This inspection took place on 21 and 22 November 2018, both days were announced.

When we last inspected the service in May 2016 we rated the service Good.

We gave the provider 48 hours' notice because we needed to be sure the manager would be available for the inspection. It also allowed us to arrange to visit people receiving the service.

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.

There was not 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. The provider had arranged for a manager from one of their other services to oversee this service. This management arrangement had been in place since July 2018.

Some improvement were required to ensure the service fully worked in line with the values and principles of 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.

Although people had their own home and made some of their own day to day decisions, we found staff were making some decisions on behalf of people without evidence the person lacked the capacity to make these themselves. Where restrictions were placed on people, for example, the kitchen being locked, there was a lack of evidence that this was the least restrictive option. The manager told us they would review all restrictions in place and ensure these were made in line with the Mental Capacity Act 2005.

People’s communication needs were not always fully met. The manager put plans in place to address this. Although relatives told us there had been some improvements since the new manager had been in post, they had not felt their concerns were listened and responded to.

Some areas of medicines management needed to be improved. Although there were a range of risk assessments in place, we found risks to people were not all identified and mitigated. Incidents were not always recorded and reported in line with the providers policy.

Although staff told us they felt supported in their role, one to one staff supervision had not been held regularly and in line with the providers policy.

Relative raised concerns about staff skills and knowledge to support their family members. The manager had arranged for staff to receive training and had an ongoing plan to ensure this was kept up to date.

Our observations of staff interactions were mixed. Confidentiality was not always respected. Relatives told us they thought most staff wanted to do the best for their family members and some of them were, “Really good” and they were, “Generally lovely.”

The systems in place to monitor the quality and safety of the service were not fully effective.

Relatives thought their family members were safe. There were systems in place to protect people from harm and abuse. Staff knew how to recognise and report abuse and felt confident concerns would be acted upon.

There were enough staff available to meet people’s needs. Recruitment procedures were in place to ensure staff employed were suitable for their role.

People received support from specialist health professionals where relevant. People were involved in the planning and preparing of their meals.

People had individual care plans that identified their needs and preferences.

Craegmoor Supporting You in the Southwest provides personal care and support to people living in their own homes in North Somerset. At the time of this inspection there were five people who received support from the service. The support people received ranged from 15 hours each week to 112 hours each week depending on people’s individual needs. The service provided domiciliary support to people in their own homes and a supported living service. A supported living service is where people have a tenancy agreement with a landlord and receive their care and support from a care provider. As the housing and care arrangements were entirely separate people can choose to change their care provider if they wished without losing their home.

The inspection took place on 23 March 2016 and was announced.

There was 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.

People and their relatives were happy with the support arrangements provided. People told us they felt safe and were treated with respect.

Systems were in place to protect people from harm and abuse and staff knew how to follow them.

The service had systems to ensure medicines were administered and stored correctly and securely. There were enough staff available to keep people safe and meet their needs. A recruitment procedure was in place and staff received pre-employment checks before starting work with the service.

Risk assessments had been carried out and they contained guidance for staff on protecting people. Care plans provided information about how people wished to be cared for and staff were aware of people’s individual care needs and preferences. Reviews of care had been carried out so that people could express their views and experiences regarding the care provided. People and their relatives were involved in the care planning process.

People had access to healthcare services and were supported to attend health appointments.

Staff received training to understand their role and they completed training to ensure the care and support provided to people was safe. New members of staff received an induction which included shadowing experienced staff before working independently. Staff received supervision and told us they felt supported.

People and their relatives thought staff were caring and knew the people they were supporting well.

There were systems in place to receive feedback from people who use the service, staff and relatives. People and relatives were aware of how to raise concerns and they were confident if they raised concerns these would be responded to.

The registered manager and provider had systems in place to monitor the quality of the service. The service had an action plan in place that identified improvements and the progress made against these.