Housing and Support Solutions is a domiciliary care agency registered to provide personal care for people who may have learning disabilities or autistic spectrum disorder, physical disability or mental health needs and who are supported to live independently. The service provided the regulated activity of personal care for 16 people in North East Lincolnshire at the time of the inspection.

We undertook this comprehensive inspection on the 5, 6 and 11 January 2017. At the last inspection on 9 and 10 November 2015 we found the registered provider was in breach of one of the regulations we assessed. We issued a requirement notice as assessments of people’s mental capacity and records of best interest decisions were not in place to demonstrate staff were acting lawfully in relation to aspects of people’s care and treatment.

During this comprehensive inspection we found improvements had been made in two domains and have changed the rating for the domains ‘Effective’ and ‘Well-led’ to Good. We have kept the rating for 'Safe',‘Caring’ and ‘Responsive’ as Good. The overall rating for the service has improved and changed to ‘Good’.

The service had 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 2008 and associated Regulations about how the service is run.

We found the registered manager and staff better understood their responsibilities under the Mental Capacity Act 2005. They were aware of the need to gain consent when delivering care and support, and what to do if people lacked capacity to agree to it. People’s abilities to make decisions had been assessed and appropriate support had been provided to ensure that their views were taken into account when making decisions. Relatives and other professionals had been involved when important decisions about care had to be made.

People received their medicines as prescribed. However, documentation relating to ‘as and when required’ medicines needed to be more robust.

We found people who used the service were protected from the risk of harm and abuse because staff had received safeguarding training and they knew what to do should they have any concerns. Staff were recruited safely.

Positive and caring relationships had been developed between staff and people who used the service. We saw people were treated with respect and their dignity was maintained. Staff were overheard speaking with people in a kind, attentive and caring way.

Staff supported people to be involved in their care and to make choices about how they spent their time. Wherever possible staff encouraged people’s independence and supported them to access the local community. Care plans contained information on the care people needed and the risks they faced. Staff were aware of people’s health care needs and the support they provided helped to maintain them. Staff liaised with health and social care professionals for advice and guidance when required.

People told us they liked the meals provided and were offered support to prepare their own meals when they wished to do this.

People who used the service had a wide range of support needs. Some people required support from the service 24 hours a day and other people were more independent and received support for just a few hours a day to help with their daily routines. Overall there were enough staff to meet people’s needs and new staff had recently been recruited to maintain appropriate numbers of staff. Staff training and the on-going support staff received from the management team meant that the care provided was calmly delivered, safe and effective.

There was a quality monitoring system that ensured people’s views were listened to, any complaints were addressed, audits were completed and checks carried out on st

The provider held a twice yearly forum to consult with people who used the service. People we spoke with were aware of the forum but had not attended so far. People told us they were respected and their dignity was upheld. A person who had progressed to living in his own flat told us, “They built my confidence. I have come a long way.”

People and their relatives spoke positively about the care they received. One person said, “I read my personal plan and my health action plan and I am happy with explanations. Everything is straightforward and I have no problems.” A relative told us, “They are great with him. There’s no problem ever with getting anybody if we need help. They always seem to be patient with him. It’s not just the care, but they will look after how he feels. Whenever he is upset the support workers are absolutely excellent with him. He has confidence in them.”

People we spoke with said they felt safe with the service. One person said, “I feel 100% safe with all the staff.” A relative told us, “We feel he is totally safe. They are aware of problems he has had. They go with him to appointments so that no one takes advantage of him.”

People spoke positively about the staff that worked with them. One person told us, “Support workers are very good. The staff that work with me are very understanding. They explain things to you.”

Annual surveys of people who used the service were issued in easy read format.

Housing and Support Solutions is a domiciliary care agency registered to provide personal care in North East Lincolnshire for people who may have learning disabilities or autistic spectrum disorder, physical disability or mental health needs and who are supported to live independently.

The service is required to have a registered manager. 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 registered manager had left the service in June 2015. A new manager had been appointed and was in the process of collating information for their application to be the registered manager.

The last full inspection took place on 13 January 2014 and the registered provider was compliant in all areas assessed.

In recent months there had been organisational restructuring at senior management level and at location level. We found improvements were being made to the management of the service and new quality monitoring systems were being implemented. Staff felt comfortable about sharing their views and talking to the manager if they had any concerns or ideas to improve the service provided. Staff demonstrated a good understanding of their role. People felt able to raise complaints or concerns and were confident these would be dealt with.

Staff supported people to make choices where possible about the care they received. However, when people were unable to make their own decisions we found staff had not followed the correct procedures to complete mental capacity assessments and involve relatives and other professionals when important decisions about care had to be made. These issues meant the registered provider was not meeting the requirements of the law regarding consent. You can see what action we told the registered provider to take at the back of the full version of the report.

We found people who used the service were protected from the risk of harm and abuse because staff had received safeguarding training and they knew what to do should they have any concerns. Risk assessments were completed for areas that impacted on people’s lives and posed a risk for them.

We found staff were recruited safely and in sufficient numbers to meet the needs of people who used the service. Changes had been made to the staff rotas and further were planned, to deploy staff effectively and provide a more person centred service.

There were gaps in the staff training programme which the manager followed up with the registered provider’s training team during and following the inspection. We found staff received guidance, support, supervision and appraisal. This helped them to be confident when supporting people who used the service.

People who used the service received person-centred care based on their wishes and preferences. The care plans were being reviewed, updated and re-written in consultation with people who used the service and their relatives. Staff were aware of people’s health care needs and the support they provided helped to maintain them. Staff liaised with health professionals for advice and guidance when required.

We observed positive interactions between staff and people who used the service. We saw people were treated with respect and their dignity was maintained. Staff were overheard speaking with people in a kind, attentive and caring way.

People who used the service had access to a range of activities within the local community, this included day services, vocational and educational courses.

We found staff supported people to take medicines as prescribed. Staff had received training in medicines management. Staff supported people to maintain their nutritional needs. They assisted people to make choices about their meals in line with their care plans.