About the service: Hendre Care provides care and support to people living in four ‘supported living’ settings, 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. Nine people lived in the service when we inspected.

People’s experience of using this service: The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice, control, independence and inclusion. For example, people's support focused on them having as many opportunities as possible to gain new skills and increase or maintain their independence.

People and staff told us they felt safe at the service. People received support to take their medicines safely. Risks to people's well-being were recorded and updated when their circumstances changed. Staffing was provided at safe levels that enabled people to go out and access the community when they chose to with support.

People's rights to make their own decisions were respected. People were supported to access healthcare services if needed. Staff had appropriate skills and knowledge to deliver care and support in a person-centred way. The training lead was keen to pursue any learning opportunities and ensured training was well monitored.

The emphasis of support was towards enabling people. Staff encouraged positive risk taking so people could experience new things and develop. This had led to people feeling fulfilled and living an active life. People were complimentary about their staff and the positive relationships they had with them.

The values of the organisation of offering choice, inclusion and respect were embedded. This supported people to receive a positive service. Staff were aware of their roles and responsibilities. Work to continuously improve was noted and the management team were keen to make changes that would impact positively on people’s lives.

Rating at last inspection: Good (report published September 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

This inspection took place on the 30 July 2016 and was announced. We gave the provider 48 hours’ notice that we would be visiting. This was because the provider offers a supported service to people living in their own homes and we wanted to make sure that people and staff would be available to speak with us.

Hendre Care provides personal care to people with learning disabilities in supported living accommodation. Currently they are providing care and support to eight people living in three separate supported housing units.

There was a registered manager in post at the time of 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.

At their previous inspection in June 2014 they were seen to be meeting all of the standards in the old inspection ratings.

Although staff had an awareness of the Mental Capacity Act and Deprivation of Liberty Safeguarding (DoLS), there were still some people using the service who were being restricted and for whom the provider had not made the relevant DoLS applications.

People were kept safe. Relatives believed their family members were kept safe. Staff had received training and understood the different types of abuse and knew what action they would take if they thought a person was at risk of harm. Staff were provided with sufficient guidance on how to support people’s medical support needs. People were kept safe by staff that were able to recognise the signs of abuse and raise concerns if needed.

People were supported to have their medical needs met.

People were supported by staff that had been safely recruited.

People were supported with their medication by staff that had received appropriate training.

Relatives felt that their family members were being supported by staff with the appropriate skills and knowledge to care and support them.

Staff were trained and supported so that they had the knowledge and skills to enable them to care for people in a way that met their individual needs and preferences.

People were supported to make choices and were involved in the care and support they received.

Staff were caring and treated people with dignity and respect. People’s choices and independence was respected and promoted and staff responded to people’s support needs.

People and relatives felt they could speak with the provider about their worries or concerns and felt they would be listened to and have their concerns addressed.

The provider had quality assurance and audit systems in place to monitor the care and support people received to ensure the service remained consistent and effective.

We carried out an inspection of Hendre Care. We looked at records at the provider’s office location and also visited people that lived at one of the three twenty-four hour supported living homes. This was with the permission of the people that lived there.

We looked at information to help us gather evidence about the quality of the provider’s care and support to people that lived there. On the day of our inspection, the provider told us that eight people received care and support.

We spoke with the manager and with staff on duty. We also spoke with two people that used the service and spoke with four relatives. Our conversations with people helped us to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? and, Is the service well led?

Below is a summary of what we found. The summary is based on our findings during the inspection, speaking with people and their relatives about the service, staff members supporting people and from looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We asked two people that used the service if they felt safe with staff supporting them. They smiled at us and nodded. All of the relatives spoken with told us that they felt that their family member was safe receiving a service from the provider. One relative told us, “I am one hundred per cent happy.”

There was a system in place to record accidents and incidents. Staff spoken with showed that they were aware of the reporting system. We saw that 14 accidents and incidents were recorded for January to March 2014. We saw that the provider had taken appropriate action to reduce the risk of them re-occurring.

There was a system in place to handle concerns and complaints. The provider told us that one complaint had been received since our last inspection in December 2013.

The registered manager told us that no new staff had commenced employment with them since our last inspection. We sampled some staff files and found that they all contained the required pre-employment checks. This meant that the provider ensured that people employed were suitable to work with vulnerable adults.

As part of our inspection we asked the provider about how they implemented the Mental Capacity Act 2005. They told us that they made the appropriate referrals for people when needed. We saw documented evidence that mental capacity assessments had been completed and ‘best interest’ meetings had taken place for people when needed. This meant that the provider was aware of their responsibilities under the Mental Capacity Act.

Is the service effective?

We saw that the provider's Statement of Purpose had been reviewed and updated in January 2014.

We saw that people were supported to take part in individual activities that were planned for. We observed people taking part in meaningful activities when we visited two people in their home.

Is the service caring?

One person we spoke with told us that they thought staff were, “Kind.” One relative told us, “Staff are excellent.” Another relative told us, “I am happy with my family member’s care and feel that staff are professional.”

People that used the service and their relatives were asked for feedback about the quality of the service provided so that improvements could be made where needed.

Is the service responsive?

Most relatives spoken with told us they had no concerns or complaints. One relative told us, “I find the manager approachable. If I had any concerns I would speak with them.”

Care records showed that that the provider responded to people's changed needs and worked with other healthcare professionals as needed.

Is the service well led?

We saw documented evidence that showed that the provider worked with other

health care professionals and made referrals for advice and guidance when needed.

The service had a quality assurance system. Records looked at such as spot checks on staff showed that audits took place and were effective.

When we visited, the service was providing personal care to 9 people who were not able to give us their views because of their complex needs and conditions. We used a number of methods to understand the experiences of the people who used the service including speaking with their relatives, a person who commissions the service, looking at care records and speaking with staff.

People told us that the workers caring for their relatives had a good manner, respected people's dignity and spoke to them as adults. A relative told us, “They know how to talk to them. They know [person’s name] as well as I do.”

Care was planned and designed to meet the individual health and welfare needs of the people who used the service. A person we spoke to expressed confidence that their relative’s care was planned, managed and delivered with dignity in the way that was promised.

We saw that the provider had made suitable arrangements to ensure that people who used the service were safeguarded against the risk of abuse.

We found that there were enough skilled, qualified and competent staff to provide people with the care they required to meet their individual needs.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received so they could identify, assess and manage risks to their health, safety and welfare.

The service provided care and supported living to eight people who lived in three households at the time of our inspection.

We found that people’s needs were assessed and care was planned and delivered in line with their individual care plan. Risks associated with people's needs, conditions and preferred lifestyle were assessed and care plans were in place to manage these risks to balance safety with independence and rights. Most relatives of people who used the service that we spoke with were very positive about it.

We found that the provider had staff recruitment procedures in place but these were not always properly followed to ensure people's safety.

There were sufficient numbers of staff on duty to meet people's needs and staffing rosters for households reflected the daily contractual requirements for each person, including overnight.

People’s personal records were fit for purpose, kept in good order and provided up to date information for staff to support and provide care for the person. Staff records and other records relevant to the management of the service were kept and all records were available for us to see when we asked for them.

When we last inspected the service in March 2013 we found that the provider did not have a system for analysing information about the quality of the service. Although we found some significant improvement on our visit of 28 November 2013 there were still shortfalls in quality monitoring that could put people at risk.