This inspection was carried out between 10 June and 13 June 2016. The inspection was announced, and we gave the provider 48 hours’ notice to ensure there was a manager available to assist with the inspection process.

Hadley care provides personal care for adults in their own homes and for people in supported living. This includes people living with physical disabilities and people with learning disabilities.

At the last inspection carried out in June 2013, there was one breach of Regulations. This had been successfully addressed at this inspection.

Hadley care is required to have a registered manager in post and the time of the inspection visits there was not one in post. However an application had been made by the manager to register with CQC. 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 and secure using the service. There were systems and procedures in place which were followed to ensure appropriate pre-employment checks were made on staff prior to them working with the people who used the service. Staff understood how to protect people from potential harm and how to report any concerns.

New staff completed a period of shadowing and induction training prior to them supporting people with their care needs. The provider ensured staff received training relevant to their roles and responsibilities.

Staff treated people with dignity and respect. People felt the staff understood their individual needs. The management team ensured people were involved in their own care and decision making. Staff understood the key principles of the Mental Capacity Act (MCA) 2005.

Care plans contained information to assist staff in providing personalised care. People were given information on what to do if they had any concerns or complaints. Staff felt confident if they had any concerns or complaints the registered manager and management team would take action and endeavour to resolve them.

People had their individual care plans reviewed to ensure they received the care and service they required. People were listened to and felt their individual needs were understood by the staff. Staff reported any changes to people’s health conditions to ensure continuity of care.

The registered manager and the management team strived to provide people with the support of staff at the time when they wanted it. This could change daily as some people had commitments such as a day centre or visiting families.

People’s independence was promoted and encouraged by staff who understood their individual needs. Staff were aware of people’s needs and wishes and supported them in a personalised manner. When needed, staff assisted and supported people with their nutritional needs and meal preparation.

The provider had processes in place to monitor the quality of the service people received. There were clear arrangements for the day to day running of the service. The service was managed by a team who understood their roles and responsibilities in providing a good service to people.

People were happy with the care and support they received at Handley Care Services. A relative of someone receiving care told us, "I have never seen her so happy. She is busy all the time and the staff are superb."

We saw that improvements were being made to the way that care was planned at Handley Care Services and that new care plans were detailed and personalised. Risks were assessed and managed and people’s health needs were being included in their care plans.

We looked at medication systems and saw that arrangements were appropriate for medicines to be administered and recorded safely.

We found that staff were trained, or training was planned to provide appropriate support for people, and that this included specialist training to meet people’s particular needs.

The manager was monitoring the quality of the service and identifying and managing risks. They told us that they were creating a new system to collate information about the quality of the service.

We examined care files and found that consent was not being obtained for people’s care. Because of their learning disability, some people were unable to make decisions about their care. The provider was not making appropriate arrangements to obtain their consent and ensure that decisions made on people's behalf were in their best interests.

We spoke to people and their relatives and found that they were generally happy with the care provided.

We found that people’s privacy and dignity was respected and that people and their relatives were involved in making decisions about their care. We also found that people were provided with opportunities to be independent and to be involved in their community.

We saw that staff had received appropriate training about how to protect people from abuse and were able to describe how this was done. We also saw that staff were recruited using appropriate procedures. We also found that staff received appropriate training and support to provide people’s care.

We saw that although some assessments and care plans were in place that these were not fully accurate and had not been updated to include changes in people’s care needs. We also found that risks that could affect people were not always assessed as part of the planning of their care and also that it was unclear whether people were always receiving their prescribed medication. Because of this we found that the provider was not fully protecting people from the risk of receiving unsafe or inappropriate care.

When we visited the agency and the group of people they support at home, because of the degree of learning disability exhibited by most of the people living there, we only spoke to two of them indirectly about the service they receive. They told us ‘I like living with in this house, staff are good to us’ and ‘this is my room and these are all my things; I look after everything myself’’.

We observed the group of people within their home and saw how they interacted with staff. Where verbal skills were limited, staff communicated in very individual ways. Our discussions with staff indicated a commitment to individual working and they told us about ‘having their best interests in mind’.

Staff told us that the documentation in care records was used routinely in helping them support people safely and we discussed the particular problems about supporting one of the group whose medical condition presented severe challenges to this. This was one of two concerns that were raised with us before we visited; these were discussed during the visit and are reported in full below.