The inspection of Harmony Supported Living Limited took place on 12 July 2018.

Harmony Supported Living Limited provides support to adults with learning disabilities and enduring mental health needs, living in their own 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. At the time of our inspection 11 people were receiving support from the registered provider, three of which were receiving personal care.

We previously inspected the service on 8 August 2017. The service was rated as ‘requires improvement’ in three of the five key questions and overall, and as ‘good’ in the key questions of caring and responsive. There were no breaches of regulation identified on the previous inspection. On this visit, we checked to see if improvements had been made.

At the time of our inspection the service did not have a registered manager. The last registered manager had left in March 2018. 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 service was currently being managed by the nominated individual who had also applied to become the registered manager.

Although people told us they felt safe, we found aspects of the service that were not safe.

Staff recruitment was not robust, a declaration on a job application form had not been followed up at interview and two staff recruitment files did not contain a reference from the previous/last employer and one recruitment file only had one reference.

People were not protected against the risks associated with the administration of medicines as this was not always carried out in a safe way. ‘As required’ PRN medicine protocols were not in place. Some staff had not received annual medicine competency assessments.

Accidents and incidents were recorded correctly and the operations manager had oversight of them.

Sufficient staff were deployed to meet people’s needs. Staff received induction training. Staff new to caring were required to complete the Care Certificate.

Staff had not received regular support, training, supervision or appraisal assessments of their performance.

Records showed people had seen a range of healthcare professionals, such as GPs, community mental health teams and podiatrists, to meet their wider health needs.

The service was compliant with the Mental Capacity Act 2005.

People were supported to remain independent and maintain relationships with people that matter. People told us they had access to a range of activities.

People’s support plans were not regularly updated. However, changes to support requirements were discussed at staff meetings.

People and their relatives felt confident how to complain if they needed to. No complaints had been made by people or relatives since the last inspection in August 2017.

Regular audits were not in place to monitor the safety and quality or the service.

People and their relatives had not had opportunities to provide feedback about the service.

Staff attended regular team meetings.

This is the second time the service has been rated requires improvement. We have also identified breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The inspection of Harmony Supported Living Limited took place on 8 August 2017. This was their first inspection since their registration with the Care Quality Commission on 8 February 2016.

Harmony Supported Living Limited provides support to adults with learning disabilities and enduring mental health needs, living in their own homes. On the day of our inspection 11 people were receiving support from Harmony Supported Living Limited.

The service had 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.

People felt safe and staff were aware of their responsibilities in keep people safe from harm. Care plans contained person centred risk assessments and the registered manager told the service supported a culture of positive risk taking.

We reviewed three staff files and found robust pre-employment checks had not been completed on one staff member prior to them commencing employment.

Staff supported people to manager their medicines, staff had completed relevant training and an assessment of their competency had been completed to ensure they had the relevant knowledge and skills. We have made a recommendation regarding the safe management of some medicines.

There was a system in place to support new staff learn about their role. Staff completed training and received supervision. The records of supervision detailed the discussions that had been held between staff and the registered manager, although there was no evidence of supervision or recent training for one member of staff who had been recently employed.

People 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.

Support with meals was tailored to meet individual people’s needs. Staff supported people to access health care services as required.

People were supported by kind, caring staff who knew them well. Staff encouraged people to learn life skills such as managing their medicines and learning to cook. People’s records were stored confidentially to reduce the risk of unauthorised access. People were respected by staff and treated people with dignity and respect.

Staff supported people to access their local community and participate in activities they enjoyed. Each person had a care plan which provided details about their individual support needs, this included their physical and mental health needs. Records were reviewed and updated at regular intervals.

The registered manager and the senior support worker completed regular audits of the service. Where shortfalls were identified action was taken to improve and this was shared with the staff team. Staff meetings were held when information was shared and discussed. Feedback was also gained from people who used the service. The registered provider met with the registered manager and senior support worker to review the quality of the service people received although at the time of the inspection the registered manager did not receive formal feedback from these meetings. There were a range of policies in place but these were not always personalised to the service and implementation and review dates were not recorded.

We have made a recommendation about the submission of statutory notifications.