Learning Together Limited is based in Stonehouse and provides personal care to people living in their own homes in Gloucestershire. Learning Together is a small service that supports people to live in their own home. They specialise in providing care for people living with autism who might require intensive support to manage their anxiety and associated behaviours. They provide 24 hour care and support to two people with a core group of staff and various support times to five other people. Many of the staff had supported the people since the service began in 2012.

At the last inspection on 7 August 2014, the service was rated Good. At this inspection we found the service remained overall Good but was Outstanding in one area, Responsive.

Learning Together promoted a 'Culture of Gentleness' approach when supporting people to manage their anxiety and associated behaviours. Gentle Teaching International is a global community worldwide who work together to develop promote and strengthen the values of ‘Gentle Teaching’ every day. The basic values are gentleness, kindness, forgiveness, companionship, community and inclusion. There was less focus on 'behaviour' and more on fostering safe and kind relationships to bring about real and lasting change. Throughout this inspection we saw this approach in action. We heard many examples of how staff’s exceptional skills in applying the Gentle Teaching approach had brought people an enhanced sense of wellbeing and exceptional quality of life without restrictions. For example, two people who had lived in secure units now had freedom with support in the community and a quality of life that was previously unimaginable. Staff worked with families to ensure consistent support for people and relatives told us how this had enhanced people’s well-being. Staff worked creatively using distraction and giving people responsibilities to support them to manage their anxieties so they could access a range of community activities and life full lives. People were supported to feel valued at all times. Staff used the ‘Gentle Teaching' approach’ in their relationships with people who responded well to the staff. There were enough staff with the skills to keep people safe and recognise when people were becoming anxious and interact with them well in their home and the community. Suitable staff were recruited to support people and they were able to choose which staff they wanted to be with. The staff managed people’s medicine well and stored them safely.

Staff had individual meetings, training and team meetings to help ensure the support they provided for people was improving the person’s experience and making a difference in their lives. 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.

Staff knew people well and told us about their characters with compassion for them. People had an inclusive relationship with staff and freedom to access the community with support. They were involved in planning their days with the support staff and relationships with people were forged based on mutual respect.

Health and social care professionals that visited the service were positive about the personalised care and support people had from staff and had seen the improvements for people. Families told us the service had made vast improvements to people’s lives and they also received advice and support from the agency staff to promote the ‘gentle approach’ and continue the improvements they had seen.

There was clear and sustained management to support staff, people and their families to achieve the best possible outcomes for people. Relatives and people met regularly with staff and communication was well established with the families to exchange ideas. Quality assurance procedures included the views of people and their families and improvements had been made from their

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

When we visited there was a registered manager in post, this person was the also the registered provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The provider had short notice of this inspection and was given 48 hour notice. This was because the office was not always staffed as care is delivered to people in their own homes.

Learning Together is a small service that supports people to live in their own home. They specialise in providing care for people living with autism. They provide 24 hour care to two people with a core group of staff. Many of the staff had supported the people since the service was commissioned.

People could be confident their care needs were being met and they were involved in the planning of their care. People were encouraged to be active and be part of their local community. They were encouraged to maintain relationships with friends and family ensuring there was a good network and circle of support.

There were clear procedures in place to recognise and respond to abuse. Staff had received training in this area. Positive behaviour management approaches were in place to support people. This helps to protect people from the risks of abuse.

People were supported by staff that been through a thorough recruitment process and had received appropriate training which was relevant to their roles. Staff felt supported in their roles.

People were provided with a safe, effective, caring and responsive service that was well led. The organisation’s values and philosophy were clearly explained to staff and there was a positive culture where people felt included and their views were sought.

We previously inspected the agency in August 2013. At that time we had concerns that recruitment and selection processes were not robust, that staff were not properly trained or supervised and the monitoring of the quality of the service was not effective.

When we returned to the agency to check whether improvements had been made, we found positive changes had been made in all of these areas. Employment files were complete in respect of recruitment processes and checks had been made to ensure correct procedures had been followed.There was a new induction process in place with detailed information showing how staff had been supported during their first few months of employment.

Although some staff needed to complete areas of their mandatory training, training development plans were in place that showed how this was to be achieved. We were assured there was a commitment to get all staff up to date in all areas of this training and that their training needs were reviewed in supervisions. Staff were supervised on a regular basis and met as a team. They discussed how people could be supported effectively with their needs and what good practice measures could support this.

Quality assurance processes had been implemented and action taken where needed to improve the service for people. Family members had been asked for their feedback by completing annual questionnaires and we saw comments received had been acted on.

We spoke with three staff whilst completing the inspection and left our contact details with the provider so other staff could contact us if they wished. None of the other staff contacted us.

We spoke with a social worker involved in the care placement for one person. They were happy with the care being provided and confirmed they felt the person had been supported to make good progress.

Observations during our visit showed that the staff treated people with respect and it was clear that the service was led by the needs of the people being supported. Both people led active lifestyles.

The parents of the two people agreed that since Learning Together had been providing a service both people had improved. One parent commented, “Their life has completely changed, from a locked environment to getting more independence and autonomy. They (the staff) are very kind they have a gentle approach”.

Our inspection found non-compliance with three outcomes; Requirements relating to workers, Supporting workers and Assessing and monitoring the quality of service provision.

We were unable to ask the people being supported by the staff what they thought of the service they received due to their disabilities.

The registered manager identified in this report left the employment of the provider in the week before this inspection was completed. At the time of this inspection the nominated indivdual was completing the registration process to become the registered manager.

During our inspection we spoke to two relatives of the people who used the service, three members of staff, the registered manager and a health professional.

The service specialises in providing care to people affected by an autistic spectrum condition. We visited the office of Learning Together which was situated near to part of their service which provided living accommodation for two people.

The people who used the service were unable to verbally express their experience of the service. We observed staff encouraging and enabling people who used the service to be involved in how their service is run. Interactions between the staff and the people who used the service were warm and respectful.

We found that staff supported people to be involved in all aspects of their life. Staff members are provided with coaching that specifically target ways to facilitate active participation in tasks. One relative described the provider’s approach as ‘‘enlightening and it’s working’‘.

We found that people's needs were assessed and care and treatment were planned and delivered in line with their individual care plan. Staff members demonstrated a good knowledge of the people they supported. The staff we spoke with felt supported to undertake their role and staffing levels were adequate.

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We found that the provider had a system in place to deal with complaints, including providing people who used the service with information about the procedure for raising concerns.