This announced inspection took place on the 4, 6 and 7 December 2018.

Positive Community Care Limited is registered to provide two registered activities from the same location. At the last inspection on 27 June 2017 we inspected the regulated activity of accommodation for persons who require nursing or personal care and rated the service good in all key questions. At this visit we inspected the second regulated activity of personal care in Positive Community Care Limited domiciliary care agency. The service in relation to personal care relates to people living in their own houses and flats in the community and specialist housing. The service is for older people who may be living with dementia and younger people with mental health and/or other disabilities.

This personal care service provided care and support to people living in 18 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 supported living settings were situated across five local authorities.

Not everyone using Positive Community Care limited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection a service was being offered to 73 people however, only 5 of those people were being offered the regulated activity of personal care.

The registered manager had left the service in September 2018. 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. The provider had recently recruited an area manager who was intending to register with the CQC.

Whilst staff were offered an induction and shadowed experienced staff they were not always being supported to complete their training in a timely manner. Therefore, we could not be assured people living in some of the services were being supported by staff equipped with all the necessary knowledge and skills.

Although there was evidence of robust risk assessment in more established settings we found in a ‘newer’ setting that the risks to people had not been thoroughly identified and therefore measures to keep people safe were not in place and accessible for staff reference.

The provider was not always working in line with the Mental Capacity Act 2005 as they had not always taken the necessary steps to ascertain people’s capacity about their finances and had not ensured relatives managing their money had the legal right to do so.

The provider had systems in place to audit the medicines, incidents and accidents, safeguarding alerts and complaints. However, the above concerns had not identified and addressed in a timely manner.

People told us staff were friendly and caring. In almost all instances staff interactions with people observed and heard were positive and kind. People said staff respected their privacy and people were supported to be as independent as possible to uphold their self-respect.

Staff supported people to undertake a variety of activities at home and in the community. People’s diversity support needs were identified and they were supported in their cultural observances.

The provider assessed people’s needs prior to offering a placement and people had person centred care plans that informed staff how they wanted to be supported.

Staff administered medicines in a safe way and people were supported to access appropriate health care for both their physical and mental health.

Positive Community Care is registered to provide two regulated activities from the same address. These are accommodation for persons who require nursing or personal care (for a care home type of service) and personal care (for care to be delivered in people’s homes). During this inspection we only inspected the care home service.

The care home is registered for up to nine people with mental health needs. At the time of our inspection nine people were living in the home. The home consists of neighbouring properties in a residential area which have been adapted into one home. Bedrooms are arranged across the ground and first floor with two communal living areas, a dining room and large garden with sheltered areas.

At the last inspection in April 2015 the service was rated 'Good.' We found the service remained 'Good' at this inspection.

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.

People told us they felt safe living at the home. Staff were knowledgeable about how to protect people from avoidable harm and abuse. The service had robust systems in place to safeguard people from harm. Risks to people were identified during the assessment and care planning process and people were involved in developing plans to mitigate the risks they faced. People and staff told us they thought there were enough staff working in the home. Records showed staff were recruited in a way that ensured they were suitable to work in a care setting. People were supported to take medicines and medicines were managed in a safe way.

Staff told us, and records confirmed they received the training and support they required to perform their roles. People consented to their care, and where people lacked capacity to consent to their care appropriate authorisations were in place. Staff demonstrated they were knowledgeable about the Mental Capacity Act (2005) and understood its application. People told us they were given choice about their meals and records showed people were supported to eat a balanced diet in line with their preferences. People told us they were supported to have their health needs met and records showed the service escalated concerns about people’s health appropriately and supported people to access healthcare services as they needed.

People and staff told us they had the time to build up positive relationships with each other. Staff spoke about the people they supported with kindness and respect. People’s cultural, religious and relationship needs were supported by staff. People told us they felt that staff respected them and treated them in a way that maintained their dignity. People told us they were given privacy when they wanted it.

The home completed robust assessments of people’s needs before they moved into the home and people were involved in the assessment and care planning process. People were involved in regular reviews of their care. People were supported to attend activities in the local community and their independence in doing so was promoted by staff. People’s bedrooms were personalised to their tastes and people’s achievements were celebrated by the home. People knew how to make complaints and the provider had robust systems in place to ensure that people’s feedback was captured and acted upon.

People and staff spoke highly of the registered manager. There was a positive culture within the home which valued people as individuals and promoted their skills and achievements. There were systems in place to monitor and evaluate the quality and safety of the service. Records showed that clear actions were taken to address concerns and escalate issues where this was necessary.

At the time of our inspection there were seven people living in the home and one person was using the domiciliary care services (personal care for people living in their own homes) aspect of the Positive Community Care Limited.

We spoke with three people who use the service and five staff. We also contacted the representative of the person who uses the domiciliary care service, who provided us with information about the service provided to their relative. People who use the service spoke positively about the support they received from the staff. They said the staff were caring and gave them the support they wanted. Comments we received from people were “they are all lovely”, and “the staff are always ready to help”. People also told us they were able to spend their time as they wished, on their own, or in the company of other people.

We saw the people who use the service and the staff had developed positive relationships with each other and there was a relaxed atmosphere within the home.

People or their representatives were involved in identifying where they needed support and how this was to be provided. This was reflected in the care plans which detailed how people’s needs were to be supported by the staff. However, we found a lack of assessments carried out prior to people moving to the home, which did not ensure the home could meet their needs.

Staff received support and training to ensure they were competent to support people with their needs.

However, we identified that the staffing levels of the home were not sufficient to meet people’s needs and ensure that risks to people were minimised.

There were seven people living at the home at the time of this visit, three of these people were spoken with. We also spoke with the manager of the home, the deputy manager and one other member of staff. A visiting relative was also spoken with. No one was using the domiciliary care services (personal care for people living in their own homes) at the time of the inspection.

People were given choices and involved in their care. One person said "I like it here" and another said "the staff are good". People were encouraged to pursue their interests and care plans detailed people's needs and what action staff should take to meet these. People told us that they were involved in their care and able to express their views about life at the home.

The systems for storing and administering medication protected people from harm and encouraged people to maintain some independence in this area where appropriate.

There were sufficient numbers of staff on duty. However, staffing numbers had been reduced during the day which could potentially impact on the running of the home.

The records viewed were up to date, clear and had been updated to reflect people's changing needs as necessary.

This inspection took place on 15, 16 and 20 April 2015 and was unannounced. At the last inspection on 7 January 2014 we found the service was not meeting the regulations relating to staffing and assessment of people’s needs. At this inspection we found that improvements had been made in all of the required areas.

Positive Community Care provides accommodation and personal care to nine people and personal care to people either in their own homes or shared accommodation within supported living services. During our inspection we visited the registered care home and two supported living schemes. There were 18 people using the service at the time of our visit.

The service did not have a registered manager. The previous registered manager had left the service in December 2013. We had been informed about this by the provider in accordance with their responsibility as set out in our regulations. The provider was in the process of applying to be the registered manager. 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 using the service told us they felt safe and we saw there were systems and processes in place to protect people from the risk of harm.

Assessments carried out by the staff ensured that people’s needs were identified and met. Risks were assessed and reviewed regularly to ensure people’s individual needs were being met safely. Staff spoke confidently about people’s needs and treating each person as an individual.

There were sufficient numbers of staff to support people to live a full, active and independent life as possible in the home and community. Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Medicines were stored safely, and people received their medicines as prescribed.

CQC is required by law to monitor the implementation of the Mental Capacity Act (MCA) 2005 and the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and least restrictive way, when it is in their best interests and there is no other way to look after them. The service met the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Where people did not have the capacity to consent to specific decisions the staff involved relatives and other professionals to ensure that decisions were made in the best interests of the person and their rights were respected.

There was a programme of training, supervision and appraisal to support staff to meet people’s needs.

People were supported to keep healthy and well. Staff responded to people’s changing needs and worked closely with other health and social care professionals when needed.

Staff were caring, and treated people with dignity, compassion and respect. Care plans were clear and comprehensive. They were written in a way to address each person’s individual needs, detailed what was important to them, how they made decisions and how they wanted their care to be provided.

People were supported to access activities, education, employment and facilities in the local community, so that they developed their skills and independence. Opportunities were provided for people to be part of the local community and the service celebrated people’s achievements.

People, staff and families told us that the management team were open, approachable, inclusive, and supportive. There was a transparent and open culture within the service and staff were supported to raise concerns and make suggestions about where improvements could be made.

The provider regularly sought people’s, relatives and staff’s views about how the care and support they received could be improved. There were systems in place to monitor the safety and quality of the service that people experienced.