About the service: Community Support Service (Dom Care) provides care and support to people living in ‘supported living’ settings, so that they can live as independently as possible. They also provide a domiciliary service to people in their own homes. The service’s office is based in Rickmansworth and the support for people receiving personal care is in and around this area. 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 service was supporting seven people who needed support with personal care who were using the service.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen ' Registering the Right Support' CQC policy.

What life is like for people using this service: People who used the agency told us they felt confident in the management team and how the service operated. They told us good staffing levels afforded people responsive and dignified support.

There were sufficient staff to meet people's needs and staff had time to spend with people. Risk assessments were carried out and promoted positive risk taking which enabled people to live their lives as they chose.

People received their medicines safely.

People received person centred care and support based on their individual needs and preferences. Staff were aware of people's life history, and their communication needs. They used this information to develop positive, meaningful relationships with people.

Staff were respectful of the fact they were working in people's homes. The service offered flexible support to people and could adapt to meet people's needs and support them as they wanted.

Where restrictions had been put in place to keep people safe this had been done in line with the requirements of the legislation as laid out in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. Any restrictive practices were clearly recorded and regularly reviewed to check they were still necessary and proportionate.

People were involved in planning their care and decisions about how care was delivered. Easy read information was provided to help people make informed decisions. Where necessary other supporting information was provided such as visual and audio materials. We observed people were in charge of their routines and were able to request support when they needed it.

Staff were recruited in a safe way and following a recent recruitment campaign, there were enough staff to meet people's current needs. Staff were supported by a system of induction, training, one-to-one supervision and appraisals to ensure they were effective in their role.

People were supported to access health professionals when needed and staff worked closely with those professionals to ensure their health and social needs as well as their well-being was monitored.

The registered manager and provider worked well to lead the staff team in their roles and ensure people received a good service.

More information is in Detailed Findings below

Rating at last inspection: At our previous inspection the service was rated Good. (Report published 3 March 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At our last inspection we rated the service Good. At this inspection the service remained Good.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We carried out an unannounced inspection of the Community Support Service (Domiciliary Care) on 18 and 19 April 2016. We made telephone calls to people who used the service and members of staff on 21 April 2016.

Community Support Service (Domiciliary Care) is a community based service providing care and support to people living in their own homes and in three supported living settings. At the time of our inspection, there were eleven people using the service. Eight People lived in three different houses; some houses had been converted into flats where they received around the clock support from staff, and three people lived in their own homes and were supported for no less than two hours every week.

The service has two registered managers in place. 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 were safe using this service. There were risk assessments in place that gave staff guidance on how risks to people could be minimised and how to safeguard people from the risk of possible harm.

People’s care needs had been assessed, and care plans put into place. These care plans were personalised to each individual and took into consideration people’s preferences and choices. Staff supported people to attend health care visits such as GP appointments and hospital visits when required.

Staff were caring and respectful of the people they supported. They had built positive relationships with people and were clearly knowledgeable about people’s needs.

The provider had an effective recruitment processes in place and there were sufficient numbers of staff to safely support people. Staff understood their roles and responsibilities within the service and were trained in meeting people’s needs. They received supervision and support, and gained people’s consent before they provided care or support.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service. The provider also had effective quality monitoring processes in place to ensure that they were meeting the required standards of care.

People we spoke with told us that they had been treated with respect, and had received the care and support they needed. People said they felt involved in planning their care and support. People confirmed that staff assisted them to access the community and to undertake their daily activities.

People and relatives we spoke with said they were mostly visited by the same support workers. People confirmed that when the support worker had been unable to come, due to exceptional circumstances, such as snow the agency had phoned them to let them know.

We saw evidence that staff had received training and that there were appropriate measures in place to ensure that staff were suitable for the role as support worker. The agency had a complaints procedure in place and people who used the service knew how to complain should the need arise.

The people who use the service and relatives and carers who support them, who gave us their views during telephone interviews between 11 November and 25 November 2011, consistently told us they were provided with a very good service. People described the service they were being provided with as ‘positive’, caring, ‘adaptable’ and ‘flexible’.

People told us about staff supporting them to be active members of the local community by taking them shopping and organising trips and activities of special interest to them.

People told us about the support they receive from staff to enable them to live independently in the community.

People told us feeling part of the wider local support network, provided by Mencap, was important to them and they were kept informed about social events and activities they could take part in.

People told us that the care workers who visit them at home treat them with respect and listen to what they have to say. They told us the care workers and managers keep them informed if there any changes to the timing of their planned visits. People confirmed that new staff were introduced to them before they visited on their own.

People and their relatives were complimentary about the staff and the care and service they received. A person who used the service said, “They are very nice. They take me shopping. They usually come on time. I enjoy shopping.”

The people who used the service had a learning disability and some had more complex needs. The relatives we spoke with felt very involved in helping to plan their care packages. A relative commented, “They provide a good service. We have the same care worker every time. I get to review and sign the care plan as well.”

Another relative said, “My (relative) loves the staff and enjoys being taken out for activities. The staff are very patient. They allow my (relative) to do things at their own pace. My (relative) is encouraged to do the things that they (the relative) like to do.” This was echoed by another relative who said, “The staff accompanied my (relative) to the care centre, out shopping and to other activities. My relative chose what they like to do. The staff are very encouraging and helpful.”

The members of staff we spoke with had a good knowledge of the people they supported.

We were told that the manager had visited people in their own homes and had checked on the care workers to ensure that people’s care needs had been met appropriately.