Staff demonstrated they were knowledgeable about the different types of abuse that could occur and confirmed they completed training in relation to safeguarding people from the risk of abuse.

Staff told us that they felt well supported and they had the information they needed for their roles. We saw there were team meetings that incorporated training in supporting people with learning disabilities and challenging behaviours. We saw supervision sessions took place for all staff with the manager on a regular basis.

We saw the service had a complaints policy and procedure in place. The support plans we reviewed documented the complaints and concerns procedure in a pictorial format so people could understand it better.

This inspection took place on 11 and 15 December 2014 and was announced. We gave the provider 48 hours’ notice of the inspection because the service is small. We needed to be sure that the registered manager would be in. The previous inspection took place on 13 December 2013 under the Commissions old way of inspecting services. The provider had met the standards that were inspected.

The service has a registered manager. 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.

Bridge House is the headquarters for 1st Enable limited. 1st Enable support five people in a cluster flat setting in Chester city centre. A new cluster provision of flats has recently opened on the outskirts of Chester. At the time of our inspection one person was living there. 1st Enable also support five other clients who live in individual accommodation of their own in the Chester and Ellesmere Port area.

People were supported by staff that had the required skills to promote their safety and welfare. People had been provided with information in an understandable format so they knew what was meant by ‘keeping safe’.

People who used the service were involved in the recruitment of staff to ensure they were happy with the people who were going to support them. There was a system in place to match new members of staff with people who used the service in order to ensure that staff were matched effectively in line with the person’s needs. Staffing numbers were sufficient to meet the needs of the people who used the service.

Medicines were managed safely and people told us that staff supported them with their medication and always received it on time.

People’s nutritional needs had been assessed and staff were knowledgeable of people’s nutritional needs. People told us they had plenty of choices with regards to what they wanted to eat. Relatives told us that their relatives’ health had improved as a result of the care provided by staff.

People told us that staff were caring. We saw good interactions between people who used the service and the staff team. People were involved in the planning of their care and had an opportunity to say what was important to them. They also had the opportunity to discuss their future wishes and aspirations.

We found that people had an opportunity to take part in the activities they enjoyed inside their home and out in the community. Relatives told us they had no complaints about the service. They told us they knew how to make a complaint and felt the manager was approachable.

Systems were in place for checking on the quality of service provided and processes were in place to deal with any areas identified for improvement. The management team had vast experience in supporting people with learning disabilities and autism and spoke passionately about the vision for the future of this service.