The inspection took place on the 21 March 2018 and was announced.

92 Cromwell Road provides tailored support packages for people with a learning disability or autistic spectrum disorder. This service provides care and support to people living in a ‘supported living’ setting, 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. At the time of the inspection three people were living in the service. People have their own bedroom and shared the communal facilities. The service is situated in a residential area with easy access to local amenities and transport links.

At the last inspection on 27 January 2016 the service was rated overall Good. At this inspection we found the service remained overall Good. At the last inspection robust supervision of care staff had not always been in place. We asked the provider to take action to make improvements in supervision procedures and this action has been completed. One member of staff told us, “Now we know further ahead when they (Supervisions) are happening. They are much more regular. Personal Development Plans (PDP’s) the (Annual review process) are done annually and refreshed at six months.”

Systems had been maintained to keep people safe. People remained protected from the risk of abuse because staff understood how to identify and report it. Assessments of risks to people had been developed. Staff told us they had received supervision, and continued to be supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Care staff had the knowledge and skills to provide the care and support that people needed.

People's individual care and support needs continued to be identified before they received a service. Care and support provided was personalised and based on the identified needs of each person. People had been listened to, supported to be independent and they were involved in decisions about their care. Staff had a good understanding of consent.

Relatives were very happy with the care provided. People continued to be supported by kind and caring staff who treated them with respect and dignity. They were spoken with and supported in a sensitive, respectful and professional manner. People were supported to access a range of social activities.

The provider continued to have arrangements in place for the safe administration of medicines. People were supported to get their medicine safely when they needed it. People were supported with their food and drink and this was monitored regularly. People continued to be supported to maintain good health.

Relatives and staff told us the service continued to be well led. One member of staff told us, “We are working on moving upwards. We have more direction.” Staff told us the registered manager was always approachable and had an open door policy if they required some advice or needed to discuss something. The registered manager carried out a range of internal audits, and records confirmed this. People and their relatives were regularly consulted about the care provided through reviews and by using quality assurance questionnaires.

This inspection took place on 27 January 2016 and was announced.

92 Cromwell Road is a supported living scheme where people live in their own home under a tenancy agreement, and is registered to provide personal care. People received personal care or social support in their flat to promote their independence. The support provided was tailored to meet people’s individual needs and enable the person to be as autonomous and independent as possible. At the time of the inspection there were three men with a learning disability receiving a service of personal care and support, and whose behaviour can be complex. The service is based in a four storey detached Victorian building, situated in a residential area with easy access to local amenities, transport links and the city centre.

The service had a registered manager, who was present throughout the inspection. They had been in their current post for a number of years and knew the service well. 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.

The service was going through a significant period of review, where the provider and local stakeholders were looking at the service provision and what was needed and how the service would best be provided in the future.

Care staff were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Care staff had been able to attend refresher training to meet the provider’s requirements, plans were in place to promote good practice and develop the knowledge and skills of staff. They told us they felt well supported. However, care staff had not received regular supervion at a frequency to meet the provider’s policies and procedures. This is an area in need of improvement.

Relatives told us people were safe in the service. One relative told us, “He seems very happy there. He is in good hands. “People were supported by staff that were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Medicines were managed and administered safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.

Care and support provided was personalised and based on the identified needs of each individual. People were supported where possible to develop their life skills and increase their independence. People’s care and support plans and risk assessments were up-to-date, detailed and reviewed regularly. One relative told us, “I could not be happier where he is.” Another relative told us, “He is looked after extremely well.”

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice. Where people were unable to make decisions for themselves staff had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action to arrange meetings to make a decision within their best interests.

People were supported to eat a healthy and nutritious diet. People had access to health care professionals. They had been supported to have an annual healthcare check. All appointments with, or visits by, health care professionals were recorded in individual care plans.

People were supported by kind caring staff. There were sufficient numbers of suitable staff to keep people safe and meet their care and support needs. The number of staff on duty had enabled people to be supported to attend social activities. One relative told us, “They make sure they take people out. It’s wonderful. “

Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They confirmed that they felt valued and supported by the registered manager and senior care officer, who they described as very approachable.

Relatives, staff and visiting healthcare professional told us the service was well led. People and their representatives were asked to complete a satisfaction questionnaire to help identify any improvements to the care provided. People had the opportunity to attend regular weekly ‘tenants' meetings’. The registered manager told us that staff carried out a range of internal audits to review the quality of the care provided, and records confirmed this. The registered manager also told us that they operated an 'open door policy' so people living in the service, staff and visitors could discuss any issues they may have.

There were three people who used the service at the time of our visit, whose care provided came under review as part of this inspection. We used a number of different methods to help us understand the views of these people. They had complex needs which meant they were not all able to tell us about their experiences. We spoke with one person who used the service in the communal areas. We observed the care provided, looked at supporting care documentation, medication records, staff records and records relating to the management of the service. We spoke with the registered manager who is referred to as the manager in the report, three care workers one of whom was from the organisation’s bank staff and the relatives of two of the people who used the service.

This told us people who used the service or their representatives had been involved in making decisions about their care and treatment and where they were able to, gave consent to the care. People’s care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan.

Appropriate arrangements were in place in relation to obtaining, storing, administering handling and recording medicines.

People’s care had been provided by care workers who understood their care needs. There were sufficient numbers of staff with the right skills and qualifications to meet the needs of the people who used the service. However, no all the care workers had received an update for all their training within the timescale as required by the provider.

Systems were in place to review and monitor the quality of the care provided.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences. We viewed supporting care documentation, spoke to one person who used the service, the relative of another and a visiting healthcare professional who told us:

People had expressed their views and where possible people who used the service had been involved in making decisions about their care and treatment.

Peoples’ needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan.

Peoples’ care had been provided by care workers who understood their care needs.

People knew who to talk to if they had any concerns about the care provided.