The inspection took place on 8 January 2019. We told the provider two working days before our visit that we would be coming because the location was registered as a supported living service providing care for people in their own homes and we wanted to make sure the registered manager would be available.

The last inspection of the service was on 19 December 2017, when we rated the service requires improvement for all key questions and overall. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least ‘good’.

At this inspection of 8 January 2019, we found they had made the necessary improvements.

Heston Care Services provides care and support to people living in a 'supported living' setting, so that they can live in their own home 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 the time of our inspection there were two people living in the supported living service and both were receiving personal care. Both service users had a learning disability and mental health needs.

The service was the only location managed by the provider, who was an individual.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

People using the service were happy there. Their needs were met, and they were supported to learn new skills and make choices about their lives. There was evidence that one person's mental health had significantly improved as a result of the care and support they were receiving at the service. People were treated respectfully by kind and caring staff, some of whom were specifically recruited because they shared the same ethnic background as people using the service and could speak with them in their first language. Whilst people took part in a range of different activities, the provider was seeking to establish more structured routines and regular activities to help people develop further skills.

The staff were appropriately trained and supervised. They had the necessary skills to care for people and meet their needs. The registered manager worked closely with the staff team to offer support, guidance and training. There were enough staff to meet people's needs and keep them safe. The provider's recruitment procedures ensured that the staff were suitable.

People had consented to their care and treatment. For more complex decisions where they lacked the mental capacity to understand these, the provider had acted in accordance with the appropriate legislation to ensure that decisions were made in their best interests.

People had enough to eat and drink and made choices about the food. People were supported to access healthcare services and the staff worked closely with the other professionals caring for people. The risks to their wellbeing had been assessed and planned for and they received their medicines safely.

The provider had effective systems for monitoring the quality of the service and making improvements. Accidents, incidents and complaints were investigated, and the provider learnt from these to improve the service. People using the service and other stakeholders were asked for their views about the service.

We undertook an announced inspection of Heston Care Services on 19 December 2017. We told the provider two days before our visit that we would be coming because the location provides a supported living service for people in their own homes and staff might be out visiting people.

This service provides care and support to people living in one ‘supported living’ setting, so that they can live in their own home 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 the time of the inspection the service was providing support through the supported living service for two people but only one person received care that comes under the Regulated Activity of Personal Care. Therefore we are only able to refer to the care provided and records of that one person.

This was the first inspection since the provider registered the location with the Care Quality Commission (CQC) in September 2016.

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 provider had a recruitment process in place but appropriate references were not always requested from the most recent employer and a record of references obtained by telephone were not recorded to provide an audit trail that appropriate recruitment processes had been followed. This meant the provider could not ensure new care workers were suitable and had the appropriate skills and knowledge for the role.

Risk management plans were not in place to provide care workers with guidance on how to reduce risks when providing support and to promote people’s safety.

The provider had a procedure for the administration of medicines but records did not clearly identify who had administered medicines which increased the risk of medicines not being administered as prescribed.

The provider did not have processes in place to ensure care was provided within the principles of the Mental Capacity Act 2005 and to help protect people’s rights.

Care worker had regular support with the registered manager but the training provided was not structured.

Information was not provided for people using the service in an accessible format such as using clear, plain English or pictures to meet their communication needs.

The provider stated they completed a ranged of audits but the outcomes were not recorded. It was therefore not clear what the findings of the audits were and what areas had been identified for improvement.

Regular meetings were held with external professionals involved in providing support but notes were not made of the discussions to provide an audit trail and to maintain a record of the decisions made.

We found breaches of regulations in relation to need for consent, safe care and treatment, good governance, staffing and fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of the report.

The provider had procedures to record and investigate incidents and accidents, safeguarding concerns and complaints so learning took place and to prevent reoccurrence of similar issues.

The number of care workers required to provide appropriate support was identified through the local authority referral so people were cared according to their support plan.

An assessment of the person’s support needs had been completed before they started to receive support.

Care workers understood how to maintain a person’s privacy and dignity when providing support.

Support plans identified the person’s religious and cultural supports needs to assist the care workers in providing appropriate care to me