The inspection took place between 23 November and 5 December 2018 and was announced. The service was last inspected in February 2016 when it was rated ‘Good.’ In February 2016 we made a recommendation about how medicines were disposed of. We followed up on this recommendation at this inspection.

The London Borough of Hackney, Housing with Care provides care and support to people living in 14 ‘supported living’ settings, so they can live in their own home 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 14 schemes were all located in the London Borough of Hackney and ranged in size from eight to 40 self-contained flats. Most of the schemes were designed to meet the needs of older adults, although some were specialised for particular groups including adults with learning disabilities aged over 50 and people living with a particular type of dementia.

There was one registered manager who was responsible for seven of the schemes. A second manager had applied to register with us who was responsible for the other seven schemes. 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.

People told us they felt safe and staff were able to describe the support they provided to ensure people were safe. However, care plans and risk assessments were poor quality, lacked details and were not personalised.

Risks faced by people in the receipt of care had not been appropriately identified and measures in place to mitigate risks were not clear or robust. There was insufficient information about people’s medicines to ensure they were managed safely and records did not show people had been supported to take medicines in a safe way. Although staff had a sound understanding of safeguarding and incident reporting, the systems in place to monitor and respond to incidents and allegations of abuse were piecemeal and there was a risk that trends and themes were not identified.

People did not feel involved in developing their care plans and did not always feel they had been offered choice about their care provider. Care plans had not been developed in line with best practice and guidance for meeting people’s specific needs. There was insufficient information about people’s healthcare needs, dietary requirements, cultural background and sexual and gender identity. We made a recommendation about ensuring the provider was able to offer appropriate support about people's sexual and gender identity. There was a risk that people’s preferences and needs would not be met because these were not recorded.

People gave us mixed feedback about the staffing levels in the service and the impact this had on their experience of care. While some people felt there were enough staff who had time to chat, others found staff rushed and busy. Staff were recruited in a way that ensured they were suitable to work in a care setting. Some of the schemes had very high agency use, with half of their shifts being covered by agency workers. Staff received regular supervisions, but the records did not demonstrate they had received the training they needed to perform their roles.

People did not always know how to make complaints, but were confident that if they had cause to make a complaint their feedback would be responded to appropriately. Records showed complaints were responded to in line with the provider’s policy. The systems in place for learning from complaints were not operating effectively.

People told us they liked living in the schemes and would be happy to stay there until the end of their lives. Information a

This inspection took place on 23, 24, 25 and 26 February 2016 and was announced. The provider was given 48 hours’ notice because we wanted to be sure there would be someone at the office when we called. We told the registered managers we would visit some of the schemes over the next few days. At our previous inspection on 3 October 2013 we found the provider was meeting the regulations we inspected.

Supported Living Schemes (also known as Housing with Care) provides personal care and support to people living within supported housing. At the time of our visit the service was providing support to 270 people in 15 schemes across the London Borough of Hackney. All of the people using the service were funded by the local authority.

There were two registered managers in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

One of the registered managers was responsible for eight schemes, the other for seven schemes. There were10 scheme managers covering the 15 schemes, who each reported to one of the registered managers.

People and their relatives told us they felt safe using the service and care workers had a good understanding of how to protect people from abuse. Staff were confident that any concerns would be investigated and dealt with. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns. Scheme managers were notified when training was due to expire and requested refresher training for care workers.

People’s risks were managed and care plans contained appropriate risk assessments which were updated regularly when people’s needs changed. Care workers worked with all people across individual schemes to ensure they were aware of the needs of each person. The service had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service.

People who required support with their medicines received them safely and all staff had completed in-depth training in the safe handling and administration of medicines, which was refreshed every three years. However not all schemes had a recording system in place for the disposal of medicines.

Care workers received an induction training programme to support them in meeting people’s needs effectively and were always introduced to people when they started work at the scheme. They shadowed more experienced staff before they started to deliver personal care independently and received regular supervision from management. They told us they felt supported and were happy with the supervision they received.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). Care workers respected people’s decisions and gained people’s consent before they provided personal care.

Care workers were aware of people’s dietary needs and food preferences. Care workers told us they notified the team leaders or scheme managers if they had any concerns about people’s health and we saw evidence of this in people’s care plans. We also saw people were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, occupational therapists and district nurses.

People and their relatives told us care workers were compassionate and caring and knew how to provide the care and support they required. Care workers understood the importance of getting to know the people they supported and showed concerns for people’s health and welfare.

People told us that staff respected their privacy and dignity and promoted their independence. There was evidence that cultural requirements were considered wh

As part of our inspection, we visited one of the supported living schemes, which provided accommodation for up to 30 people. We spoke with five people who use the service and a friend of one person, all of whom told us that they were happy with the quality of care offered. People told us that staff supported them well. We also spoke with the registered manager, the scheme manager, four care workers and two housing officers.

Each person who spoke with us agreed the care workers met their individual needs. One person told us, "I’m very satisfied, everyone is lovely. I wouldn’t change anything." Another person commented, “I’m happy about everything, I’m quite contented.” A friend of one person said, "it’s very good, I’d say it is five star accommodation. I’ve never seen her so happy.” The housing officer told us, "the staff are good. The standard of care is very good.” Staff working in the scheme were able to meet people's needs. They were aware of each person's care needs and their cultural and religious backgrounds.

There were enough qualified, skilled and experienced staff to meet people’s needs.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

The provider was ensuring that the Care Quality Commission was informed without delay allegations of abuse in relation to the service as required.

As part of our inspection, we visited one of the supported living schemes, which provided accommodation to up to 41 people. We spoke with seven people who use the service, all of whom told us that they were happy with the quality of care offered. People told us that staff were caring and friendly. One person told us, "I have been happy ever since coming here." Another person commented, "my care workers are very good and I have never had to complain." Most people told us staff supported them well.

People were involved in planning their care and they were supported with dignity and respect. There was a stable group of care workers working in the project. Staff were aware of each person's care needs and their cultural and religious backgrounds.

Staff told us they felt supported by the management team. They felt they were able to access appropriate training, but they commented it would sometimes take some time before the training would be made available to them.

The registered person failed to notify the Care Quality Commission without delay of any abuse or allegation of abuse in relation to a service user, as required by Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.