This inspection took place on 22 and 24 January 2018 and was announced.

We last undertook a comprehensive inspection at NAS Community Services (Somerset) in September 2016. At this inspection we found the provider to be in breach five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 11, Need for consent, Regulation 12, Safe Care and treatment, Regulation 17, Good Governance, Regulation18, Staffing and Regulation 19, Fit and proper persons employed.

Following the inspection in September 2016, we served two Warning Notices for breaches in Regulations 11 and 17. In addition to this, we set requirement actions relating to breaches 12, 18 and 19. We also asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good. The provider told us they would make the required improvements by February 2017.

We undertook a focused inspection in February 2017 to check the provider was meeting the legal requirements for the two regulations they had breached that resulted in them being served Warning Notices. During the focused inspection we found the provider had taken action to ensure compliance with these regulations.

During this comprehensive inspection we found that improvements had been made in some areas, however we found some similar concerns to the inspection in September 2016, which resulted in breaches of the regulations.

NAS Community Services (Somerset) provides care and support to people living in three ‘supported living’ settings, so that 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 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.

There was not a registered manager in post. 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. The previous registered manager had left the service, the provider had recruited a new manager who had left the service the week prior to our inspection. The provider was in the process of recruiting a new manager. Senior managers were overseeing the services and there was a deputy manager in post.

All of the relatives we spoke with and staff felt the service was a safe place for people. However, we found risks relating to people were not always recorded and formally assessed. Recruitment procedures were not always consistently followed to ensure staffs suitability to work with vulnerable adults.

People's legal rights in relation to decision making were not always upheld. Where people lacked capacity to make decisions for themselves the principles of the Mental Capacity Act 2005 were not always followed.

The quality assurance processes in place to monitor care and safety and plan on-going improvements were not fully effective.

There were systems in place to protect people from abuse and the staff we spoke with knew how to follow them. There were enough staff available to meet peoples need’s. People’s medicines were managed safely.

Staff knew people well and we observed staff were caring in their interactions with people.

There were clear guidelines in place detailing how to support people when they became anxious. Incidents and accidents were reviewed

This inspection took place on 13 February 2017 and was announced. It was carried out by one ¿adult social care inspector.¿

The NAS Community Services (Somerset) provides personal care and support to people living in ¿their own homes in North Somerset. At the time of this inspection there were six people who ¿received 24- hour staff support from the service. The service provided a supported living service. A ¿supported living service is where people have a tenancy agreement with a landlord and receive ¿their care and support from a care provider. As the housing and care arrangements were entirely ¿separate people can choose to change their care provider if they wished without losing their ¿home.¿

A registered manager was responsible for the service. This 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. ¿

We carried out a comprehensive inspection of this service on 14, 16 and 20 September 2016. ¿Breaches of legal requirements were found as people's legal rights in relation to decision making ¿were not always upheld. There were ineffective quality assurance systems in place to make sure ¿any areas for improvement were identified and addressed.¿

After the comprehensive inspection, we used our enforcement powers and served two Warning ¿Notices on the provider on 3 November 2016. These are formal notices which confirmed the ¿provider had to meet the legal requirement in respect of people's legal rights in relation to decision ¿making by 5 December 2016. They had to meet the legal requirement in respect of effective ¿quality assurance systems by 6 February 2017.¿

We undertook this focused inspection to check they now met these legal requirements. This ¿report only covers our findings in relation to these requirements. This means the rating of these key questions remain the same. ¿You can read the report from our ¿last comprehensive inspection, by selecting the 'all reports' link for on our website at ¿www.cqc.org.uk

We found action had been taken to improve the effectiveness of people’s care and in how well ¿led the service was. The provider had carried out a review of each person’s ability to make ¿decisions. This review had also considered what decisions people needed help with and what ¿needed to be decided upon in each person’s best interests.¿

Others close to each person, such as their parents and health professionals involved in their ¿care, had been consulted when best interest decisions had been made . This meant people’s ¿legal rights in relation to decision making were upheld. ¿

The management structure within the service had been improved. The registered manager was ¿now supported by two deputy managers. Regular quality and safety audits were being carried out. ¿Where areas for improvement had been identified, these had been addressed. ¿

Other management systems and structures had also been improved. Staff were now provided ¿with regular supervision (a one to one meeting with their line manager). There was an effective ¿system to monitor this was being provided to all staff. Staff recruitment checks were monitored. ¿This ensured all relevant checks were completed for all new staff to ensure they were suitable to ¿support vulnerable people in their own homes.¿

The legal requirements had been met; the provider had therefore complied with our Warning ¿Notices.¿

The National Autistic Society Community Services provides personal care and support to people living in their own homes in North Somerset. At the time of this inspection there were eight people who received 24-hour staff support from the service. The service provided a supported living service. A supported living service is where people have a tenancy agreement with a landlord and receive their care and support from a care provider. As the housing and care arrangements were entirely separate people can choose to change their care provider if they wished without losing their home.

The inspection took place on 14, 16 and 20 September 2016 and was announced.

There was a registered manager in post. 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 had communication difficulties associated with their autism. We visited two of the homes where people were receiving services and met four people. We had very limited communication with the people we met. We used our observations and discussions ¿with people’s relatives and staff to help form our judgements.

Medicines were not always managed safely. Where risks relating to people were identified these were not always regularly reviewed and updated.

There were sufficient staff available to meet people’s needs. Safe recruitment procedures were not always followed.

People’s legal rights in relation to decision making were not always upheld. Where people lacked capacity to make decisions for themselves the principles of the Mental Capacity Act 2005 were not always followed.

There were some gaps in staff training but the registered manager had plans in place to address this. New members of staff received an induction which included shadowing experienced staff, they told us this prepared them for the role.

Staff did not always feel supported and commented there was a lack of management presence in some of the services. Staff did not always receive regular one to one supervision with their line manager. Where improvements were identified with staff performance, this was not always regularly monitored and reviewed.

People received good support from health and social care professionals. Staff were skilled at ¿communicating with people, especially if people were unable to communicate verbally.¿

People’s records did not always include information that promoted dignity and respect. We observed staff were caring in their interactions with people. Relatives told us staff were caring.

Relatives were involved in the planning and reviewing of people’s care. Some of the care records we looked at needed reviewing and updating. People were supported to access their community.

All of the relatives we spoke with and staff felt the service was a safe place for people. ¿ There were systems in place to protect people from abuse and the staff we spoke with knew how to follow them.

The quality assurance processes in place to monitor care and safety and plan on-going ¿improvements were not always effective.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People who used the service had communication difficulties and were not able to comment on the service they received. We therefore spoke with three parents who were closely involved with their relative's care. We spoke with the manager, three senior staff and with two care staff.

People who used the agency were encouraged and supported by staff to make decisions about their day to day lives. Parents spoken with said their relatives made choices within “what is good for them.”

Parents we spoke with were very happy with the care and support provided by staff. They said staff understood their relative's needs. Support with personal care was tailored to each person’s needs. One parent said that intimate personal care was carried out “sensibly and sensitively.” People were given appropriate support with their medicines.

Parents stressed the importance of the relationship between staff and people using the service. One parent described staff as an “extended family.” Staff spoken with had an excellent understanding of people's needs.

People who used the service and their parents were involved in planning and reviewing the care provided. Parents said they were always listened to. One parent said “there is regular communication at all levels” and if they raised a concern “something is always done.”

Staff training and supervision had improved. The provider had improved the system to regularly assess and monitor the quality of service that people received.

People who used the service had communication difficulties and were not able to comment on the service they received. We therefore spoke with four parents as they were closely involved with their relative’s care. We also spoke with the manager, one senior member of staff and with care staff.

Each parent we spoke with told us that staff were polite, kind and treated their relative with respect. They told us that care workers worked closely with them to plan and review the service each person received. One parent said “They have been providing care for two years. We have always been very much involved in xxxx care.”

Parents were very happy with the care and support provided by staff. They said that staff provided consistent care. Parents comments included “I think the care is very good. All of the staff are really good. They know xxxx well and understand his needs” and “It’s the best service I’ve come across for my son.”

Parents told us they felt their relative’s were protected from abuse. They felt safety was a key priority for staff. One parent told us “I would say yes they are definitely safe. The staff are very hot on people’s personal safety.”

Staff training was not up to date. There was no system in place to ensure that staff had completed or refreshed their training to ensure they provided safe and effective care.

The provider’s auditing of the service was not effective. This could place people who used the service at risk.