This inspection took place on 03 & 04 January 2017. It was an announced visit to the service.

We previously inspected the service in January 2014. The service was meeting the requirements of the regulations at that time.

Chiltern Support and Housing Limited provides support to people in their own homes and supported living properties. Nine people were receiving a service at the time of our visit. These were younger adults with a range of needs including learning disabilities, autistic spectrum disorder, brain injury and neurological conditions in the High Wycombe and surrounding areas.

The service had 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.

We received positive feedback about the service. A social care professional told us “I have a client in supported living and have been very pleased with the care and support provided.” They said their client “Has thrived with the care in place. He is happy at the house and his ability has increased…and able to manage personal care.” They said the person’s “Cognition improved with good nutrition, social interaction, prompting as required. Staff have been friendly and caring.” Another social care professional said “We are generally satisfied with the support received.” They added “They are local and so it’s easy to talk to the management, to get timely assessments and negotiate cost of packages. We have not had concerns with this provider that we have not been able to resolve. I find them responsive and always improving.” They said the service had “Good staffing levels and adequate social stimulation for residents.” Comments from relatives included “I have always been happy with them; they do quite a difficult job” and “They try very, very hard. I’m very contented for my relative to be there and looked after.”

We found people were safeguarded from the risk of abuse. Staff understood about safeguarding and did not have any concerns about care practices. There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns.

People were supported to be as independent as possible. Written risk assessments had been prepared to reduce the likelihood of injury or harm to people during the provision of their care.

There were sufficient staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. Staff received appropriate support through a structured induction, supervision and training. We saw staff interacted well with people and had developed positive relationships, often involving humour.

People’s needs were recorded in care plans. These had been kept up to date to reflect changes in people’s needs. Staff supported people to attend healthcare appointments to keep healthy and well. People’s medicines were handled safely and given to them in accordance with their prescriptions.

The service was managed well. The provider regularly checked quality of care at the service through visits. Records were maintained to a good standard and staff had access to policies and procedures to guide their practice.

People were able to choose how their health, social care and support needs were met. If they were unable to make these decisions for themselves, family members or advocates were involved in the decision making process.

The care and support that people received was tailored to ensure it met their individual needs and preferences. Guidelines were in place which documented how any assessed risk was to be managed. These helped staff manage risk and promote people’s safety and comfort.

There was a recruitment procedure in place, to ensure suitable staff were employed to work with people receiving care and support.

People spoke of staff as "very supportive", "they are brilliant the most patient, caring people I can't speak higher of them...all I can say is anyone that gets care from them are very lucky." "The staff are very good, we had been struggling for the last three years, he responds well to them."

People told us they were involved in making decisions about their care and were involved in the review of their care and support. One representative of a person who had started a package of care and support the week of our visit told us ''We were involved in the care planning process and we are meeting with the provider next week to make some amendments to it.'' They told us they had met with the care and support staff prior to receiving the care and support and said ''They've been very respectful and respected X's and the families wishes.''

We saw people’s needs had been assessed and their care and support was planned and delivered in line with their care plan. We saw potential areas of risk had been identified in each person's care plan. Any risks in delivering the care and support had been discussed with people and measures had been put in place to minimise such risks. People's care plans and risk assessment were regularly reviewed and updated to make sure the information was still accurate for their situations.

Newly appointed staff were provided with an induction programme and shadowed experienced care workers until they felt comfortable and were competent in undertaking their role alone.

Staff had the appropriate training and support to give them the knowledge and skills to undertake their roles competently and in a safe manner.

People said they felt safe and knew who to speak to if they had any concerns.