Our inspection of Pharos Supported Services took place on 21 December 2017. At our last inspection in January 2017 the provider was rated as ‘Requires Improvement’ in the key questions of Safe and Well Led. There were breaches in Regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found that the required action had been taken and the provider was now meeting the regulations.

This service provides care and support to 22 people living in six ‘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 no 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. However two managers were jointly responsible for the management of the service and one of these managers had submitted their application to register.

People were supported by staff who knew how to report concerns of abuse and had the knowledge to manage risks and keep them safe. There were sufficient numbers of staff available to support people and staff had been recruited safely. Medication records evidenced that medications had been given in a safe way.

Assessments completed took into account people’s needs under the equality act. People’s rights were upheld as they were supported by staff who understood the principles of the Mental Capacity Act. Staff received training and support in order to support people effectively and people were supported to access healthcare services where required.

People were supported by staff who were kind and caring. Staff respected people’s privacy and dignity. People had support with their communication needs and felt involved in decisions about their care. People were supported to maintain their independence where possible.

People were involved in the planning and review of their care. The provider was responsive in making changing to people’s planned care to ensure that people’s needs could be met. People knew how to make complaints and there was a system in place to investigate any complaints made.

Systems in place to monitor the quality of the service had not been completed consistently and areas for improvement had not always been acted upon in a timely way. People spoke positively about the management of the service and had been supported to provide feedback on their experiences.

The office inspection took place on 30 November 2016 and we visited people who use the service on 8 December 2016. The inspection was announced. We gave the provider short notice before our visit that we would be visiting to ensure the registered manager was available.

On 07 January 2016 we carried out a focused inspection because at the previous inspection on 21 October 2016 we found that the provider was not meeting all the regulations as a result we issued requirement notices. At this inspection we found that some improvement had been made but we identified that further improvements were required.

Pharos Supported Living is a domiciliary care service that provides care and support to people mainly in a supported living environment. This meant a number of people live in the same building but have different flats within the building. There is a communal room if people chose to use this; alternatively they have the same facilities in their individual flats as would a person living in the community. There were nine people living in two supported housing and one person living in the community. The support provided is for people who may have a learning disability, physical disability or autism. The service supports some people on a 24 hour basis and others who may require support with personal care needs at specific times of the day and/or night.

There were two registered managers in post who job shared. 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 were safely recruited with all the relevant checks completed to ensure that people were supported by staff that was suitable. The provider did not always follow their own procedure in ensuring that staff were competent before supporting people alone.

The provider had processes and systems in place that kept people safe and protected them from the risk of harm. Staff had received training and understood the different types of abuse and knew what action they would take if they thought a person was at risk of harm but was unclear how to escalate concern if the provider did not take action.

People had been involved in the planning of their care, the support of relatives and other healthcare professionals, to ensure that care was provided in the person best interest. The provider was aware of the action to take to protect people's legal rights.

Most staff received adequate training but not all training was thorough and staff competencies assessment and supervision were not always completed to ensure staff had the knowledge and skills to enable them to care for people in a way that met their individual needs and preferences.

Where appropriate people were supported to access health and social care professionals. Staff was caring and treated people with dignity and respect and people felt they could speak with the staff about their worries.

People were assisted them when they had given their consent. Care staff ensured that people who needed support with preparing meals and drinks received the support they needed.

Staffing levels and on call arrangements for the supported living accommodation was not always clear, to ensure adequate staff were available to support people.

There were systems in place to monitor the quality of the service provided but these were not always effective in identifying areas for improvement.

We inspected this service on 7 January 2016. This was an announced inspection and we telephoned the provider the day before our inspection to ensure we had an opportunity to speak with people who used the service.

The service was registered to provide personal care for people and we visited people who received support within their own flats; this was part of a complex which included a residential service managed by the provider.

The service did not have a registered manager, although we have received an application we are currently reviewing. 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 chose how to spend their time and staff sought people’s consent before they provided care and support. However, some people were unable to make some decisions and it was not always clear how decisions had been made in their best interests. Some people had restrictions placed upon them as they were not able to go out alone as they needed support to remain safe in the community. Applications had been made to review if these restrictions were lawful; although the provider had not considered how all aspects of support may be restricting people.

People were provided with opportunities to develop their interests and join in social activities and be independent. However, some people were not sure if they needed support for all activities and how this should be provided, as their care records did not include this information. Other people needed support as their behaviour may harm themselves or others. Support plans to guide the staff had not been developed to ensure care was given consistently.

People knew how to report concerns and staff knew how to keep people safe and helped people to understand risks. Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service.

People were supported to be responsible for their medicines. Staff knew why people needed their medicines to keep well.

People received an agreed level of staff support at a time they wanted it. People were happy with how the staff supported them.

People were helped to prepare and cook their own meals and people were responsible for shopping and planning their meals. People could choose their own food and drink and were supported to eat healthily.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 21 October 2015 and 2 November 2015. The inspection was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service incorporating supported living services for adults with learning difficulties and we needed to be sure that someone would be in. At the last inspection carried out in 09 January 2014 under previous inspection method, the provider was deemed compliant.

Pharos Supported Services provides personal care and support to people living in their own homes at Pedmore Walk. At the time of inspection, there were four people living in self-contained individual flats. Only one person received the regulated activity of personal care. The site had a shared lounge area in the form of a conservatory, a sleep in room for staff and a staff office on the ground floor.

Pharos Supported Services required a registered manager to be overseeing the service. 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 time of this inspection, there was no registered manager in post. Although the provider had employed a manager, the provider had not yet submitted their application for registration of the manager with the CQC.

The provider had effective systems in place that protected people from abuse and avoidable harm. Staff undertook risk assessments with the input of healthcare professionals. The manager had a clear understanding of what to do if potential abuse was reported to them.

Staff were recruited using thorough procedures and only after appropriate checks were completed. The service had appropriate levels of staff based on people’s assessed needs. People received care and support from staff that had the skills and knowledge to carry out their roles effectively.

Staff ensured that consent was obtained and people were involved in their day-to-day care. Appropriate actions were taken to ensure any restrictions in place on people’s movements were done in their best interests.

Our review of records and discussion with the provider indicated people, at the time of inspection, received their medicines as prescribed. People, were supported by staff, to access healthcare professionals when they needed to see them.

Staff treated people in a caring way and took account of their choices in the way they wanted support provided. Staff treated people with kindness and respect and maintained people’s dignity and privacy.

People who responded to the CQC survey felt that staff listened to and involved them in how they wanted to receive support. People also told us that staff responded quickly when they asked for support.

Staff we spoke with recognised the importance of knowing people’s routines, so that, people received personalised support.

Staff met with people regularly, took the time to get to know them and supported them in undertaking activities according to their hobbies and interests.

Systems were in place that supported and encouraged people to share their views of the service they received. However, we did not see that the views of relatives had been sought.

The provider had systems to monitor the quality of the service to help them in their efforts for improvements in quality of the service received by people but these were not always effective.

During the inspection we spoke with three of the four people that used the service, the manager and three support workers.

All the people that used the service told us that they were being cared for. One person told us, “They are looking after me.” We found that people received the care and support they needed in a safe way.

All the people that we spoke with said that they felt safe with the support workers that supported them. We saw that the provider had taken steps to ensure that people using the service would be protected from abuse.

All the people that we spoke with told us that the support workers were caring. One person told us, “The staff treats me very well. They are like family to me.” We found that staff were well supported to carry out their role to a good standard.

People using the service that we spoke with had no complaints about the service. We found that systems were in place to handle people’s complaints.