About the service: This service provides care and support to people living in five supported living houses individually located within the community, so that they can live 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.

Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities.

Not everyone using Creative Support – North East Lincolnshire Services received regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. The service supported 16 people when we inspected.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. People’s support focussed on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s experience of using this service: Staff were exceptionally motivated to provide person-centred care based on people’s choices, preferences and likes. People were extremely well supported to do the things they wanted to and go where they wished. Staff dedication was highly praised by health and social care professionals. Any dissatisfaction in receiving the service was addressed and resolved.

People were safe from harm because the provider had systems in place to manage safeguarding concerns and staff were appropriately trained in this area. Any risks they experienced were also managed and their homes were assessed for safety. However, this was hindered by a lack of available communal space in some of the houses. Sufficient numbers of staff were employed and worked in the houses so that people’s needs were met. People were safely supported with their medicines, keeping their homes clean and ensuring they had good food hygiene.

Staff were trained, skilled and well supported by the management team to do their job. We saw people had good relationships with the staff who protected their rights to lead as normal a life as possible. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Everyone we spoke with told us staff were kind and caring. They said people were respected, staff championed their privacy and dignity and encouraged their independence in all aspects of life.

People had the benefit of a service that was positive, inclusive and forward-looking. There was a registered manager in charge of the whole staff group and unit managers in each of the houses. The management team made lots of checks on how well the service was provided and documents held in the services office and the houses were secure to ensure confidentiality of people’s information.

More information is in the Detailed Findings section below.

Rating at last inspection: Good (The last report was published 16 July 2016)Why we inspected: This was a planned inspection based on previous rating.

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

This service was last inspected on 3 July 2014 and 5 September 2014, the latter being to follow up a compliance action issued in July 2014, when improvements were found to have been appropriately implemented in relation to medicines management and staffing arrangements.

This inspection of Creative Support - North East Lincolnshire Service took place on 15 June 2016 and was unannounced. We subsequently carried out a further inspection visit on 17 June 2016 which was announced. This was to enable us to meet some people living in supported living arrangements in their own homes and was in consideration of their needs and ensure they would be available. At the time of our inspection the service was providing personal care to 15 people under supported living arrangements.

Creative Support - North East Lincolnshire Service is a Domiciliary Care Agency that is registered to provide personal care to people who live in supported living accommodation arrangements. Each of the supported living services provides support to people who have their own tenancy agreements and live in their accommodation. The people using the service receive individual bespoke support hours depending on their assessed needs, following an assessment by the local authority who commissions the service. The aim of the service is to provide people with the support they need to live as independently as possible.

There was no registered manager in post, following a recent decision by the previous registered manager to step down from this post. A regional locality manager was providing direct managerial support to the service at the time of our inspection. They told us they would be submitting an application for their skills and competencies to be formally assessed for the position as registered manager. 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.

Due the complex needs of people who used the service, some people were unable to provide clear verbal comments about their experiences and views about the service. We therefore observed their interactions with staff.

Staff were safely recruited and received training to ensure they could recognise and report issues of potential abuse. Staffing levels were monitored to ensure there were sufficient numbers available to keep people safe from harm. Assessments concerning the management of known risks for people were carried out and reviewed to enable staff to keep people safe. Staff training was provided to ensure they knew how to manage the behaviours of people who used the service and incidents and accidents were recorded and analysed to enable them to be minimised. Staff were provided with training to ensure they knew how to administer medicines safely and audits of Medication Administration Records (MARs) were carried out to ensure potential errors were identified and action taken to minimise them reoccurring.

People who used the service were supported by staff who received a range of training to ensure they were able to meet their needs. People who needed support with making informed decisions and choices were protected by use of legislation to ensure their human rights were protected

People received person-centred support that was based on their individual wishes and needs and were involved in the development and reviews of their support where this was possible. People were encouraged to maintain a healthy and balanced diet to ensure their nutritional needs were met. People’s medical needs were supported with involvement from health professionals where this was required.

We observed staff interacted positively with people who used the service and involved them in making decisions, to ensure they were happy with how their support

This inspection was carried out by an adult social care inspector and was completed to follow up an inspection on 3 July 2014 when we issued a compliance action in relation to the assessing and monitoring of the quality of the service. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and the staff who supported them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At our last inspection on 3 July 2014 we issued a compliance action as we found audits of the administration of medicines had failed to identify errors in the signing of records. We also found some staff shortages and a lack of clarity in the staff rotas which led to one person not receiving care in accordance with the service commissioned by the local authority.

At this inspection we found the provider had implemented new checks to ensure all documentation relating to the administration of medicines was accurate. We also saw new staff recruitment had taken place and new staff rotas ensured the correct service was delivered to people.

Is the service effective?

People were encouraged to express their views about their support.

People’s health and support needs were addressed on a regular basis.

Staff received appropriate professional development and support.

Is the service caring?

Staff interacted with people in a kind and friendly manner.

Care files contained detailed information about people’s needs.

Satisfaction surveys and review meetings enabled people to share their views.

Is the service responsive?

Care records were personalised and were updated regularly.

People had access to a variety of activities

Is the service well-led?

Learning from accidents and incidents took place.

Staff were clear about their roles and responsibilities.

There was evidence of a personalised approach to enable people's wishes and feelings to be respected.

People said they liked their support and that staff were, “Good.” Relatives said communication was, “Great and on-going.” They said they were encouraged to speak up about any concerns and had, “No qualms” and “Couldn’t say anything negative about the service."

We saw that people looked comfortable with staff. People who used the service said that staff were, “Helpful and "Kind." Relatives told us they were, “Very satisfied” with the service.

We saw evidence of close working arrangements with community based professionals, One social worker told us the service “Worked pro-actively” with their team and that a particular individual had made “Massive progress” since they had begun receiving support from the service.

People said staff were, “Friendly” and that they felt safe. They said staff listened and that any concerns were taken seriously. Relatives said they were, “Reassured” and had “Confidence” the provider took action to follow things up when required.

Staff told us they received good support from their manager. We observed staff demonstrated warmth and enthusiasm for their work. Relatives told us staff, “Definitely had the skills” to perform their roles.

We found people who used the service were supported to freely express their views and that regular audits were carried out, to enable the provider to monitor the quality of the service.

This inspection was carried out by a social care inspector over two days. We were accompanied by staff from the local authority to two of the projects managed by the service, following an allegation of concern about short staffing arrangements.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Due to the complex needs of the people using the service we were unable to gain some people’s views. We therefore used a number of different methods to help us understand their experiences. This included observing how staff supported people, speaking with staff and checking records. If you want to see the evidence supporting our summary please read the full report.

Below is a summary of what we found.

Is the service safe?

We observed care and support was delivered to people who used the service in a safe way by staff who had received appropriate training.

We saw that systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helps the service to continually improve.

There was evidence that robust background checks were carried out on new staff before they were employed, to make sure they were suitable to work with vulnerable people. We saw that checks with the Disclosure and Barring service (DBS) were renewed for staff every three years.

The service had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to ensure people’s human rights were protected. Relevant staff had received training on this to enable them to understand when an application about this should be made and how to submit one. This meant that people’s rights would be safeguarded as required.

Is the service effective?

We found people were encouraged to express their views about their support and be involved in making decisions about this. Staff we spoke with gave us examples of how people were involved in making decisions about their care and support.

We saw that people’s health and support needs were assessed on a regular basis. We found that people who used the service and their relatives had been involved in the development of their plans of support and these were reviewed and updated.

Staff received appropriate professional development. We saw that staff had access to a variety of appropriate training to help them meet the needs of the people they supported.

Is the service caring?

We observed staff interacted with people in a kind and friendly manner and had a good understanding of people’s individual needs. We observed people appeared comfortable and at ease with the staff.

We observed care staff were considerate of people’s needs and responded to them in a compassionate and professional manner. We saw care staff communicated sensitively with people using a variety of signing and touch when required, giving them time to respond.to what was being asked. We saw that people were provided with support that was appropriate for their needs and that encouragement was provided to help them be as independent as possible.

Care files contained detailed information about people’s needs, including what was important to them and how to support their personal aims and goals. We saw that care and support was provided to people in accordance with their individual preferences.

Satisfaction surveys and review meetings were used by the provider to enable people and their representatives to share their views on the quality of the service provided. This helped the provider to assess the quality of support people received.

Is the service responsive?

Care records demonstrated that when there had been changes in people’s needs, outside agencies had been involved, to make sure people received the correct care and support.

Records showed people had access to a variety of social activities. During our visit we observed people being supported to go out into the community and participating in stimulation activities.

The service had a complaints procedure which was available to people who used and visited the service. There was evidence the provider listened to people’s views and followed up their concerns appropriately to put things right.

Is the service well-led?

Whilst we saw that learning from incidents / investigations took place, there was evidence the quality assurance system for this could be further improved. We saw medication omissions had been previously identified from audits of the service and that a new medication strategy implemented following this. We checked the medication records in one of the projects and saw evidence that recent audits of these had failed to identify when staff had not signed appropriately for these. We also found evidence, in one of the projects, that staff were not providing the specified hours commissioned for one individual and were unable to find evidence this had been reported to the provider.

Staff were clear about their roles and responsibilities. We saw that staff had access to policies and procedure to inform and guide them in their work. There was evidence staff training and development needs were assessed by the provider to ensure staff were able to meet people’s needs and help the provider to arrange future training when this was required.

The service worked well with other agencies and external services to ensure people who used the service received care in a joined up way.

What people who used the service, and those that matter to them, said about the care and support they received:-

A relative told us they, “Couldn’t be more satisfied” with the service provided and that staff had “Given structure and put boundaries in place.” They told us the service maintained good communication with them about their member of families complex needs. They said, “All credit to the carers…they take advice and are open and welcoming.” The relative told us they were included in decisions about support that was given and “Feel part of the team.” They told us they had, “An open relationship with Creative Support and staff.”

Another relative told us, “We are very pleased with the service….xxxx loves it there.” “It was the best thing we ever did.” They told us, “Staff look after xxx very well” and trusted the staff.

Relatives all told us they had confidence in the provider to put things right when required and knew how to make a complaint if this was needed. One told us they, “Speak up if needed” whilst another told us, “They listen to us and keep us informed …issues are dealt with quickly.”

We saw recent comments from a social care professional in a recent survey that stated, “I raised my concerns with the manager and felt they were listened to and compromises made to make things better.”