We carried out an announced inspection of the service on 20, 27 and 29 March 2018 and 12 April 2018. This service provides care and support to people living in 20 ‘supported living’ settings, known as ‘projects’ so that they can live as independently as possible. The projects referred to are people’s homes. 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 present during the inspection. 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.

Future Home Care Limited Nottinghamshire currently supports 43 people, all of which received some element of support with their personal care. This is the service’s second inspection under its current registration. During the service’s previous inspection on 23 and 24 February 2017, we rated the service overall as ‘Good’. During this inspection, we found some areas of concern and the overall rating has now changed to ‘Requires Improvement’. The details of the reasons why are explained in the summary below and in the body of the main report.

The risks to people safety were not always appropriately assessed and acted on. Where people had identified risks to their health, assessments were not always in place to assist staff with reducing the risk to people’s safety. Some people received continuous supervision as required however, others did not. There was an inconsistent approach to the writing and reviewing of people’s support plans. Support plans were not always updated when people’s needs changed and guidance was not always in place to enable staff to know how to respond to people’s needs in the appropriate way.

Staff told us previously there had been a requirement for them to work longer shifts due to constraints on staff numbers; however, they also told us this had improved recently. Records showed that in one project some staff worked long continuous shifts, which could pose a risk to people’s safety. Staff were recruited safely. Agency staff were used to covers shifts. Most agency staff had the required training for role although records showed one agency staff member did not.

People were protected against the risks of experiencing avoidable harm. Staff could identify the potential signs of abuse and knew who to report any concerns to. Staff had received sufficient training to reduce the risk of the spread of infection. Assessments of the environment people lived in were carried out to ensure they were safe. Accidents and incidents were regularly reviewed, assessed and investigated by the registered manager.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. Assessments of people’s ability to make decisions had been carried out for some decisions where required but not all.

People’s physical, mental health and social needs were assessed and provided in line with current legislation and best practice guidelines. However, further guidance would be beneficial for some health conditions such as epilepsy. People were supported by staff who had completed a detailed induction and training programme. However, the frequency of the supervisions for staff was inconsistent. Where people required support

We carried out an announced inspection of the service on 23 and 24 February 2017. Future Home Care Limited Nottinghamshire is a service that provides personal care services and support for people who are living with a learning disability. People are supported to live where and with whom they want, for as long as they want, with the on-going support needed to sustain that choice. At the time of the inspection there were 33 people using the service.

On the day of our inspection there was a registered manager in place. 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.

Staff could identify the potential signs of abuse and knew who to report any concerns to. Risks to people’s safety were continually assessed and reviewed. There were enough staff to keep people safe and to meet their needs. People’s medicines were managed safely, with minor areas identified in terms of checking handwritten entries on people records were recorded accurately.

People were supported by staff who completed an induction prior to commencing their role. They had the skills and training needed and their performance was regularly reviewed to enable them to support people effectively.

The principles of the Mental Capacity Act (2005) had been followed when decisions were made about people’s care. People were supported to maintain good health in relation to their food and drink and people felt involved in buying and cooking the food they wanted. People’s day to day health needs were met by staff and referrals to relevant health services were made where needed.

Staff were kind, caring and compassionate. Staff understood people’s needs and listened to and acted upon their views. People’s privacy and dignity were maintained. People felt staff treated them with respect. People were involved with decisions made about their care and were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates.

People led active and meaningful lives and were supported to follow the activities and hobbies that were important to them. People had detailed person centred support plans in place that recorded their preferences and likes and dislikes. People’s support records were regularly reviewed with people involved with the process. People were provided with the information they needed if they wished to make a complaint and they felt their complaint would be acted on.

The registered manager led the service well and was supported by a team of project managers who were held accountable for their role. The provider had ensured the working environment demanded excellence, but also recognised and rewarded strong staff performance. The registered manager and project managers were well liked by all. People, relatives and staff were encouraged to provide feedback about the quality of the service and this information was used to make improvements. Robust quality assurance processes were in place to ensure people received high quality care and support. Regular provider level audits were also completed to ensure standards remained high and to address any areas that required improvement. A small number of reportable incidents had not been forwarded to the CQC, however records showed these had been fully investigated.