We inspected the service on 4 April 2017. We gave the registered manager 24 hours’ notice of our inspection because we needed to be sure they would be available.

Mosaic: Shaping Disability Services provides personal care and support for people in their own homes. At the time of our inspection 14 people were receiving personal care and support from the service.

There was a registered manager in place. It is a requirement that the service has a registered manager. 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 felt safe with the support they received. Staff understood their responsibilities to help people to remain safe including the reporting of suspicions of or actual abuse. However, one allegation that a person had made had not been alerted to the local authority for their consideration of any action that needed to be taken. A manager made contact with the local authority on the day of our visit so that they were aware of the allegation.

Risks to people’s health and well-being were assessed and staff had guidance on how to support people to remain safe. The provider had a safe system in place for dealing with and managing accidents and incidents and staff knew what action they should take. There were procedures available for staff to follow in the event of an emergency, such as a fire.

The provider’s recruitment procedure was safe and they carried out checks on the suitability of prospective staff. People were satisfied with the number of staff the provider had recruited and they received support when they required it.

People received their prescribed medicines when they required them. Their medicine records were not always competed accurately. The provider told us they would make improvements to their checking processes to address this and they supplied us with evidence of this after our visit. Staff knew their responsibilities to handle people’s medicines safely.

People told us that staff had the required skills and knowledge. We found that staff had received some of the required training. This included assisting people to move position. There were topic areas that staff required additional training or an update in such as first aid and medicines. The provider sent us evidence after our visit detailing that training had been arranged as well as competency checks for staff to make sure they were working safely.

Staff members received an induction when they started to work for the provider as well as on-going guidance from a manager so that they knew their responsibilities. Staff told us they received good support.

People were asked for their consent before support was provided by staff. They were involved in decisions about their care. Staff knew what action to take when there were concerns about a person’s ability to make decisions for themselves. People had support plans that they had contributed to and were reviewed with them. This ensured that staff had up to date information and guidance about people’s specific support requirements.

People received support that was flexible to their requirements and based on their preferences. They received support from staff who were consistent and on time.

People received the support they needed to prepare their meals where this was required. Staff took action where there were concerns about people’s eating and drinking including seeking specialist advice. People received support to make sure their health and well-being was maintained.

People were supported by staff who were kind, listened to them and were compassionate. Their dignity and privacy was protected. Staff knew the people they supported including their preferences and things that mattered to them.

People knew how

We inspected the service on 14 April 2016 and the visit was announced. We gave 48 hours’ notice of our visit because we needed to be sure somebody would be available at the office.

Mosaic: Shaping Disability Services is a domiciliary care agency that provides personal care support in people's homes. At the time of our inspection 19 people were receiving care and support.

The service had a registered manager. It is a requirement that the service has a registered manager. 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 felt safe. Where required, staff had assessed any risks to people’s health and well-being to ensure that they supported them safely. Staff had checked that people’s equipment and their homes were safe.

Staff knew how to protect people from the risk of abuse and avoidable harm. Staff knew how to report concerns and had received training to protect people from abuse. The provider had plans to keep people safe during emergencies.

People were generally satisfied with the punctuality of staff providing their care and support and staffing arrangements. There were enough staff to keep people safe and they had been checked for their suitability prior to working for the provider.

Where staff supported people with their medicines, this was completed in a safe way. Some staff required an update to their medication training. We found that the medicines records of two people required a review.

People did not always receive care and support from staff who had the necessary skills and knowledge. This was because staff had not always received regular and appropriate training. For example, half of the staff team required first aid training.

Staff had received an induction when they had become employed by the provider but had not met regularly with their supervisor. Staff did not have regular opportunities to receive guidance and support about their work in order to provide effective support to people.

People received support from a staff team that knew their responsibilities under the MCA. Staff were able to explain how to gain people’s consent and how to offer choices to people who may have required additional support to do this.

People received support to stay healthy. Staff knew how to do this and sought extra support from healthcare professionals where this had been required. Staff followed the provider’s guidelines when they supported people’s specific health needs.

People were receiving support from staff who cared. Their privacy and dignity had been respected and their personal care records were being stored safely.

Staff knew about people’s support requirements and they supported them to remain as independent as possible. Where people required support to make choices, information on how people could access this had been made available.

People had contributed and were involved in planning and reviewing their care and support where they could. There was a risk that people did not receive the support that met their current needs. This was because reviews had not taken place every three months as detailed in the provider’s procedures. This meant that staff did not have up to date information about people’s care and support requirements.

People’s support plans were not always person centred and individual to each person. This meant that staff did not always have detailed information on people’s preferences.

People knew to make a complaint and the provider had a procedure to deal with any received. The provider sought people’s feedback about the quality of the service. However, the provider had not taken action to address any concerns or suggestions for improvements made.

People and their relatives felt that the service

People said they were involved in their care from the moment they began using the service. One person said, “When you start with Mosaic you have a meeting when you tell them what care you want.” Another person said, “I have a good relationship with the carers. They don’t tell me what to do, I tell them what to do. I have a routine and they follow it.”

People also said the service is flexible to fit in with their lifestyles and individual needs. One person told us, “If I’m going out I might be back late so they have to change the time they come and help me go to bed. They don’t mind doing this as long as I tell in advance.” Another said, “I didn’t want a male carer so I told them (Mosaic) and now I don’t ever get one.”

People told us that Mosaic delivers a good service and they were satisfied with the care they received. One said, “Mosaic has been fantastic. It is an excellent service, very helpful.” Another person commented, “I get help with getting up and going to bed and also if I go out. I haven’t got any complaints at all. The staff are good and we always have a laugh when they come.”

People also told us they felt safe using the service and knew who to speak to if they had any concerns. One person said, “I feel safe and secure because I can contact the staff when I need them.” Another commented, “If I have a problem I got to the manager. I have confidence in him.”

People said they were involved in how the service was run in a number of ways including consultations, service user meetings, and staff recruitment. This has led to improvements being made to the service. Comments included, “We have a meeting which we organise ourselves. If I’ve got problems I raise them there”, and “The manager comes to see me sometimes to ask me if everything’s alright.”

We spoke with six people using the service and four relatives. We also read five people’s care records and documents.

People told us they were satisfied with the care received and said that staff always sought consent before they were helped. One person said: “For me this support is very good. People living here all have a disability and can live independently because of support we get from staff.” A relative said: “It’s good that …. gets to enjoy things that every young person does, like socialising, going bowling or to the cinema” and “The staff that supports ….. understands her and there’s trust.”

At the time of our inspection visit the majority of people managed their own medicines. There were policies and procedures in place and staff were trained to ensure they supported people to manage their own medicines.

People told us that they received care and support from regular staff that stayed for the right length of time. One person said: “The staff and the manager are wonderful people.” People received a copy of the staff rota in advance so that they knew which staff member would be supporting them. Training records showed staff were appropriately trained. This enabled staff to provide the tailored care and support to people using the service.

People’s personal confidential information, staff records and other records relating to the management of the service were kept secure and up to date.