This inspection took place over several dates. On the 14 November 2017 we visited the site office. On the 16 November 2017 we telephoned relatives in order to obtain their feedback about the service. On the 8 February 2018 we visited people in their own homes and on 19 February 2018 we telephoned staff members in order to obtain their feedback about the service. At their last inspection on 17 August 2016, they were found to be meeting the standards we inspected. At this inspection we found that they had continued to meet all the standards.

Delrow Community is registered to provide domiciliary care to adults with learning disabilities, mental health needs and older people. The service supports up to 55 people living within nine separate houses. People living at Delrow Community receive care in line with the supported living model where all staff employed by Camphill Village Trust provide care and support to people over a twenty four hour period. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

At the time of this inspection 51 people were being supported to live independently. Some people being supported by this service had complex needs including learning disabilities, physical disabilities and Autism.

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.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People told us they felt safe at the service and they liked the way staff supported them to live their lives with choices and opportunities. Relatives told us they were happy how people were looked after and they felt the service was safe and met peoples` needs.

People were involved in developing their care and support plans and relatives where appropriate were invited to participate in developing and reviewing people`s care and support plans.

Relatives and staff told us there were enough staff to meet peoples` needs and support them with the activities they chose to do.

People lived an active life and had been provided with opportunities to pursue their hobbies and interests both within the service and in the wider community.

People were supported by staff who were trained and received regular supervision. People were encouraged to eat a healthy, balanced diet and there was access to healthcare professionals when needed. Staff understood the importance of giving people choice and listening to their views and opinions.

Staff members understood their roles and responsibilities and were supported by the management team to maintain and develop their skills and knowledge.

People’s personal care records were kept securely to ensure unauthorised people did not have access to them. Staff spoke with people in a kind, patient and friendly way and people were treated in a dignified manner. Staff consistently ensured people’s social needs were met, and people felt staff listened to them and valued their views.

There was a complaints process available and people were asked for their views at meetings. In addition relatives told us they were regularly asked to give feedback about the service and they felt positive about how the home was managed.

The management team were passionate about providing the best possible support for people and they actively supported people and staff to achieve this. There were quality assurance systems in pla

This focussed inspection took place on 17 August 2016 and was unannounced. At our last inspection on 23 and 30 June 2015 we found that the service was meeting the required standards in all areas. This visit was arranged so that we could be assured that people remained safe, well cared for and with a positive and open leadership due to several recent and significant management changes within the service.

Delrow Community is registered to provide domiciliary care to adults with learning disabilities, mental health needs and older people. Delrow Community is part of Camphill Village Trust. The service supports up to 55 people living within nine separate houses. Until 2014 people lived as part of a ‘life sharing model’ of support which meant that staff, known as co-workers, and their families lived together with people who used the service and supported them on behalf of the Delrow Community. People living at Delrow Community now receive care in line with the supported living model where all staff employed by Camphill Village Trust provide care and support to people over a twenty four hour period but did not live within their houses.

There were 50 people accommodated at the service at the time of this inspection. The service had a manager in post who is currently in the process of being registered with the Commission. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 told us that they felt safe at Delrow community and were confident to approach the staff for support. People had health care and support plans in place which ensured staff knew how people liked their needs to be met. Risks to people’s safety and welfare had been identified and care had been planned to enable people to live as safely and independently as possible. There were sufficient numbers of staff available to meet people’s care and support needs.

Robust and effective recruitment processes were used to ensure that all staff employed at the service were of good character and had the skills, abilities and experience necessary to do their jobs.

Staff received training in how to safeguard people against the risks of abuse and knew how to report any concerns they had, both internally and externally if the need arose.

There were sufficient numbers of staff available who were deployed in a consistent and effective way across the service. Staffing arrangements reflected and took account of people’s individual needs and levels of dependency which meant that care and support was provided in a calm and patient way.

Appropriate steps were taken to ensure that identified risks to people’s health, safety and well-being were mitigated in a safe and effective way that promoted their independence. Accidents, falls and injuries were recorded and investigated thoroughly to identify emerging risks, patterns and trends.

Medicines were stored, administered and managed safely. People were supported by trained staff to take their medicines on time and in accordance with prescriber’s instructions

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Staff members understood their roles and responsibilities and were supported by the management team to maintain and develop their skills and knowledge.

The atmosphere within each of the houses was welcoming and relaxed. We found that staff had developed positive and caring relationships with the people they supported. People were actively involved in all aspects of their care and support as much as they were able to. People were supported to access support from external advocacy services to help them make decisions about matters in their daily lives. Relatives and friends were encouraged to visit at any time and people were actively supported to maintain family relationships. Staff promo

Delrow community provided domiciliary care to people with learning difficulties. Delrow community is a small village with ten separate houses for people to live in. People were supported by unpaid workers known as ‘House managers’ or ‘guest volunteers’. The workers lived in the houses with the people who used the service.

The people we spoke to were satisfied with the care they received and liked living in their home within the village. One person told us, “I’ve lived here for a long time” and that, “we do a lot of activities, we go dancing and do the workshops. I’m very happy here”.

However, we identified concerns around how peoples care was planned because documentation was not sufficiently detailed to adequately support people. We also found that some incidents had not been reported to safeguarding or the Care Quality Commission. Arrangements for supervision and appraisal were not consistent amongst different groups of workers. Complaints were recorded and responded to appropriately.

We undertook a visit to follow up on concerns previously identified. We were provided with the necessary evidence to enable us to form our judgement. We did not speak to people using the service the provider was able to evidence that the required action had been taken or that progress had been made.

The provider had developed contracts for private fee payers. The recruitment processes had been improved, although the service had not employed anyone since our previous visit. We also found that progress had been made with regards to audits but that they had not been formally recorded and a broader range of audits was needed.

People told us that they were involved in their care and support plan. They felt that their needs and preferences had been taken into account and where possible acted on. People said that the staff treated them with respect, and provided care in a manner that preserved their dignity. They also told us they felt safe and that they were confident people acted in their best interests. One person told us, “Staff look after me; I couldn’t be looked after better”.

Although people we talked to were happy with the care they received we identified concerns around some of the systems and practices during our visit. People paying for the service were not provided with a contract detailing the services provided or the fees due. We found that some people may have been doubled charged for personal care, although this had already been indentified by the provider and was in the process of being rectified.

There was a general lack of quality monitoring including; audits and surveys had not being undertaken. Internal investigations for reported serious incidents had not being undertaken.

Pre-employment checks were being undertaken but were in need of improvement.

When we last inspected the service on 27 and 29 May 2014 we found them to be not meeting the required standards and they were in breach of regulation 20 and 21 of the HSCA 2008 (Regulated Activities) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 17 (2) (d) and regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that they had met these standards.

The inspection took place on 23 and 30 June 2015 and was unannounced.

Delrow Community is registered to provide domiciliary care to adults with learning difficulties, mental health needs and older people.

Delrow Community is part of Camphill Village Trust .The service supports up to 55 adults who have a learning disability or a mental health need living within nine separate houses. Until 2014 people lived as part of a ‘life sharing model’ of support which meant that staff, known as co-workers, and their families lived together with people who used the service and supported them on behalf of the Delrow Community.

However everyone living at Delrow Community now received care in line with the supported living model where all staff employed by Camphill Village Trust go into the nine houses to give care and support over a twenty four hour period but did not live within these houses. There were 46 people accommodated at the service at the time of this inspection.

We found that the management and staff had worked hard in the past 18 months to try to ensure that people who lived within the Delrow community were supported to express their concerns and anxieties about the recent changes. We saw that people had been supported within their regular house meetings as well as one to one meetings to raise any issues or anxieties they had.

The home had a manager in post who is currently in the process of being registered with the Commission. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others.

People felt safe at Delrow community and were confident to approach the staff for support. People had health care and support plans in place which ensured staff knew how people liked their needs to be met. Risks to people’s safety and welfare had been identified and care had been planned to enable people to live as safely and independently as possible. There were sufficient numbers of staff available to meet people’s care and support needs. People’s medicines were managed safely.

Staff members understood their roles and responsibilities and were supported by the manager to maintain and develop their skills and knowledge. People enjoyed a varied healthy diet and their health needs were well catered for.

The atmosphere in all nine homes was welcoming and relaxed. We found that staff had developed positive and caring relationships with the people they supported. People were actively involved in all aspects of their care and support as much as they were able. People were supported to access support from external advocacy services to help them make decisions about matters in their daily lives. Relatives and friends were encouraged to visit at any time and people were actively supported to maintain family relationships. Staff promoted people’s dignity and treated them with respect.

People and some relatives told us they had been fully involved in the planning, delivery and reviews of the care and support provided. However there were also some negative comments expressed by some families that preferred the old model of care and had therefore been reluctant for their relatives to move towards to more independent living and had therefore chosen not to be fully involved in the planning and delivery of the care provided to their [Relative]

The confidentiality of information held about people’s medical and personal histories had been securely maintained. People were supported to be individuals. The provider had made arrangements to support people and their families to raise concerns and meetings were held for people to discuss all aspects of the care and support provided at all nine homes.

People were offered an exceptionally diverse and inspirational range of activities both within the home’s on-site day care facilities as well being offered the opportunity to experience social and community activities within the local area.

Measures were in place to monitor the quality of services provided, reduce potential risks and drive improvement. The general manager co-ordinated and delegated specific responsibilities with regard to monitoring of all aspects of service provision. They personally and regularly checked key aspects of service provision in a formalised and structured way.