We inspected this service on 25 January 2017. This was an announced inspection and we gave the provider two days’ notice in order to arrange for staff to meet with us and to visit people in their own home. The service provides a domiciliary care service for adults with a learning disability in two houses in or near to Long Eaton. We call this type of service a 'supported living' service. People's accommodation was provided by a separate landlord, usually on a rental or lease arrangement. The service was solely responsible for the provision of the support service and not for the provision of the premises. The offices for the agency are located at the Petersham Community Centre. At the time of the inspection four people were being supported by the service.

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.

It was last inspected 29 April 2016 and we found that the provider was not always considering people’s capacity to make decisions for themselves. At this inspection we found that improvements had been made and people’s capacity had been assessed to make decisions. If they were not able to make their own decisions then they were made with people who were important to them in their best interest.

Quality systems were not always completed to ensure that the homes were well run. Some staff did not have the opportunity to attend team meetings to ensure they were providing a consistent approach to care.

People were kept safe by staff who understood their responsibilities to protect them. They were supported to make choices about their care and what they wanted to achieve. They planned their week to make sure they pursued their interests and did the activities that they liked. They had care plans in place to support this and they were involved in reviewing these regularly.

We saw that there were enough staff to support people and that those staff had been recruited following procedures to check that they were safe to work with people. They received training and support to ensure that they could support people well. We saw that they had positive relationships with people and that they used specialist equipment to assist people to make choices about their care. People were supported to make their own decisions about their care and support.

Risks to people’s health and wellbeing were assessed and actions were put in place to reduce them so that people could lead as independent lives as possible. Medicines were given to people safely and records were well maintained and managed. Staff supported people to maintain their health and to participate in managing their own wellbeing. We saw that people chose their own food and drink and were supported to have a balanced diet.

The manager was approachable and listened to people. This included responding to complaints and implementing actions from them.

We inspected this service on 29 April 2016. This was an announced inspection and we telephoned the week prior to our inspection in order to arrange home visits and telephone interviews with people. The service provides a domiciliary care service for adults with a learning disability within two houses in or near to Long Eaton. We call this type of service a 'supported living' service. People's accommodation was provided by a separate landlord, usually on a rental or lease arrangement. The service was solely responsible for the provision of the support service and not for the provision of the premises. People required 24 hour support and their support package was based on their individual needs. The offices for the agency are located at the Petersham Community Centre. The service is registered for community support . At the time of the inspection four people were being supported by the service.

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.

Staff had some awareness of the Mental Capacity Act 2005 MCA but the service had not assessed people’s mental capacity. The service had not kept records about this or consistently sought MCA assessments from the local authority.

Some people who used the service had a wide range of support needs, and required support from the service 24 hours a day. Other people were more independent and received support for just a few hours a day to help with their daily routines.

People were safe and staff knew what actions to take to protect them from abuse. The provider had

processes in place to identify and manage risk. People received care from a consistent staff team who were well supported and trained.

The provider had systems in place to support people to take their prescribed medicines safely.

People were supported with meals and to make choices about the food and drink they received. Staff supported people to maintain good health and access health care professionals when needed.

Assessments had been carried out and personalised care plans were in place which reflected individual needs and preferences. The provider had an effective complaints procedure and people had confidence that concerns would be investigated and addressed.

The service benefitted from a clear management structure. A range of systems were in place to monitor the quality of the service being delivered and drive improvement when necessary.

We found one breach 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.

We visited the main office and one of the supported living homes to check if people were being supported in a comfortable environment and having their needs met. We spoke with two family members who told us people were supported by care workers who they knew. We saw there were arrangements in place for medicines and for diet and nutrition. We saw people were provided with a choice of suitable and nutritious food and drink.

We found medicines held within the home had arrangements in place that were satisfactory and would keep people safe.

Family representatives told us they could approach care workers and knew they would be listened to. They told us they were satisfied with the service provided.

We looked at the support plans to see how people's wishes were included in the care provided to them. We saw people were asked to sign their care plans. One person’s relative told us, “I have complete trust in the staff and would expect them to do the right thing by my relative”. They told us staff knew their relative really well.

We spoke with one relative they told us, “staff understand my relative’s needs and will keep me informed at all times of any changes. I think they are marvellous”.

We tried to obtain direct quotes from the people we met but we were unsuccessful. We saw them in their home environment and they looked to be comfortable in their surroundings.

We spoke with one relative who told us they had no concerns about their relative’s diet. They told us, “my relative manages really well considering their difficulties. I think staff has the right approach for them”.

One relative told us staff managed to give their relative their medications really well. They would give them their tablets then with the next spoonful they would be given some food and checked to see that it was taken.

When we arrived people were out either at the day centres’ or out on other activities escorted by staff. We met people later on in the day.

We spoke with one relative they told us they were satisfied with the service provided, had no concerns because they regularly communicated with staff, found staff to be helpful in understanding their relative's care.

We met four people who received support from staff at the domiciliary care service. Due to people’s communication skills they were unable to communicate their experiences of care to us, but did appear happy and comfortable with the support provided to them.