The inspection was unannounced and took place on 13 September 2018.

Hebe Healthcare provides personal care for people, living in a converted property where there are individual flats with shared facilities, such as a kitchen, dining area and lounge area. Staff provide personal care and support to people. There were seven people receiving personal care when we inspected. At the last inspection on 03 December 2015, the service was rated as Good. At this inspection we found the service remained Good.

A registered manager was in place. A 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 said they felt safe living at the scheme with support from staff. Staff understood how to protect people from abuse and received regular training around how to keep people safe.

People told us they received their medicines as prescribed and there were enough staff to support them. Staff said on-going training was in place to ensure they had the skills to meet the needs of the people they supported. People had positive relationships with staff, who knew their individual needs.

People told us that they liked the staff who supported them and were positive about the care that they received. They felt they were listened to and staff understood they could only care for and support people who consented to their care.

People were encouraged to be as independent as possible. They were supported to access healthcare appointments and to maintain a healthy diet which reflected their choices and preferences.

People said staff treated them with dignity and respect. Staff spoke warmly of the people they cared for and said they enjoyed their role and felt supported by management team to provide a good service.

Staff respected people's individuality and diversity and care files contained information about people's personal histories and people’s preferences, so staff could consider people's individual needs when delivering their care.

People told us staff were quick to respond when they were unwell and supported them to access other healthcare professionals when required.

People told us staff and the management team were approachable and if they had any concerns they would be listened to and dealt with appropriately.

People told us they enjoyed living in the scheme and spoke positively about the new management team and the improvements made. The provider ensured regular checks were completed to monitor the quality of the care that people received. Areas identified for improvement were acted on.

We inspected this home on 9 September 2015. This was an unannounced Inspection. The service was registered to provide care and support to people who live in supported living accommodation who may have a learning disability or mental health support needs. At the time of our inspection ten people were living in supported living accommodation.

The service was previously inspected in May 2014 and at that time we found the service was not compliant with four of the regulations we looked at. At that time the provider did not have suitable arrangements in place for managing care and support needs of some people who used the service which impacted on others who used the service. Arrangements for assessing and monitoring the quality of service provision were not effective and concerns were also identified in respect of arrangements to ensure there were appropriate staffing levels at all times and arrangements that ensured that people were protected by the maintenance of appropriate records for care and treatment of people. The provider took action and at this inspection we found improvements had been made.

The registered manager was present during our inspection. 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 we spoke with told us that they felt safe and relatives we spoke with confirmed this. We found that staff knew how to recognise when people might be at risk of harm and were aware of the provider’s procedures for reporting any concerns.

There were sufficient numbers of staff available to meet people’s individual needs on our visit. People, their relatives and staff confirmed this was the case.

People were supported by staff who had received training and had been supported to obtain qualifications to enable them to ensure that care provided was safe and followed best practice guidelines. Recruitment checks were in place to ensure new staff were suitable to work with people who needed support.

People received their medicines as prescribed. Action was taken to reduce the risk of potential errors where medicines were not needed routinely or not in a monitored dosage system.

People’s needs had been assessed and care plans developed to inform staff how to support people in the way they preferred. Measures had been put into place to ensure risks were managed appropriately. These ensured that people were involved in making decisions which minimised restrictions on their freedom, choice and independence.

People’s nutritional and dietary needs had been assessed and people were supported to eat and drink sufficient amounts to maintain good health. People were supported to stay healthy and were supported to have access to a wide range of health care professionals.

The service was meeting the requirements in respect of people’s right in line of the Mental Capacity Act 2005 Code of Practice with staff being aware of their responsibilities under Deprivation of Liberty Safeguards.

People told us, that they were happy with their home and their independence. We saw staff treated people with respect and communicating well with people. People told us they continued to pursue individual interests and hobbies that they enjoyed in life and they were happy with the range of activities available to them.

There was a complaints procedure in place. People told us they had opportunity to raise concerns and that they were listened to. Relatives told us they knew how to raise any complaints and were confident that they would be addressed.

We found that whilst there were systems in place to monitor and improve the quality of the service provided, these were not always effective in ensuring the home was consistently well led. We found that improvements were needed.

We spoke with three out of the four people that were receiving a service from Hebe Healthcare on the day of the inspection. They told us that they were happy living in the supported living scheme and with the support they received. Comments made included: “There’s nothing bad here,” “I feel safe here,” “I am happy with the staff.”

People said that felt supported when they became upset. We spoke with two support staff and the manager who told us how people should be supported. They were clear about any boundaries that needed to be maintained and this helped people receive consistent care. Records made about support people needed were clear and confirmed what we had been told.

People were assisted to maintain their independence, they were given choices about their lives where appropriate and supported to maintain existing relationships. People were supported to participate in a structured plan that gave them flexibility to make choices and retain their individuality.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were asked for their views about the service and action was taken on any issues they raised.

We inspected this service so we could consider our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? One inspector carried out this inspection.

There were eight people using the service at the time of our inspection. Below is a summary of what we found. The summary is based on speaking with three people who used the service and, a relative and three members of staff supporting them. We also spoke with the manager of the service and two health / social care professionals.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People and a relative confirmed that they believed that the service was safe. Their comments included: "I love it and the carers (staff) are nice," and "The staff are nice, I work in the office with X (name of staff member). Yes I am safe."

However, we had concerns about the safety of one person who used the supported living service. The initial assessment for one person had outlined potential safety issues which has not been adequately risk assessed and shared with the funding authority to alert them to risks with the level of staff support that had been agreed. The provider ensured that this risk was addressed at the time of our visit and we contacted the local safeguarding authority.

There were appropriate arrangements in place to ensure that medication was administered safely and that the spread of any infections could be controlled.

New staff were recruited appropriately and checks on applicants' previous employment and their safety to work with vulnerable people were undertaken.

We found that records were not always kept of the outcome of people's visits with health professionals, details of who provided the support and when were not kept and incidents were not consistently recorded. This meant the service did not have records to manage the service.

CQC monitors the operation of Deprivation of Liberty Safeguards. There had been no applications to deprive any people of their liberty at the time of our inspection.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to planning and delivery of safe care and staffing.

Is the service effective?

People's healthcare and support needs had been assessed before people received the service and care plans were usually in place. Reviews were undertaken on a routine basis however, these did not always take into incidents that had occurred between reviews. This meant that reviews of people's care were not always effective.

People, relatives and health / social care professionals told us that people received the support they needed. Their comments included: "They helped me get a bus pass, sort out my pension and get stronger tablets from my doctor," and "They communicate well with us and people get good support from the staff."

There were effective arrangements in place to ensure that staff had equipment to help prevent the spread of infection. Staff and people we spoke with confirmed that this equipment was available and used. Staff were aware of the policies and procedures about infection control.

Care staff told us and records showed they had staff meetings to discuss practice issues and any concerns about the care of people who used the service.

Is the service caring?

We observed interactions between the manager, staff and people who used the service and saw good interactions between them. Staff were observed to patient and kind with people and able to redirect people when necessary. People confirmed that staff were kind their comments included: "I love it (here)," "My relative has made friends and is happy to stay" and " Yes the staff are good."

We noted in care plans that there were details of what was important to people in their daily lives such as certain activities, having their hair dyed, contact with relatives and specific type of food or food preferences. People were encouraged to maintain these choices of lifestyle.

Is the service responsive?

A relative told us that they could contact the service when needed either day or night and they would get a response. If they had concerns they told us that they could contact the manager and they would put it right. We saw that there were tenants meetings and some surveys that were completed with people. These concentrated mainly on activities. People were attending activities if they wished to.

Is the service well-led?

The service was led by a manager who had the qualifications, skills and experience to provide a good, well led service.

There were no records of any complaints made to the home. We saw copies of compliments made by two relatives and a social care professional about the support to four people who used the service. Systems were in place to monitor people's views of the service.

We found that the risks to people had been identified but the system to review the quality of the service was not effective and had not led to action being taken when identified risks had not been acted on. The system for audit and monitoring of the service had failed to identify that the records were not consistently completed and maintained.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation management of risks to people.