The inspection took place on 16 August 2016 and was announced. The provider was given 48 hours’ notice because the location provides a flexible care service; we needed to be sure that someone would be available to assist us with our inspection and that we could access the information we needed.

Look Ahead Domiciliary Care (Hertfordshire) provides care and support for up to 10 people with learning disabilities to live independently. Look Ahead Domiciliary Care (Hertfordshire) provides the personal care and support element and an independent landlord owns the property. The service also supports two further people who live in a neighbouring town to live independently. On the day of this inspection eight people were in receipt of the support provided under the regulated activity.

We last inspected the service on 06 December 2013 and found the service was meeting the required standards at that time.

There had not been a registered manager at Look Ahead Domiciliary Care (Hertfordshire) since the previous registered manager left the organisation in February 2016. A new manager had been recruited and had been in post since April 2016. They had submitted their application to register with CQC and this was in process at the time of this 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.

People had health care and support plans in place to help ensure that staff knew how they liked their needs to be met. Risks to people’s safety and welfare had been identified and care had been planned to enable people to live as safely and independently as possible. There were sufficient numbers of staff available to meet people’s care and support needs. People’s medicines were managed safely. There were clear arrangements in place in the event of emergencies.

The systems in place to recruit staff were robust to help ensure that the right people were recruited to provide people’s care and support. Staff received on-going training to help ensure that they kept up to date with good practice and refresh their skills and knowledge. Consent to care and treatment was understood by the staff team and people were supported in line with the legislation. Information was available in communal areas about advocacy services should people feel they needed additional support with decision making.

Support was provided to promote healthy eating and access to health care services. Staff were caring and promoted people’s independence as much as possible. People were supported to access a range of activities outside their homes. People’s relatives told us they would be comfortable to raise any concerns with the management team and confident that they would be acted upon.

The culture of the service was open and staff were motivated and clear about the manager and provider’s objectives. The provider had arrangements to receive feedback from people who used the service and to drive forward improvement including regular monitoring by representatives of the provider.

When we inspected Look Ahead Domiciliary Care on 06 December 2013 we found that people were routinely asked for their consent about their every-day care and the staff acted in accordance with their wishes.

Staff members worked to personal care guidelines which emphasised people’s right to control when, how and from whom they received care. One person told us, “They always ask me if it’s alright and I say ‘yes’”.

People's needs were assessed and their care was planned according to their individual needs. We found that care plans were centred on and specific to each person because they were actively involved in their assessment of need. One person said, “We have a one-to-one meeting every few months and we talk about what I need.”

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place for supporting people with their medicines. Accurate records were maintained in relation to medicines.

People and staff members reported to us that there were always enough staff on duty to support people. The provider’s staffing requirement was based on the number of hours of support that the service were contracted to provide for each person.

People were asked for their views about the way the service provided their care and their views were acted on. One person told us, “We have customer meetings every two weeks and I go to them all.”

The provider operated an effective quality management system involving reviews by a senior member of the provider’s regional management team.

When we visited Look Ahead Domiciliary Care (Hertfordshire) on 9 November 2012 we found that people were involved in making decisions about the way their care was delivered. One person told us, "My needs have changed. I told the staff and [this resulted in] changes for the better to my support plan." We also found that people’s community involvement was supported and that they took part in communal activities in the apartment block as well as in the community.

People experienced care and treatment according to their individual needs and that kept them safe from harm. One person told us, "I like it here. I get help with everything I need." We also found that the service used a proactive care planning system. This allowed support to be delivered according to a person's established needs as well as responding to needs throughout the day. One person said, "I don't have any worries about anything".

People using this service were safe from the risk of abuse because the staff understood the nature of abuse and knew how to respond to concerns. One person told us they felt really safe.

People living in this apartment block were supported by visiting staff who were motivated and properly trained for their role.

We found that the provider had an effective system to monitor the quality of the service and that people using the service were involved in this process through regular meetings and the opportunity to provide feedback.