This service provides personal care and support to people living with learning disabilities, including some with physical disabilities. At the time of our inspection there were 105 people using the service across shared supported living settings located within North Derbyshire and North Nottinghamshire. This enables people to 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.

The service is run from an office in the village of Holmewood, north east from Chesterfield town centre. We carried out this inspection on the 12, 13 and 14 February 2018. We visited the provider’s office on the 14 February 2018. The provider was given four working days’ notice of our inspection to arrange and seek people’s permission for us to speak with them in their own homes on 12 February and to speak with some people’s relatives by telephone on 13 February 2018.

There was a registered manager for the 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 personal have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in October 2016, people who used the service were not protected from risks associated with ineffective monitoring and evaluation of the service. We asked the provider to complete an action plan to show what they would do and by when to improve the service. This was because the provider needed to improve the key question about how they ensure the service is well led in relation to its management, governance and oversight; to at least good. This is the second time the service has been rated as Requires Improvement.

Required care and service improvements had not always been proactive, timely or sustained. Revised service planning, management, communication and quality monitoring systems were introduced to reduce any related risks to people from this. Further improvement was required to fully ensure people received consistent and effective care with timely and sustained improvement when required.

Action was taken by the provider in consultation with the local authority to address recent safeguarding concerns relating to the safety and effectiveness of people’s care, medicines and monies at the services. Subsequent improvements to related safety and staffing systems showed lessons learned learnt from this to ensure people’s safety.

People felt safe at the service and relatives felt they now received safe care. Recognised staff recruitment procedures were followed for people’s safety.

Staff understood risks to people’s safety from their health conditions, equipment or environment and their related care requirements. Revised care planning, incident reporting and related management monitoring and analysis helped to further ensure people received safe, consistent and least restrictive care.

People were protected from harm and abuse; both they and their relatives were informed and confident to report any concerns if they needed to. Staff knew how to recognise and report the suspected or witnessed abuse of any person receiving care at the service.

Safe working systems were monitored and ensured for the prevention and control of infection, any equipment used for people’s care and for emergency contingency planning.

Staff had not always obtained people’s consent or appropriate authorisation for their care and people had not always received consistent care in their best interests. Management improvement actions were in progress to address this where required.

Overall, people were supported to maintain their health and nutrition and to obtain and use any care equipment they needed. This was don

Enable Care and Home Support provide personal care and support to adults with learning disabilities who need care in their own homes. The service is run from an office in Holmewood near Chesterfield and they provide care to people in North Derbyshire. We carried out this inspection at the provider’s office on 19, 24 and 31 October 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure the manager was available. In addition we also carried out visits to people using the service on 19 and 25 October 2016.

The service did not have a registered manager at the time of our inspection visit. 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 not addressed issues requiring improvement at our last inspection in July 2015. Some people’s risk assessments and care records had not been updated. There were systems in place to monitor and improve the service but these were not always effective as they had not acted on issues in people’s care records or established trends and reasons for incidents.

At our last inspection in July 2015 we found people’s capacity to make decisions was not always assessed and decisions were not always made in people’s best interests. We found this had improved. The principles and requirements of the Mental Capacity Act (2005) were being met. When required, best interest decisions and capacity assessments had been completed. People were supported by staff who knew them well. Staff were aware of promoting people’s safety, whilst providing information to support people to make day-to-day decisions.

People were safeguarded from abuse because the provider had relevant guidance in place and staff were knowledgeable about the reporting procedure. The provider's arrangements for staff recruitment and deployment helped to make sure there were sufficient staff who were fit to work at the service to provide people’s care.

Staff understood their roles and responsibilities for people's care and safety needs and for reporting any related concerns. The provider's arrangements for staff training and their operational procedures supported this.

People received appropriate support to manage their meals and nutrition when required. This was done in a way that met with their needs and choices. People’s health needs were met. Referrals to external health professionals were made in a timely manner.

People and their relatives told us the care staff were caring and kind and that their privacy and dignity was maintained when personal care was provided. People and their relatives were involved in the planning of their care and support.

People were supported to maintain their independence and participate in a range of leisure pursuits that met their individual needs and preferences.

Complaints were well managed. The provider had obtained feedback about the quality of the service from people, their relatives and staff.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Some people using the service were unable to share their views with us. People able to express their views said they were happy with the care and support they received, and felt their needs were being met.

People told us they are given information to help them make decisions about their lives. One person told us ‘’Staff explain things to me in a way I can understand to help me to make choices’’.

People said they are involved in various leisure and social and activities of their choice, and they are encouraged to do things for themselves, where able.

People felt that staff respected their privacy, dignity and independence. They also felt listened to and able to express their views and raise any concerns with staff if they were unhappy.

Relatives we spoke with praised the care and support their family member received. They felt that staff are very caring and respond to individual’s needs. Relatives described the staff team and the service as excellent.

Enable Care and Home Support provide personal care and support to adults with learning disabilities who need care in their own homes. The service is run from an office in Holmewood near Chesterfield and they provide care to people in North Derbyshire. We carried out this inspection at the provider’s office on 30 July and 05 August 2015. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure the manager was available. In addition we also carried out visits to people using the service on 31 July 2015 and 3, 4 and 5 August 2015.

A registered manager was 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.

We found there were inconsistencies in documents related to decision making. People were not always assessed to see if the non-prescribed medicines they were taking were in their best interests and not everyone who did not have capacity to make a decision had been assessed to see if decisions made were in their best interests. Staff were not always able to tell us how they would assess people’s capacity to make decisions.

This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found people’s health care needs were not always addressed promptly and people were at risk of not having timely access to healthcare or attending scheduled appointments.

Complaints were not always addressed in an effective or timely manner. There had been repeated complaints about property maintenance and financial charges that were not fully resolved.

There were inconsistencies in how risks to people were identified and managed. Risks to people and care plans were not reviewed on a regular basis which meant there was the potential for individual needs not to be met.

People were not always fully protected from abuse because the provider’s procedures were not followed consistently.

The service had been undergoing a period of transition following several changes at the executive level of the organisation. This had led to inconsistent management practice.

Staff were appropriately trained and supported. They had all undergone a comprehensive induction programme and, where necessary, had received additional training specific to the needs of the people they were supporting. One said “The line manager I currently have supports me well.”

Most people using the service were supported in their food choices and had sufficient to eat and drink. One person told us, “The food is good, staff help me.”

People were cared for by staff that were caring and who respected people’s views and choices. They spoke positively about the service they received. They told us they were well cared for and felt comfortable and safe with the staff who provided their support. One person said: “I like the staff, they help me” and another told us “They look after me.’’ People’s privacy and dignity was maintained.

People received care that was personalised and responsive to their needs. We saw people had varied social lives and were encouraged to participate in interests on their choice

There were sufficient staff to ensure people’s needs were met in a timely manner. Recruitment procedures were comprehensive and ensured suitable staff were employed to work with people using the service.

The provider had detailed policies and procedures relating to medicine management.

Staff understanding and competency regarding medication handling was subject to regular monitoring checks and medicine training was updated appropriately.

The provider had systems in place to monitor and improve the service provided and there were regular audits of key areas such as medication and health and safety.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.