About the service: Littleton House is a supported living service that was providing personal care to 20 people at the time of our inspection, some of whom may have a learning disability, autism, mental health or physical disability. The service supported younger and older adults.

This service provides care and support to people living in six separate supported living settings, so that people can live 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. The office is onsite of the supported living homes, so we were able, with people’s permission, meet and speak with them during our visit.

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.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. The report was published 01 February 2017.

Why we inspected: This was a scheduled inspection based on the previous rating.

People’s experience of using this service:

• People continued to tell us they felt safe and well supported.

• Staff had a good understanding in how they protected people from harm, and recognised different types of abuse and how to report it.

• Potential risks to people had been identified and people had involved with decisions in how to reduce the risk of harm.

• There were enough staff on duty to keep people safe and meet their needs.

• People’s medicines were managed and stored in a safe way. Safe practice was carried out to reduce the risk of infection.

• People’s care continued to be assessed and reviewed with the person involved throughout.

• People were supported to have a healthy balanced diet and were given food they enjoyed.

• 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 support this practice.

• Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice.

• Staff treated people as individuals and respected the choices they made.

• People’s care was delivered in a timely way, with any changes in care being communicated clearly to the staff team.

• People were supported and encouraged to maintain their hobbies and interests.

• People had access to information about how to raise a complaint, where complaints had been received the provider had managed these inline with their policy.

• The registered manager was visible within the service, they spent their time listening to them.

• The checks the registered manager made to ensure the service was meeting people’s needs focused upon people’s views and experiences.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

At our last inspection in October 2015 the provider was meeting the regulations but we identified that improvement was required in some areas. People were at risk of having decisions about their care being made by people who did not have the right to do so. The provider had also not informed us of some incidents where they were required to do so and quality assurance systems had not always been effective. This inspection identified that these issues had been addressed but some further improvements were needed.

This service is registered to provide personal care to people in their own homes. At the time of the inspection the service was providing care and support to 20 people who lived in shared accommodation on the same site as the location of the office for Littleton House. Some people were receiving 24 hour support and others received fewer hours of support each day, according to their assessed needs and level of independence.

A registered manager was employed at 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.

Staff were trained in recognising possible signs of abuse and they knew how to report any possible suspicions to the relevant authority. Staff demonstrated awareness of possible warning signs of safeguarding concerns and the action to take. All of the staff we spoke with told us they were confident that if they reported any safeguard concerns to the manager they would be dealt with appropriately. Action had been taken to respond to concerns about staff practice but the local authority had not been notified of these issues.

People were usually supported by staff who were familiar with their needs but there was some use of agency staff to cover staff vacancies. Staff were recruited appropriately and there were sufficient numbers of staff to meet people’s needs. People’s medicines were safely managed and administered by staff who had received training and had been assessed as competent to administer medicines.

Staff had received induction training when they first started to work for the service and received on-going training to make sure that they continued to have the skills to provide people with appropriate care and support.

People were supported to eat enough food and drink by staff who understood their nutritional needs. People's health was supported by access to a variety of health professionals.

People said staff were caring and that they had built up close relationships with the members of staff who supported them. People told us they were able to make everyday choices for themselves. People and, where appropriate, their relatives were consulted about their preferences and people were treated with dignity and respect. Improvements were needed to make sure people’s privacy was consistently respected. Staff we met spoke enthusiastically about the people they were supporting, and were able to explain people’s needs and preferences.

Staff we spoke with told us the registered manager was friendly and supportive, however two care professionals described two examples where they felt the practice of the registered manager could be improved. We saw there was a process for staff to contact the registered manager during out of hours if they required additional support or guidance.

People who lived at the home, their relatives and staff were encouraged to share their opinions about the quality of the service and there were effective systems in place if people wished to make a complaint.

Improvements were needed to how the service was managed to include systems for responding to incidents and some aspects of record keeping. The registered manager showed us that the provider has recently purchased a new care planning

This service has delivered regulated activities since January 2013.

During our inspection we spoke with the registered manager, business manager, two care workers, two people who received support from the agency and the relative of a person who received support from the agency.

People expressed their satisfaction with the service they received. One person told us that the staff who supported them were ‘’nice.’’ Both people who used the agency told us that staff supported them to participate in lots of activities. A relative of a person using the service told us, ‘’It’s absolutely brilliant. Staff are always on time and there have been no issues.’’

During the inspection we looked at two people's care records. It was not evident that care was always planned in a way that ensured people's safety and welfare.

Recruitment practices needed to be improved. The arrangements for ensuring staff were of good character were not always robust.

Staff told us that they felt well supported in their role. They told us that they found the manager approachable and that they were able to call the office if they had any concerns.

People using the service had opportunities to express their views about the service they received.

At our last inspection in July 2014 the provider was meeting the requirements of all the regulations we looked at but we identified that improvement was required in some areas. This included the systems for the recruitment of new staff and for monitoring quality.

This service is registered to provide personal care and to people in their own homes. At the time of the inspection the service was providing care and support to people who lived in shared accommodation on the same site as the location of the office for Littleton House. Some people were receiving 24 hour support and others received fewer hours support each day, according to their assessed needs and level of independence.

A registered manager was employed at 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.

Staff were trained in recognising possible signs of abuse and they knew how to report any possible suspicions to the relevant authority. Staff demonstrated awareness of possible warning signs and the action to take. All of the staff we spoke with told us they were confident that if they reported any safeguard concerns to the manager they would be dealt with appropriately.

Staffing structures were clear and care staff were consistently assigned to provide care to specific individuals. Staff were recruited appropriately and there were sufficient numbers of staff to meet people’s needs. Staff had received induction training when they first started to work for the service and received on-going training to make sure that they continued to have the skills to provide people with appropriate care and support.

People told us they were able to make everyday choices for themselves but people were at risk of having decisions about their care being made by people who did not have the right to do so. We saw some examples in people’s care plans where the support provided may be restrictive to the person.

People said that staff were caring and they were happy to be supported by the service. Staff enjoyed seeing the people they supported and were happy to help them as much as possible. People had developed positive relationships with the staff who supported them. The service promoted people’s privacy and dignity and people were supported by staff of their choosing.

Staff we spoke with told us the manager was friendly and supportive. We saw there was a process for staff to contact the manager out of hours if they required additional support or guidance.

We saw evidence that some incidents had been used to learn from mistakes but that a detailed analysis of all incidents and accidents was not undertaken. This would have assisted in identifying any patterns or themes which could mean that people were at increased risk of harm.

The provider had failed to understand some of their responsibilities. Whilst a copy of the locations previous report was on display in the office showing the rating of the location we saw that the provider’s website did not tell people the rating of the location. The manager told us they had not been aware of the requirement to do this and would ensure this was rectified. We looked at the provider’s website following our visit and saw this had now been done.

Whilst the provider had informed us of some of the incidents they were required to, we had not submitted all of the notifications they were required to do so by the regulations.