This was an unannounced inspection carried out over three days on 28 March, 20 April and 16 May 2018. On the first day the visit was unannounced as the provider did not know we would be visiting. On the other two days our visits were announced as we had made appointments to visit people in their homes. Five people were using the service at the time of our inspection.

This was the first rated inspection of the service since it was registered.

Education and Services for People with Autism (ESPA) Agency is registered to provide personal care to adults with an autism spectrum disorder or related condition. People are supported by staff to live individually in their own homes.

The service also provides care and support to people with an autism spectrum disorder in two 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.

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.

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 have made a recommendation that a supported living model of care is operated, rather than a residential model as some of the organisational business was carried out from people’s own homes.

Some people who used the agency had complex needs which meant they did not express their views about the service. During the time we spent with people we saw they appeared comfortable with staff. Other people told us they felt safe and staff were kind.

Staff knew the people they were supporting well. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. Staff had developed good relationships with people, were caring in their approach and treated people with respect. Care was provided with patience and kindness.

There were sufficient staff employed and people received a reliable and consistent service. Staff were well supported due to regular supervision, annual appraisals and a robust induction programme, which developed their understanding of people and their routines. Staff also received a wide range of specialised training to ensure they could support people safely and carry out their roles effectively.

People were supported to access health care professionals when required. They received varied and nutritious diets with involvement from other professionals to obtain advice for any specialist needs. They were supported to receive their medicines and manage their finances safely.

Staff were aware of the whistle blowing procedure which was in place to report concerns and poor practice. There were enough staff available to provide individual care to people. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making approaches, when people were unable to make decisions themselves.

People were involved in decisions about their care. They 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. Information was made available in a format that helped people to understand if they did not read. This included a complaints procedure. People

This inspection took place on 14 December 2016 and was announced. A second day of inspection took place on 20 December 2016. This was the provider's first inspection since they recommenced providing a service on 1 December 2016.

ESPA Agency provides personal care to people in their own homes. At the time of the inspection 15 people were in receipt of personal care from the service. On this occasion we were unable to rate the service against the characteristics of inadequate, requires improvement, good and outstanding. This was because as the service had only been operational since 1 December 2016 we did not have enough information to determine the sustainability of service provision to accurately award a rating for each of the five key questions and therefore could not provide an overall rating.

The service had a 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.

The person and relatives we spoke with said the service was safe and they were happy with the support they received.

The registered manager and staff demonstrated a good understanding of how to safeguard people from abuse. Staff were aware of the provider’s whistle blowing procedure. Staff told us they were confident in raising concerns about people’s care, but did not have any to date.

We found accurate Medicines Administration Records (MARs) had been kept to confirm the support people received with medicines.

Risks to people’s safety and wellbeing were assessed and linked to appropriate care plans.

Staffing levels were consistent with people’s needs. Staff were recruited in a safe and consistent manner with all appropriate checks carried out.

Staff had received a comprehensive induction and appropriate training to carry out their roles.

The service provided personalised support to each individual. People had personalised care plans in place that included information around their preferences.

The registered provider had a complaints procedure in place for people to use should they be dissatisfied with the support they received.

The registered provider had quality assurance processes in place to monitor service provision. However, due to the limited time the service had been operating we were unable to evidence sustainability of the processes and how they informed future development of the service.

We used a number of different methods to help us understand the experiences of people using the service, because some of them were not all able to tell us their experiences. People who used the service and their families told us they were very happy with the service they received and that staff were very caring. One relative commented; "The staff are brilliant” and “The staff are very knowledgeable”. Another relative commented; "The staff keep me well informed and I have regularly meetings with them.

People who used the service and their relatives we spoke with told us they felt safe with the staff and had no concerns. They told us that staff were always around to support them to do lots of activities for example shopping, cooking, and going out for meals.

All of the people we spoke with and their relatives said they were involved in the planning of their care and had been asked for their views when reviews were carried out.

We reviewed information of a sample of people's care records and found that their care needs were being properly planned for.

There were enough qualified, skilled and experienced staff employed to meet people’s needs. We found that the staff understood people's care needs and how to protect them from risk and harm. A system was in place to make sure that there were enough carers employed to support the people who used the service.

Complaints were responded to and the provider had a system to review the quality of the service.

We weren’t able to speak to people using the service because they had complex needs, which meant they were not able to tell us their experiences. However, we gathered some evidence of people’s experiences of the service by speaking to their relatives and other people involved in their care.

We spoke to some of the relatives of people who were using the service. One relative

commented, "Everything about the service is good" and "The staff are kind, considerate and friendly". Another relative commented, "I don’t have any problems, if I did I would tell them”.

We spoke to an advocate who was supporting one of the people who used the service. An advocate is someone who can speak on a person’s behalf and support them if they need to make choices or decisions. They told us that the staff had sought the views of the person as much as possible. They had involved them in the recruitment of staff who would be supporting them and had taken their opinions into account when planning their care package. They commented, “The staff have always included … as much as they could” and “Staff worked very closely with … and her mum”.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One relative commented, “I know that … is kept safe”.

We did not receive any comments from the people who use the service about this outcome so we asked some of their relatives for their views. Their comments included “The service our family have received has been good” and “They are very reliable”.