Hand in hands is a supported living service and provides personal care to people living in their own houses in the community. Hand in Hands also provide an outreach service to 35 people in the community three of these were provided with the regulated activity, personal care. At the time of our inspection 13 people were being provided with a supported living service.

Not everyone using Hand in Hands receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating.

This service provides care and support to people living in five supported living homes, so that they can live 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.

At our last inspection we rated the service good in safe, effective, caring and well-led. We rated the service as outstanding in responsive. At this inspection we found the evidence continued to support the rating of good and outstanding there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. Settings. At this inspection we found that well-led had achieved outstanding.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The registered manager is also the provider for this location.

The service was safe. Sufficient staff were in post and the recruitment process for new staff had helped ensure that only suitable staff were employed. People were kept safe by staff that were knowledgeable about safeguarding and knew how to report concerns appropriately. Accidents and incidents were monitored to identify any trends or patterns to ensure appropriate actions could be taken. Identified risks to people were reviewed regularly to ensure people’s changing needs and risks were managed well. Medicines were managed safely by staff that received appropriate training. People were protected from the risk of infections by staff who followed correct infection control procedures.

The service was effective. Staff had the right training and skills to meet people’s needs effectively. The registered manager ensured staff were able to develop and put in place adaptive learning systems to support staff learning. People were given choice and control over their lives and staff supported them in the least restrictive way possible. People were supported with a varied and healthy diet, support from staff promoted people’s healthy choices. People were supported to access health care services. Other professionals were positive about the service provided by Hand in Hands.

The service was caring. Staff knew people well and staff cared for them in a compassionate way. Staff respected people’s privacy and dignity and supported people to maintain relationships. Staff delivered care that was supportive, kind and caring. People were involved in deciding how their care was provided and staff promoted their choice.

The service was very responsive. People received person-centred care. People`s needs were assessed to ensure people received the support they required. People were supported to grow and achieve their goals. People were involved in creating and reviewing their care plan and they were supported to develop their independence. The registered manager and staff promoted people's independent and supported people with their relationships. People were given the opportunity to think about what was important to them regarding end of life care. People ha

The inspection took place on 11 September 2015 and was unannounced. Hand in Hands is a supported living service for up to eight younger adults who live with learning disabilities. At the time of our inspection seven people were using the service.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that no DoLS authorities had been required or obtained because it had not been necessary to restrict anybody’s liberty in accordance with the MCA 2005.

People told us they felt safe and secure. Staff had received training in how to safeguard people against the risks of abuse and knew how to report concerns both internally and externally. Safe and effective recruitment practices were followed. Flexible arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been put in place to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe. People were supported to take their medicines by trained staff. Potential risks to people’s health and well-being were identified, reviewed and managed effectively.

People were positive about the skills, experience and abilities of the staff who supported them. Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People told us they were supported to maintain good health and they had access to health and social care professionals when necessary. They were provided with appropriate levels of support to help them plan a healthy balanced diet that met their individual needs.

Staff obtained people’s consent and permission before providing support which they did in a kind and compassionate way. Information about local advocacy services had been made available for people who wished to obtain independent advice or guidance.

Staff developed positive and caring relationships with the people they supported. People and their relatives were fully involved in the planning, delivery and reviews of the support provided. The confidentiality of information held about people’s medical and personal histories had been securely maintained.

Support was provided in a way that promoted people’s dignity and respected their privacy. People told us they received personalised support that met their needs and took account of their preferences. Staff had taken time to get to know the people they supported and were knowledgeable about their background histories, preferences, routines, goals and personal circumstances.

Opportunities were available for people to pursue social interests and take part in meaningful activities relevant to their needs, both at the service and in the wider community. People and their relatives told us that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded properly and investigated promptly.

People, their relatives, staff and professional stakeholders very were complimentary about the managers and how the service operated. Measures were in place to monitor the quality of services provided, reduce potential risks and drive improvement.