At our previous inspection in February 2016 we found the provider was meeting the fundamental standards. We rated the service ‘good’ overall but ‘requires improvement’ in one key question. At that time we found the service was not following national guidelines on the information that should be recorded in relation to people's medicines. There was no evidence on the files we reviewed that the rationale for the person taking the medicine had been explained to the person and everyone involved in their care. While staff were aware of the medicines people were required to take and in what dosage, they were not always aware of what the medicine was for. At this inspection we found the service had addressed the issues and had significantly improved. Staff received appropriate training and their competencies were assessed. Staff were aware of why people were prescribed medicines and the side effects of the medicines for the people in their care.

Frontier Support Services is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service for 34 people with a variety of needs including learning disabilities, autism, epilepsy and mental health issues who are living in Croydon, Lambeth, Southwark and Wandsworth. Not everyone using Frontier Support receives a 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 was developed and designed before the values that underpin the Registering the Right Support and other best practice guidance was established. However the provider embraces the values that 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 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.

People felt safe with the staff who supported them and staff knew how to safeguard people from abuse and neglect. People received person centred care from appropriate numbers of well trained staff.

Risks relating to people’s care were comprehensively assessed and well managed by staff. Staff understood people’s needs well. People received care from staff who were deemed suitable by the provider which carried out robust recruitment checks.

People received their medicines safely. The provider had good systems in place to review accidents and incidents in order to learn lessons where things went wrong.

The service was effective. Needs assessments for people were holistic and personalised ensuring the resulting care plans were outcome focussed and considered all aspects of their lives in addition to their care needs.

Staff received high levels of support and training to ensure they had excellent skills that met the needs of people. Where people had specialist needs staff were provided with additional training to ensure they could meet people’s needs.

Peoples dietary needs and preferences were clearly identified in their support plans that staff followed closely. People’s dietary needs and preferences were met effectively.

Staff supported people to meet their healthcare needs and supported them to access specialist support and services where this was needed. Records showed staff facilitated people to engage with the community and wider support networks. This helped to ensure all organisations involved in providing support to people worked together in a holistic way.

The provider ensured staff understood the Mental Capacity Act 2005 and that people’s best

We inspected Frontier Support Services Limited on 26 February, 1 March and 2 March 2016. The inspection was announced 48 hours in advance because we wanted to be sure the registered manager would be available to speak to us during our inspection. At our last inspection of the service on 7 January 2014 we found that the provider was meeting the regulations we checked.

Frontier Support Services Limited provides support and personal care to adults who may have learning disabilities, mental health difficulties or an autistic spectrum disorder in their own homes. At the time of our visit there were 58 people using the service.

The service had a registered manager. 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 they were safe. This was also the view of their relatives. Staff were knowledgeable about how to recognise the signs of abuse and report any concerns. Care was planned and delivered to help ensure people were protected against abuse and avoidable harm. People had personalised risk assessments which gave staff sufficient information on how to manage the risks identified. People received their medicines safely.

Staff were recruited using a thorough recruitment process which was consistently applied. Appropriate checks were carried out on staff before they began to work with people. Staff arrived on time to care for people and stayed for the time allotted. There was a sufficient number of suitable staff allocated to each person to keep them safe and meet their needs. Staff understood their roles and responsibilities.

People were satisfied with the quality of care they received. Care plans provided information to staff about how to meet people’s individual needs. People were supported by staff who had the training, knowledge, skills and experience to deliver their care effectively. Staff worked with a variety of healthcare professionals to support people to maintain good health.

People spoke fondly about the staff and said they were kind and caring. People were treated with respect and felt valued. People were supported and encouraged to be as independent as they were able to be. People were enabled to spend their time day to day in the way they preferred and had many opportunities to socialise.

People's personal information was protected because it was securely stored and only accessible by staff. People's care and medical records were well organised and up to date.

The provider had not effectively communicated to people that their tenancy could not be ended if they stopped using the service. This meant that some people did not feel comfortable making a complaint as they feared this could lead to them losing their home.

There were systems in place to assess, monitor and improve the quality of care people received. The registered manager and senior management team had worked in the adult social care sector for many years and understood what was necessary to provide a quality service.

At our previous inspection of Frontier Support Services we identified that action needed to be taken by the service provider to improve care planning and support provided to people who used the service. During our follow up visit we found that appropriate action had been taken by the provider to address these concerns identified at the previous inspection.

The registered manager told us that new audit systems had been put in place to ensure that all those people who received care and support from Frontier Support Services were assessed and had care and treatment planned and delivered to meet their identified needs and expressed wishes. We were shown evidence that supported this statement. We were also told that every person who received care and support from Frontier Support Services had now been reviewed as a part of the annual review process.

We spoke with five relatives and three people who used Frontier’s services. Three other people who received services who we wanted to speak to were non-verbal due to their complex learning disability needs and therefore were not able to speak about their experiences. Those people who were able to communicate with us said that they were happy with the care and support they had received. They said that they had had enough information about the services before they agreed to have them. Some of the relatives we spoke to said that they thought communication between themselves and support staff about their relative could be improved, one person said, “one of the support workers I had been speaking to left but didn’t tell me, so I was emailing them and I got no response”.

Some people told us that they felt safe and well supported. Some said they thought their support workers were well trained and competent to do their jobs in providing care and support for them. Others said that they were “too light touch” in relation to those with very minimal learning disability needs.

All the people we spoke with told us that they knew what to do if they wanted to make a complaint and they said that they felt their concerns would be listened to appropriately.

The people who we spoke with told us that they were happy with the care and support they had received from Frontier Support Services. They said that they were provided with sufficient information about the services they received and they thought that their needs assessments and care plans involved them at the centre of the process.

People told us that they felt safe and well respected. They said they thought their care workers were well trained and competent to do their jobs in providing care and support for them. People told us that they knew what to do if they wanted to make a complaint and they said that they felt their concerns would be listened to appropriately.

We met and talked to people who use the service in the office and in supported living accommodation. The views of people who were able to comment on the service included, “very happy”.

People told us that they enjoyed the food provided and that they are involved in planning what to eat, shopping for supplies and the preparation of meals.

The home we visited was clean and tidy.

People told us they liked their homes. One person showed us their bedroom, they told us that they really liked the room and liked to play music.