We carried out an announced inspection of the service on 13 and 14 December 2016. Nottinghamshire Office is part of the Perthyn group of services and is registered to provide personal care for adults, some of who may be living with a learning disability such autism spectrum disorder. People supported by this service either live in their own homes, or in shared accommodation with others. At the time of the inspection there were 20 people using the service.

On the day of our inspection there was 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.

People told us they felt safe when staff supported them within their home. People were supported by staff who could identify the different types of abuse and who to report concerns to. Assessments of the risks to people’s safety were in place and regularly reviewed. Emergency evacuation plans were in place to enable staff to support people with safe evacuation in an emergency. There were sufficient numbers of suitably qualified and experienced staff in place to keep people safe. Safe recruitment processes were in place. People’s medicines were managed safely.

Staff were well trained, received regular supervision and felt supported by the registered manager. The principles of the Mental Capacity Act 2005 (MCA) were considered when supporting people. People were supported to plan, buy and cook their own food and were encouraged to follow a healthy and balanced diet. People’s day to day health needs were met effectively by the staff.

People felt the staff were kind and caring and treated them with respect and dignity. People were involved with decisions made about their care and support. Information was available for people if they wished to speak with an independent advocate. People were supported to live as independently as they wanted to.

People were supported to take part in the activities that were important to them; this included attending college or finding employment. People’s support records were person centred, focussed on what was important to each person and provided staff with relevant information to respond to people’s needs. People were encouraged to set goals for themselves and staff supported them in achieving these goals. People’s support records were detailed and provided sufficient guidance for staff to respond to people’s needs and wishes. Complaints and concerns were managed in line with company policy.

People, relatives and staff spoke highly of the registered manager. A number of systems were in place that enabled a wide range of people, staff and relatives to give their views about the service. Staff, including the registered manager had a clear understand of their roles and responsibilities. The provider was a member of a number of local and national forums and organisations designed to ensure their group of services adhered to current best practice guidelines. Robust quality assurance processes were in place.

One inspector carried out this inspection. At the time of our inspection the provider delivered personal care to 21 people in their own homes. Below is a summary of what we found.

We spent time speaking with people who used the service as well as speaking with staff, managers and relatives. We reviewed records and spent time observing people in their assisted living home. If you want to see the evidence that supports our summary please read the full report. We used the evidence to answer five questions.

Is the service safe?

A family member told us that they were happy with the standard of care provided by support workers.

Staff records demonstrated that mandatory training was up to date and that staff were trained to meet the complex needs of people in most cases. Staff were trained in caring for people with complex behaviour, communication needs and autism. Some staff we spoke with said that they would benefit from additional training in communication techniques for people with complex behaviour.

CQC monitors the operation of the Deprivation of Liberty Safeguards. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We spent time observing staff and people. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. We spoke with a relative who told us that they were pleased with the level of support that staff had provided but said that the provider had not ensured consistent levels of staffing.

A person told us that they felt looked after by support workers and enjoyed staff company, particularly the support they had received to live independently. People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Staff had received supervision and training to meet the needs of people when they first began using the service and on an on-going basis. Staff we spoke with told us that they were able to put their training into practice and felt that an intensive system of supervisions helped them to provide effective support.

Is the service caring?

People were supported by kind and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people, especially when they wanted to talk or were anxious. Staff took into account the complex needs of people when planning activities so that they could take part in these safely. We spoke with a person who said, "I hate gardening so [staff] don't make me do it. Instead they let me get fresh air by walking to the shops or we go out to eat sometimes."

Staff said that they were happy with the level of professional and emotional support they received from managers but that they were sometimes difficult to reach.

Is the service responsive?

People's needs had been assessed before they began using the service and these were checked by regular reviews, in which people were involved. People's needs assessments included consideration of their dietary and nutrition requirements as well as their need for stimulating activities that helped them to feel part of their community. Where a person's needs had changed, we found that the provider had taken steps to involve the relevant local professionals.

People's preferences and interests were acted on by staff who were able to support people consistently to help them to meet their needs and goals. People had access to activities that were designed to stimulate them and they were able to influence the running of the service.

Is the service well led?

Staff had a good understanding of the ethos of the service and robust quality assurance processes were in place. Staff told us that they were clear about their roles and responsibilities. Some staff told us that management support helped them to do their job effectively. We spoke with a relative who said that they had always been able to reach managers when they needed to and that they had been satisfied with the speed of the response they received.

We spoke to two people who were using the service. They told us the staff who supported them were generally respectful. One person said, "I get on well with the staff." Another person said, "They do a good job for me.”

We spoke to three relatives of people who were using the service and one person said, "I have been very satisfied. They have been excellent.” The other two relatives we spoke to had concerns about staffing levels. One person said, “If [our relative] goes out, there is only one carer. Normally there are two available. The service is cutting costs wherever it can and doing things on the cheap. We rarely see the same people providing care and the manager where [our relative] lives is leaving.” Another person said, “There are not enough staff. There is no continuity of care. People who work for the service seem to be leaving all the time. They are doing their best but I am not satisfied.”

People told us they felt safe with the support they were being provided. One person said, " I feel safe and I would speak to [name of a member of staff] if I were worried about anything.”

We found that staff were supported to provide care that met people's needs by receiving appropriate training, supervision and appraisals, however some of the staff we spoke to raised concerns about inadequate staffing levels within the service.

We also found that the provider was not taking sufficient steps to assess the quality of the service being provided.

We spoke with two people using the service. One person told us staff had visited them before they started to use the service. They told us they knew they had a care plan, but they did not know if they had an assessment or had been involved in the care planning process. The person told us staff, “Treat you like an adult”. They told us they did not want to stop having the service and said, “I love it.”

Another person told us they had a care plan and had been involved in discussions about their care. They told us that staff treated them with dignity and asked them about their preferences. They also told us that the service arranged enough social activities in the community.

We spoke with three relatives. One relative told us their relative’s dignity and privacy were respected. The relative also told us staff provided support in a way that assisted their relative to be more independent. Another relative told us staff ensured that their relative’s dignity, privacy and independence were promoted and staff were caring and nice. However, the relative also told us there were not enough activities arranged during the day. Another relative told us that staff treated their relative with dignity and respect and explained to them who would be providing support. They told us their relative enjoyed a particular social activity and staff arranged for their relative to do this regularly.

People using the service told us their needs were met. They also told us staff checked to see how they were feeling and arranged for them to see other professionals such as their GP when appropriate. One person told us their needs had been assessed.

One relative told us their relative was well cared for and staff provided care that met their relative’s needs. Another relative told us their relative was well cared for and they had complete confidence in the service up to the time of our contact with them. However, they also told us there had been recent changes to the number of staff providing support to their relative during the night and they were not happy about this. Another relative told us that their relative was well cared for and “seems really happy.” They said, “It has not upset me to go in and see [their relative] and leave [their relative] behind. I‘m happy with the service. This is important.”

People using the service told us they felt safe and their belongings and finances were protected. Relatives we spoke with told us their relative was safe.

People using the service told us there were enough staff to meet their needs and staff were always available. One person said, “I have never had this much support.” They told us that agency staff were sometimes used, but said, “As long as I get the support I need, I don’t mind who. There have been others (agency), but this is fine.”

One relative told us there were enough staff to meet their relative’s needs. They told us they would be happy if the staffing levels were reduced in the future because this meant their relative was not needing so much support. Another person told us there were enough staff and said, “There seems to be plenty of staff. At least four or five people for the three flats when I visited.” However, one relative told us that staff were caring, but there were not enough of them.

People using the service told us staff were well trained and good at their job. One person told us they were, “Really good.”

One relative told us staff were not all well trained when their relative started to use the service, but they were now. Two other relatives also told us that staff were well trained and good at their jobs.

One person using the service told us staff asked them for their views on the service and they had no complaints so far. Another person said, “I think it’s a great service. I have never been happier.” They told us they knew how to make a complaint, but had never had to make a complaint.

One relative told us they had not received a survey form to complete, but had arranged to have weekly meetings with a manager to discuss the service provided for their relative. Another relative told us there were no group meetings for relatives and they had not received a survey form to provide feedback on the service. The third relative told us they had been invited to a meeting, but had not received a survey form. They told us they felt listened to and knew how to make a complaint, but had not made a complaint.

People who used the service understood the care choices available to them. We talked to five people who used the service. They said staff supported their choices about their care. One person said, “They listen to me. I get a choice of what I want to do”. People also told us that staff treated them with dignity and asked about, and respected, their preferences. People expressed their views and were involved in making decisions about their care.

People who used the service told us the care and support provided was good and they got on well with staff. We talked to five people who used the service. One person said, “The staff are very supportive and I know them all well. They help me when I need it.” We spoke with four relatives of people who used the service. All were positive about the care and support being provided. People’s needs and risks were assessed and care and support was planned and delivered in line with their individual care plans.

There were sufficient experienced staff to meet people's needs.

People were not always cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard as some staff did not receive regular supervision.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.