About the service: In Out and About Community Support Office is a domiciliary care service which provides personal care and support to one person in their own home for two days a week. They also support the person to access the community.

The provider met the characteristics of ‘Good’ in all areas. This has improved from a rating of ‘Requires Improvement’ at the last inspection in 2015. More information about this is in the full report. This service has not been inspected since 2015 because the provider ceased to provide the regulated activity of personal care between 2016 and 2018.

People’s experience of using this service:

• The person was protected from avoidable harm. The risks to their safety had been appropriately assessed and acted on. Environment and evacuation risk assessment were not in place at the time of the inspection. Immediate action was taken to address this. The person received support from a small and consistent team of staff. The person did not receive support from staff with their medicines. There were no infection control risks. The registered manager had the processes in place to investigate and act on any accidents and incidents. To date, there have been none.

• The person’s care and support was provided in line with their assessed needs and protected the person from discrimination. Most staff training was up to date, action was being taken to address the shortfalls. Staff felt supported to carry out their role. Staff supported the person to lead a healthy and balanced lifestyle. The person was 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 support this practice.

• Staff had built a meaningful, kind and caring relationship with the person. Staff treated the person with respect and dignity and listened to and acted on their views. The person’s privacy was respected. Effective processes were in place to store records safely and in line with data protection legislation.

• The person received person centred care and support that considered their choices and preferences. Staff supported the person to achieve their agreed goals. The person was supported to access the community. Efforts had been made to provide information in a format the person could understand. No complaints had been received, but there were appropriate policies and procedures in place to act if there was. End of life care was not provided.

• Improvements had been made to the overall governance of the service. An additional member of staff was in place to support the registered manager with maintaining high quality records. Records viewed were now comprehensively completed and reviewed. The views of the person were used to help improve and develop the service. Staff enjoyed working at the service and felt respected and valued. Quality assurance processes were in place to help inform the provider of the quality of the service provided.

Rating at last inspection:

At the last inspection the service was rated as Requires Improvement (Published May 2015).

Why we inspected:

This was a planned inspection.

Follow up:

We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern we may inspect sooner than scheduled.

The service provided day care to people who had autism and they recently registered with us to provide personal care so they could extend the services they provided to more people. There were no people who needed personal care support when we undertook our visit so we reviewed the documentation and systems in place to support prospective users of this service.

The provider may wish to consider de registering their service with us until such time they require to provide this regulated activity.

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We carried out an announced inspection on 21 and 22 May 2015. In Out and About Community Support Office provides day care and supported living services to people living with learning disabilities such autism.

On the day of our inspection 12 people were using the service, one of which was supported by staff to live in their own home.

There was 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.

At the previous inspections on 4 and 7 July 2014 we asked the provider to take action to make improvements to the areas of; consent to care, care and welfare of people who use services, safeguarding people who use services from abuse, supporting workers and assessing and monitoring the quality of service provision. We received an action plan in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection we found that some improvements had been made but further improvements were needed.

People were protected from the risk of abuse and staff had attended safeguarding of adults training. Staff could identify the types of abuse and knew who report concerns to.

Assessments of the risk to people’s care was in place, but one risk assessment had not been reviewed since 2011. Personal emergency evacuation plans were in place where needed. Investigations into accidents took place although the recommendations of the registered manager were not always reviewed. People were supported by an appropriate number of staff, with the right skills and experience to meet people’s needs. People’s medicines were handled and stored safely.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The registered manager was aware of the principles of DoLS however they had not ensured the appropriate application had been made for a person whose liberty may be restricted.

Some people had decisions made in their best interest and in line with legal requirements however others does did not. People were supported by staff who received regular assessment of their work. Guidance was in place for staff to follow to ensure they were aware of how to support people effectively and to reduce the risk to people’s health and welfare. People were supported to make healthy food and drink choices and to maintain a healthy diet. People were also able to visit external healthcare professionals when they needed to.

People were supported by staff in a caring and respectful way that maintained their dignity and privacy. People had access to independent advocates if they needed them. Staff understood how to communicate with people.

People’s records and the support they received were person centred although some documents relating to people’s choices were not always completed. People could access the hobbies and interests that were important to them. People were encouraged to be as independent as they could be. People’s support plan records were reviewed by the registered manager however they did not ensure that recommendations made by them had been completed by staff. There was a complaints procedure provided for people, although this was not always produced in a format that people with a learning disability would be able to understand to understand.

The registered manager had limited auditing processes in place to assess the quality of the service people received and the risks they faced when supported by staff. Feedback was requested from people, relatives and staff on how the service could be improved but had not yet used that information to form plans to improve the service. A whistleblowing policy was in place and the registered manager had some knowledge of what needed to be reported to the CQC although further learning was needed.

People were encouraged to access to the local community. The aims, values and mission of the service were understood by staff. Regular staff meetings were carried out to ensure staff were informed of the risks to the service and how they could contribute to reducing these risks. Staff understood what was expected of them in their role.

You can see what action we told the provider to take at the back of this report.