This inspection visit took place at Merseyside Regional Office on 17 November 2016 and was announced. We told the registered manager before our visit that we would be coming. We did this to ensure we had access to the main office and the management team were available.

Merseyside Regional Office is a Domiciliary Care Agency located in Wavertree a suburb of Liverpool. The agency employ staff to provide care and support to people in supported homes and in accessing the community. The amount of support people receive varies depending on the person’s needs. At the time of the inspection the agency supported 112 people.

There was a registered manager in place. 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.

At the last inspection in February 2014 the service was meeting the requirements of the regulations that were inspected at that time.

We found the service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Records showed staff had received safeguarding training and understood their responsibilities to provide safe care and protect people.

Staff received training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

We looked at how the supported houses were staffed. Staff members spoken with said they were happy with how their houses were managed. They felt one to one support for people who lived in the house was beneficial for the person and staff members.

We found checks had been undertaken including a Disclosure and Barring Service check (DBS), and references.

People were approached with a supportive and compassionate manner and staff had a good understanding of protecting people’s dignity and privacy. We observed staff were friendly, respectful, patient and caring towards individuals.

We looked at how medicines were administered. The medicines administration record (MAR) sheets were legible and did not contain any gaps. Staff were trained to administer medication.

Staff knew people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

People who lived in the houses were encouraged to attend to their own dietary requirements as much as possible. Support and guidance was always available at mealtimes for people with complex needs.

Staff received training about the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. People who lived in the houses told us staff were respectful and supported them to make their day-to-day decisions and staff were available for guidance and support.

Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

When we visited one of the houses people who lived there were getting ready for the day ahead. People were supported to follow their chosen hobbies and lead an independent life as possible. For example one person was going out to the shops for Christmas shopping and another was relaxing in the main room watching films.

The complaints procedure was available and people said they were encouraged to raise concerns. Where people had expressed concerns appropriate action had been quickly taken and details had been recorded.

We found a number of audits were in place to monitor quality assurance. The registered manager had systems in place to obtain the views of people who lived in the houses.

People who used the service told us they had made choices and decisions about their care and support. We found that staff understood the what to do if they had concerns about a persons ability to consent to any aspect of their care and support.

We found that people received care and support which had been carefully planned around their individual needs. Staff told us they had received training in emergency procedures and they felt confident about dealing with any incident which may arise.

Appropriate staff recruitment processes had been followed to ensure that people were supported by staff that were suitably qualified, skilled and fit to carry out their role. People who used the service were invited to take part in the recruitment and selection of staff.

We found that there was a complaints system in place which people knew about and understood. People said they would complain if they needed to and they felt confident that their complaint would be listened to and dealt with in the right way.

People had been asked their views and opinions about the service and checks had been carried out to make sure people received the right care and support.

People told us before they decided to use the service they were given information about it and had an assessment of their needs carried out.

People told us that they have been involved in making choices and decisions about their lives and the support they have received. They said carers have always listened and respected whatever decisions they have made and have been provided with support when making difficult decisions. People told us that they are part of a service user involvement group and have attended meetings when they have put forward their views about the service and made suggestions for improvements. People also told us they have had regular meetings in their homes with other people they live with and carers and have shared thoughts and ideas and commented about the service they received.

People told us that they know how to complain and would do if they were unhappy about something. They told us they are sure that carers and managers who work for the agency would listen to them and sort out any problems they had.

We observed carers talking politely to people and dealing with and responding positively to the those they were supporting.

People told us that they know about their care plans and were involved in putting them together. They also told us that they know were they are kept and can look at them at any time.

People told us they have spent their time doing what they wanted and that carers have provided support whenever they needed it. People said they have been out shopping and for walks and spent time at home relaxing or doing housework. People told us they have been supported by their carers to attend healthcare appointments and they have seen their GP when needed.

We observed people moving freely around their homes and carers supporting people who needed help to get around.

People told us carers have treated them well and with respect.

People also told us that they would tell somebody right away if they were treated badly or knew of somebody else being treated badly.

One person told us they are responsible for collecting their own medication from the pharmacy and that they take their own medication as prescribed by their GP.

Other people told us that carers have always given them their medication on time.

We carried out our inspection visit over two days. On the first day we visited the agency office and spoke with the management team and viewed a selection of records. Also on the first day we met with four people who used the service and four staff. On the second day we held telephone interviews with six people who used the service and with the staff that supported them.

People were involved in the planning and review of their support and were given opportunities to express their wishes and preferences.

People who used the service made positive comments about the care and support they received from staff. Peoples comments included: “I am very happy with everything they do for me”; “The staff are fantastic” and “They know me well and know exactly what they need to do for me”.

Staff knew about the different types and indicators of abuse and they were clear about their responsibilities for reporting abuse. People told us they felt safe around the staff that supported them and that they would tell someone if they were worried about the way they were treated.

Staff received good training and support which enabled them to provide the right care and support to people who used the service. People told us they liked the staff and that they were good at their jobs.

Staff understood the importance of ensuring people's records were treated confidentially. Records were well maintained and stored securely in a way that allowed them to be located quickly.