This was an announced inspection carried out on16 August 2018. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

Our last inspection at Learning Disability Domiciliary Care Agency took place in June 2017. At that inspection, we found two breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in Regulation 12; Safe care and treatment and Regulation 17; Good governance. Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key question safe and well led to at least good.

At this inspection, we checked improvements the registered provider had made. We found sufficient improvements had been made to meet the requirement of these regulations.

This service is a domiciliary care agency. It provides personal care to people with a learning disability living in their own houses and flats in the community.

Not everyone using Learning Disabilities Domiciliary Care Agency receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

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.

Safeguarding procedures were robust and staff understood how to safeguard people they supported. People had individual risk assessments in place so that staff could identify and manage any risks appropriately. The service had appropriate arrangements in place to manage medicines so people were protected from the risks associated with medicines.

Recruitment Procedures were in place but there were some inconsistencies in staff files. The registered manager took immediate action to address this concern.

We have made a recommendation that the registered provider review their recruitment policy.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations.

People were 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 supported this practice.

We saw that people’s care plans contained information about the type of decisions people were able to make and how best to support people to make these decisions.

People were supported with their health and dietary needs, where this was part of their plan of care. Staff were aware of the people who needed a specialised diet.

Staff we spoke with told us they felt supported. Staff underwent an induction and shadowing period prior to commencing work, and had regular updates to their training to ensure they had the skills and knowledge to carry out their roles. Although some staff told us they would like further training in positive behaviour support.

We have made a recommendation about staff training on the subject of positive behaviour support.

People were treated with dignity and respect, and their privacy was protected. During the inspection we observed staff giving care and assistance to people. They w

This inspection took place on the 9 and 12 June 2017 and was announced. The registered provider was given short notice of the visit to the office. This was because we needed to be sure key staff would be available at the office to assist with the process.

The service had re-registered with the Commission in 2016 as the registered provider changed the location from where they operated. This was the first inspection of the service under the new registration.

On the day of the inspection there was a registered manager who managed the day-to-day operations of the service. 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 time of this inspection the service supported 34 people with various care needs, from social support to maintaining people's independence with full personal care needs. People we spoke with told us they were happy with the care and support they received.

People supported by the service spoke very positively about Sheffield Learning Disability Support Unit

There were inadequate arrangements in place to manage medicines to ensure people were protected from the risks associated with medicines.

The service did not have a robust quality assurance system in place to identify the issues we found during our inspection and to make the necessary improvements.

Despite these shortfalls, all staff members we spoke with knew how to keep people safe and were able to recognise the different types of abuse and how to respond to any concerns.

Robust recruitment processes and systems were in place to ensure staff members were safe to work with vulnerable people. Checks had been carried out with the Disclosure and Barring Service (DBS). The DBS identifies people who are barred from working with children and vulnerable adults and informs the service provider of any criminal convictions noted against the applicant.

Staffing levels were sufficient to meet people's needs. Staff had been received some training and support to provide them with the skills and knowledge to undertake their role. This included a better understanding about how they worked within the legal requirements of the Mental Capacity Act (2005).

Staff knew people well and people told us the staff were caring. People’s privacy and dignity were respected and promoted.

A programme of activities were in place, therefore people were supported with a range of leisure opportunities.

People said they could speak with staff if they had any worries or concerns and that they would be listened to.

We recommend the service considers current best practice guidance on meeting the end of life wishes of people who use the service.

Staff members told us and records we looked at confirmed that staff received regular supervisions and appraisals.

People who used the service had access to healthcare support as and when they required it. We saw hospital passports were in place which used the traffic light system; red to represent important information about the person, amber to represent things that were important and green to represent likes and dislikes.

Care plans were person centred and contained detailed information about the person

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.