Creative Support – Bolton Service supports people with Autism Spectrum Condition (ASC) and challenging behaviour, in their own home, providing personal care in line with a supported living model. People who use the service have their own tenancies and receive their support from staff employed by Creative Support.

This inspection took place on 25 July 2018. The provider was given 48 hours' notice of our intention to visit. This was because we needed to ensure there would be someone present at the office to facilitate the inspection.

We were assisted throughout the inspection by the registered manager and three project managers. 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 registered manager at Creative Support – Bolton Service had been registered since October 2011.

We spoke with a number of people during the inspection including relatives, staff and community professionals. People who used the service had limited means of communication and were unable to share their experiences. People who used the service relied on families or advocates to support them with decision making.

The service was last inspected on 18 May 2017 and was announced. The service was rated as Requires Improvement.

At the last inspection we found procedures were in place to manage people's medicines safely. However, these had not always been followed, which had resulted in some errors being made with medicines on several occasions. Arrangements for the safe recording and administration of people's medicines required improvement to ensure people were protected from the risk of unsafe medicines management.

This was a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found that medicines management had improved and systems were now safe. The service had sought advice around medicines management from a healthcare professional external to the organisation and had incorporated a new system for auditing medicines.

Mandatory training had been completed by all staff.

There were systems and processes in place to protect people from harm. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place.

The service had developed positive working relationships with health and social care professionals which led to joint working to expand people's communication skills.

A robust system for staff recruitment, induction and training was in place. This enabled the staff to support people effectively and safely.

People's needs were assessed before using the service and on an ongoing basis to reflect changes in their needs. Clear and well thought out arrangements were in place for people moving into the service which helped to significantly reduce possible anxiety about this change.

There were enough staff so people could take part in the activities they wished and be supported in meeting their individual needs. People had access to activities that were important and relevant to them, both inside and outside their home. People were protected from social isolation because of the support and range of opportunities offered by staff.

We observed positive relationships and observed the management team and staff interacting with people in a caring, good humoured and friendly manner. Management and staff demonstrated insight and understanding of people's personal preferences and needs.

The service had been developed and designed in line with the principles that underpin the Registering the Right Support and other best practice guidance; these values include choice, promotion of independence and inclusion. This policy asserts that people with learning dis

Creative Support – Bolton Service supports people with Autism Spectrum Condition (ASC) and challenging behaviour, in their own home, providing personal care in line with a supported living model. People who use the service have their own tenancies and receive their support from staff employed by Creative Support.

The last inspection of the service took place on 09 and 15 December 2015 and was announced. The service was rated as Requires Improvement.

This inspection took place on 18 May 2017. The provider was given 48 hours’ notice of our intention to visit. This was because the location provides a domiciliary service and we needed to ensure there would be someone present at the office to facilitate the inspection.

We were assisted throughout the inspection by the registered manager and project managers in the houses. 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 registered manager at Creative Support – Bolton Service had been in post for several years.

We spoke with a number of people throughout the inspection including, relatives, staff and community professionals. People who used the service had limited means of communication and were unable to share their experiences. People who used the service relied on families to act on their behalf in making decisions.

The service had a robust recruitment procedure in place, to help ensure that staff employed were suitable to work with vulnerable adults. There were sufficient staff on duty to ensure the needs of people who used the service were supported appropriately. Staffing numbers were looked at on a daily basis to ensure that appointments and trips and planned activities were covered.

New staff undertook an induction programme, which involved classroom based training and shadowing of experienced staff. Training was on-going, however we noted that some annual training had not been completed.

We looked at the supervision and annual appraisal record and staff spoken with confirmed they received regular supervisions. Supervision meetings enabled managers to assess the development needs of staff and to address training and personal needs in a timely manner.

Staff worked positively with external professionals to help ensure people received safe and effective care.

Procedures were in place to manage people’s medicines safely. However, these had not always been followed, which had resulted in some errors being made with medicines on several occasions. Arrangements for the safe recording and administration of people’s medicines required improvement to ensure people were protected from the risk of unsafe medicines management.

Systems were in place in relation to ordering, storage, administration and disposal of medicines. Health and safety measures were in place and up to date.

Care plans were person-centred and included information about people’s likes and dislikes, interests, family backgrounds and personalities. Care plans included a range of health and personal information to ensure that the needs people who used the service were supported.

Each person had their own bedroom and communal areas were available. Two of the premises seen were clean, tidy and well maintained. One property was clean and tidy but would benefit from a refurbishment.

Staff we spoke with had a good understanding of the basic principles of the Mental Capacity Act (2005) (MCA) and decision making process. However, the service had been unsure of the procedures with regard to notifying CQC of applications to the Court of Protection. We advised them to notify CQC of all Court of Protection applications as per requirements

We observed staff interacting in a kind and friendly manner throughout the day, the

We visited the office of Creative Support and one of the houses on 10 June 2013.

We spoke with staff and where possible with some people who used the service. We did not ask people direct questions as for some this would have been difficult for them to respond. We saw from people’s body language and gestures they were comfortable with the staff that cared for them.

We spoke at length with the family of one person who used the service. They told us that they were always involved in any decision making. They were always made welcome when visiting the home. They were pleased with the commitment of the staff that cared for X. They were delighted with the progress that X was making. They said they had finally got the right support that X required and the support for them as a family which was much appreciated. We were told X had been at a low point for some time but things had greatly improved since Creative Support had become involved.

Communication with people who use the service was limited due to the nature of their disability. However we did observe that peoples’ facial expressions and their body language appeared at ease when approached by staff.

We spoke with some members of staff. One person told us:

“I am happy with my job. We get lots of training and support from our manager”.

Another person said. “The job is very rewarding”.

This was an announced inspection carried out on the 09 and 15 December 2015.

Creative Support - Bolton provides care and support for adults who are living with autism and with mental health illnesses. The office is situated in Bolton town centre and the houses are located in the Bolton area.

There was a registered manager in place at the time of our inspection. 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 branch manager has been registered with the Care Quality Commission for several years.

At the last inspection carried out in July 2013. At that inspection we found the service was meeting all the regulations we reviewed.

As part of the inspection we attended a family forum meeting on the evening of 09 December 2015. These meetings were organised by the registered manager and provided families of people using the service with the opportunity to meet up for refreshments and discussion about the service and other items of interest.

We found medicines were managed safely. However, we have made a recommendation for the service to consider current guidance on managing minor ailments.

We looked at care files to understand how the service delivered personalised care that was responsive to people’s needs. We found that initial assessments were undertaken to determine the needs of people. Care file records contained people’s life story details and considered issues such as communication and behaviour.

We found the service had systems in place to deal with and respond to concerns and complaints. The relatives spoken with knew how to make a complaint, however some felt their concerns were listened to but not always acted on.

Staff spoken with had an understanding of the whistleblowing procedures. Staff had contacted the CQC and raised some concerns about a serious allegation and concerns over staffing levels and skill mix. This was dealt with by a multidisciplinary team meeting and suitable actions were taken by the provider.

We saw that staff had undertaken training in Mental Capacity Act 2005(MCA) and Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be unable to make their own decisions.

Systems and procedures for the recruitment of staff were safe and robust. This was evidenced through employment our examination of employment files. Disclosure and Barring Service (DBS) checks had also been completed to ensure the applicant’s suitability to work with vulnerable people.

Staff received training and development to ensure they were fully supported and qualified to undertake their roles. Supervision sessions were completed on a regular basis and records were maintained.

We found the service had systems in place to monitor and assess the quality of the service delivery.

Providers are required by law to notify CQC of certain events in the service such as serious injuries, deaths and safeguarding concerns. Records we looked at confirmed that CQC had received all the required notifications in a timely way from the service.