We carried out this inspection on 6 January 2016. We gave the provider 48 hour notice before. When we last inspected the service 11 December 2013 we found them meeting the standards. At this inspection we found that they had continued to meet the standards.

The service provided care and support to adults with severe learning disabilities or autistic spectrum disorder in their own homes. At the time of the inspection the service offered support to 30 people, however only 10 people received care and support which involved an activity the provider was registered for with the Care Quality Commission.

There was a registered manager in post and they were also the director and the nominated individual for the company. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. However, in this instance they were the same person.

People who used the service, family members and external agencies were highly complimentary about the standard of support provided. The manager involved families and other agencies to ensure people received the support they needed to express their views and make decisions that were in their best interests. Relatives and professionals were very positive about the service people received. The service specialised in supporting adults with behavioural problems who had lived in large institutions for a long period of their life or had several failed placements prior being supported by Partners in Support.

Positive risk taking was driven throughout the organisation, balancing the potential benefits and risks of choosing particular actions over others, in order to support people to live fulfilling lives. In delivering this consistent approach people were supported to try new things and make changes in their lives. The registered manager and staff had an excellent understanding of managing risks and supported people that had previously challenged services to reach their full potential.

An outstanding characteristic for the service was the time spent developing ways to accommodate the changing needs of the people who used the service, using innovative and flexible ways to support people to move forward. The registered provider was seen to constantly adapt and strive to ensure people who used the service were able to achieve their full potential. Over a period of time we have seen people be supported to progress and their support plans and environment adapted and developed to promote their independence.

There was a robust recruitment procedure to help ensure the staff recruited were suitable to work with young and vulnerable people. People who used the service and their relatives were encouraged to participate in the interviewing process for potential employees. This demonstrated the service’s commitment to the culture of inclusion and participation within the service.

The manager ensured that staff had a full understanding of people’s support needs and had the skills and knowledge to meet them. Training records were up to date and staff received regular supervisions and appraisals. There was a well-established management structure in place which ensured that staff at every level received support when they needed it. Staff were clear about their roles and responsibilities and how to provide the best support for people.

People were at the heart of the service, which was organised to suit their individual needs and aspirations. People’s achievements were celebrated and their views were sought and acted on. People were supported by staff that were compassionate and treated them with dignity and respect. Without exception, people who used the service and their relatives we talked too were very complimentary and positive about the staff that supported them.

We saw people had assessments of their needs and care was planned and delivered in a person-centred way. The service had creative ways of ensuring people led fulfilling lives and they were supported to make choices and have control of their lives.

People participated in a range of personal development programmes. Individual programmes were designed to provide both familiar and new experiences for people and the opportunity to develop new skills. People who used the service accessed a range of community facilities and completed activities within the service.

People’s nutritional needs were well met and they had access to a range of professionals in the community for advice, treatment and support. Staff monitored people’s health and wellbeing and responded quickly to any concerns.

Care plans had been developed to provide guidance for staff to support in the positive management of behaviours that may challenge the service and others. This was based on least restrictive best practice guidance to support people’s safety. The guidance supported staff to provide a consistent approach to situations that may be presented, which protected people’s dignity and rights.

There was a strong emphasis on person centred care. Family members, social care professionals told us and all the care records showed that people’s needs were continually reviewed. The plans ensured staff had all the guidance and information they needed to enable them to provide individualised care and support. People and their family members were consulted and involved in assessments and reviews. Best practice guidelines were followed and the service was innovative and creative in its approach to support. The management and staff were not afraid to challenge decisions and advocate fully on behalf of the people they supported, often with excellent results.

People were active members of their local community and led busy and fulfilling lives. There was evidence of positive outcomes for people, and that people had pursued new opportunities, progressed over time, gained new skills and increased their independence. Due to the excellent support people received from staff they were doing activities they or their family never thought possible before. Activity programs were varied and personalised, these were designed to provide a variety of familiar and new experiences for people in accordance with their individual interests and abilities. People were encouraged and supported to engage with their local community through involvement in working for charities, the local coffee shop, regular swimming, and visits to local amenities such as pubs and leisure centres.

There was an extremely positive culture within the service, the management team provided strong leadership and led by example. The registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Their ethos was “To enable people with learning disabilities to determine the life they live and strengthen their community of family and friends.” Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people. Confidentiality was respected and independence was promoted. Young people who used the service were encouraged and facilitated to participate in discussions about their care and support.

The registered manager was an excellent role model who actively sought and acted on the views of people. People and their relatives without exception told us they thought the service was extremely well managed. We found all staff were very positive in their attitude to the company and their role and said they were committed to the support and care of the people. Staff said Partners in Support was different because the manager genuinely cared about all people and wanted to make a positive difference to people`s lives.

Systems to continually monitor the quality of the service were effective and there were ongoing plans for improving the service people received. The provider gathered information about the quality of their service from a variety of sources including people who used the service, their family and friends and professionals. The strong value based attitude of the registered manager and service managers, how they led through example best practice was implemented and followed throughout the service and staff felt motivated and well supported.

The service had developed and sustained effective links with professionals and this helped them have a multidisciplinary approach in supporting people. Their success in achieving positive outcomes for people and their ability to develop best practice led to them being asked to share their ideas to other organisations that supported people with disabilities. A manager from a different organisation wrote, “Just wanted to say a big thank you for inviting us to your Rumble awards, we had a great time and it was an inspirational evening. It was so lovely to see the people you support being recognised for who they are and their personal achievements, it’s clear you have a great team who support them very well. We have taken note for us of how to run a future Rumble awards night!! Well done and thank you to all your team who made us so welcome.”

At the time of our inspection on 22 November 2013 seven people received assistance with personal care. Due to people’s complex needs the majority of people who received a service were not able to share their views of the service with us. However, we met two people and spoke with the relatives of two other people who received a service from this provider. We also spoke with five staff and the manager.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One relative said, “It’s great that [the staff] want our involvement. They always ring and discuss things.”

Care was planned and delivered in a way that ensured people’s safety and welfare. Without exception people made very positive comments about the service they or their relative received from Partners in Support. One person’s relative told us the service was, “Brilliant, absolutely brilliant.” They said since receiving a service from this provider, the person had become “…more confident and happy.” Another relative told us, “I feel [the staff] always want the best for my [relative].”

People who received a service from this provider were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People told us they liked the staff who provided their care. People’s relatives told us that they had a stable team of staff who supported them. One relative commented that they felt the provider “Chose staff very carefully” and that this meant that the right people were recruited to work with the person. However, we found that people were not protected by the provider’s recruitment procedure because new staff provided care before a satisfactory criminal records check was obtained.

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