East Living Domiciliary Care Service provides care and support to people living in four ‘supported living’ settings, 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.

This inspection took place on 5 and 12 December 2017 and was announced. The provider was given at least 48 hours' notice because the location provides a supported living service for people who are often out during the day. At the previous inspection in October 2016, the service was rated as Requires Improvement with no breaches. At the last inspection the service was providing personal care support to 77 people in supported living schemes for adults with learning disabilities and extra-care and sheltered housing schemes for older adults. Since the last inspection the service had changed its model of care and now was providing support to nine people living in supported living schemes for adults with learning disabilities.

There were two registered managers at this service. 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 who used the service, relatives and health professionals were complimentary about the standard of support provided. The locality manager involved families and other agencies to ensure people received the support they needed to express their views and make decisions that were in their best interests. Relatives and professionals were very positive about the service people received. The service specialised in supporting adults with behavioural problems.

Positive risk taking was driven through the safe use of innovative and pioneering technology in order to support people to live fulfilling lives. The registered managers and staff had an excellent understanding of managing risks and supported people that had previously challenged services to reach their full potential. The service was seen to constantly adapt and strive to ensure people who used the service were able to achieve their full potential. Over a period of time we saw that people were supported to progress and their support plans and environment adapted and developed to promote their independence.

The service had developed and sustained effective links with professionals and this helped them have a multidisciplinary approach in supporting people. Their success in achieving positive outcomes for people and their ability to develop best practice led to them being asked to share their ideas with other organisations that supported people with learning disabilities. This meant the service was being an excellent role model for other services.

People’s needs were assessed and their preferences identified as much as possible across all aspects of their care. Risks were identified and plans were in place to monitor and reduce risks. People had access to relevant health professionals when they needed them. There were sufficient numbers of suitable staff employed by the service. Staff had been recruited safely with appropriate checks on their backgrounds completed. Medicines were stored and administered safely.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff had a good understanding of the Mental Capacity Act 2005 (MCA). MCA is legislation protecting people who are unable to make decisions for themselves. We saw people were able to choose what they ate and drank.

People had access to a wide variety of activities within the community. People’s cultural and religious needs were respected when planning and delivering care. Discu

The inspection took place on 17, 18, 19 and 21 October 2016 and was announced. The provider was given 48 hours’ notice as they provide a domiciliary care service and we needed to be sure staff would be available to speak with us. The service was last inspected in January 2014 when it was compliant with the outcomes inspected.

East Living Domiciliary Care Service provides care to people in their own homes. This takes the form of supported living schemes for adults with learning disabilities and extra-care and sheltered housing schemes for older adults. At the time of the inspection 77 people were receiving personal care.

The service had 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 service had robust measures in place to ensure that people were protected from avoidable harm and abuse. Staff were knowledgeable about safeguarding adults from harm and were familiar with the provider’s policy on safeguarding. Records showed that concerns about abuse were escalated appropriately. People told us they felt safe.

The quality of measures in place to reduce and mitigate risks faced by people receiving a service varied across the schemes. Some schemes followed best practice, particularly regarding risks associated with behaviour which challenges services. However, in other schemes risks had been identified but the measures in place to mitigate them had not been captured. We have made a recommendation about risk assessments.

People were supported to take their medicines by staff. In most cases medicines were managed in a safe way, with detailed plans in place to inform staff about how to support people to take their medicines and regular audits to ensure the service was managing medicines safely. However, practice was inconsistent across the services and audits and plans were not always in place. We have made a recommendation about medicines management.

Staff were recruited in a safe way which ensured they were suitable to work in a care setting. New staff received a comprehensive induction including a period of shadowing more experienced colleagues. Staff spoke highly of the training opportunities and support available to them. This included access to specialist external training.

Care files contained records showing that people had consented to their care. Where people lacked capacity to consent to their care best interests processes were recorded. Where people had legally appointed decision makers records were less clear and it was not always possible to tell who had the legal right to consent to aspects of care and treatment. We have made a recommendation regarding records of legally appointed decision makers.

Care files contained details of people’s health needs and how they liked to be supported to have their health needs met. Where appropriate people had health action plans and health passports in place to facilitate communication with health professionals. Health information was recorded in different places in people’s files and it was not always easy to locate the most up to date information or records of health appointments. We have made a recommendation about recording health information.

People told us they thought staff cared about them. Staff told us they had time to develop caring relationships with people they supported. Care plans were highly personalised and contained details of people’s choices, preferences, cultural and religious needs. Plans contained details of people's dietary preferences and where it was within the remit of the service there were details of how to support people with activities of their choices. The level of detail regarding support to meet people’s personal care preferen

During our visit we were able to speak with two area managers and the complaints manager at the provider’s head office. We were able to assess the provider’s policies and procedures on care planning, staff training and development, safeguarding and complaints. We were able to read files of one project manager and three care support staff. We visited one home where carers provided personal care.

We saw that people were treated with respect and dignity. We noted that care plans had been written using pictorial aids and that the provider had taken steps that ensured people had been able to input into their respective care support plans.

People told us the care they received was good; they told us they were happy with their care support workers. Comments included that staff were "wonderful" and "I feel I have the best care ever.” Care was provided took into account people's welfare and safety.

People who used the service seemed happy with the care provided. Staff who we spoke with were knowledgeable with regard to the forms of abuse that could occur in people’s homes and knew how to escalate any concern. This ensured people were kept safe.

Staff were appropriately supported and trained before they commenced employment. Training records confirmed that the provider ensured that staff received regular supervision and support.

The provider had a robust complaints policy and procedure that staff and people who used this service were aware of.

People that used the service told us that they were happy with the care they received and confirmed that consent was sought before any care was given.

Care plans were detailed and holistic and evidenced the involvement of people that used the service in the planning and review of their own care.

Most services provided through the domiciliary care agency were to people living in extra care housing or within a supported living scheme. Each scheme had an allocated manager, who was based on site and was responsible for co-ordinating each person’s care and managing their own staff team.

Recruitment processes were robust and records were fit for purpose.