We undertook an unannounced inspection of Precious Homes, Flat1, Lavender Crescent. The service provides provide supported living for people with learning disabilities, mental health conditions, physical disabilities, and sensory impairments. At the time of our inspection there were 14 people using the service, eleven were residing in flats in Oster House and three people lived in the community, of which there were four people receiving personal care and support from this service in their own flats.

The service did not have 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. However, the manager of the service was at the time of our inspection in the process of registering to become the registered manager.

There were excellent systems in place to keep people safe from harm. Staff had undertaken risk assessments which were regularly reviewed to minimise potential harm to people using the service.

There were appropriate numbers of staff employed to meet people’s needs and provide a safe and effective service. Staff we spoke with were aware of people’s needs, and provided people with person centred care. Staff were well supported to deliver a good service and felt supported by each other and their management team.

The provider had a robust recruitment process in place which ensured that staff were qualified and suitable to work in the home. Staff had undertaken appropriate training and had received regular supervision and an annual appraisal, which enabled them to meet people’s needs. Medicines were administered safely by staff who had received training. Staff cared for people in a friendly and caring manner and knew how to communicate effectively with people. Staff supported people well and spent time with them.

People were supported to make decisions for themselves and encouraged to be as independent as possible. Where people were not able to make decisions for themselves, the provider had a system in place to ensure that, best interest decisions were made on their behalf which involved advocates and other professionals. People’s choices were respected and we saw evidence that people, relatives and/or other professionals were involved in planning the support people required. People were supported to eat and drink well and to access healthcare services when required.

The provider had a system in place to ensure that complaints were recorded and responded to in a timely manner as well as an effective system to monitor the quality of the service they provided.

This is a small domiciliary care service therefore the inspection team was made up of one inspector. We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

We found that the service was meeting all areas.

If you wish to see the evidence supporting our summary please read the full report.

You can see our judgements on the front page of this report.

Is the service caring?

We found that the people were cared for in their own homes and that care was planned in conjunction with the person who had as full as input into their care as their condition allowed. The staff were caring and kind. We observed interaction between staff and the people they cared for and saw that a relationship had developed between them. There was sufficient staff on duty to ensure that the staff had sufficient time to spend with the people to ensure their care was person centred and delivered in a manner that promoted their dignity.

Is the service responsive?

We were told by the people who used the service that staff endeavour to meet their needs in a safe manner. Some people who were using the service were preparing for a more independent life in the community. We were told that the staff encouraged them to develop skills to prepare for a more independent manner of living. The staff encouraged and trained the person to adopt living skills that would keep them safe.

We were told that staff made arrangement to encourage and facilitate the people to have a good social life and to accommodate their friends and family.

Is the service safe?

We saw that there was sufficiently appropriately recruited staff to meet the needs and wishes of the people. We saw that staff were aware of risk management and the balance between promoting independence and keeping people safe. Staff had been trained on positive risk management where people were encouraged to take reasonable risks so that their confidence and abilities improved. Staff had been trained to recognise and respond to signs and allegations of abuse. Medication was administered as prescribed.

Is the service effective?

Discussions with people and a review of care plans of four people showed that people or their families had been involved in establishing what care they needed and how they wanted it delivered. We saw that care plans gave detailed directions to staff to ensure the care they gave was effective this included how to interpret people’s body language. People had access to the local community, those who wanted to were encouraged and facilitated to have a social life in the community.

Is the service well led?

The service was managed in the best interests of the people who used the service. Staff told us that the manager was available to them should they need assistance. The manager supervised the staff while they were delivering care and if there were issues they were addressed straight away. Staff were well trained in all aspects of care delivery. The people told us that the manager was always there should they need anything. They said that the manager was easy to talk to and they were able to tell them if there was a problem.

There were systems in place to ensure the safety and welfare of the people. Care plans and risk assessments were reviewed regularly.

We visited both Treow House and Oster House to follow up the concerns regarding medication management as identified on the previous inspection. We spoke with two people using the service, five staff members and looked at the records for nine people using the service.

One person told us "I am settled here" and another said "I am having a party for my birthday".

Care plans were being updated and reviewed on a regular basis but one person did not have a care plan or appropriate risk assessments in place to manage the potential risks when they were away from the service.

We saw that the provider had made improvements in the management of medicines across the service, but there were still some concerns about the robustness of the systems at Treow House, that could have posed risks to the people there.

We visited the project Treow house in Houghton Regis on 20 August 2013, following concerns being raised by the local authority about the way medication was managed, the way incidents were reported, and the care people received and how staff were trained and supervised. We visited the provider at Oster house in St Albans on 28 August 2013.

During our visit to Treow house we observed people who used the service appeared positive about the care and support they received from staff. During our inspection we saw that people were encouraged to be independent in all aspects of their life. For example: with personal care, shopping and domestic tasks.

We observed that staff generally engaged positively with people. One person told us, “I had issues when I arrived here and did not like it but I have settled in well now and think that staff have supported me well.” Another person communicated that they were happy by smiling and told us they were looking forward to their holiday.

Likewise when we visited Oster house we observed positive staff engagement and people who used the service appeared happy and relaxed in their surroundings.

Prior to this inspection, we had been made aware that the local authority had some concerns about the care and welfare of people at Treow House. Although we did not observe any concerns on the day of our visit. There had been some serious incidents that involved people at the project.

On the two days of our inspection there were 24 people receiving personal care and support from this service in their own flats. 14 flats were in one building called Oster House in Hertfordshire and 14 flats in Treow House in Bedfordshire. The registered premise was at Oster House and the registered manager was present on both days.

The summary is based on what we found at the inspection by looking at records and what people told us about their experiences of the service. We spoke with seven people using the service, three relatives, eight support workers, three external health and social care professionals and three management representatives.

The inspection was undertaken by one inspector over two days and included visiting people receiving support in their own flats, contacting people by telephone and looking at records and systems at the provider’s offices.

Is the service safe?

People told us they felt safe. Safeguarding vulnerable adults from abuse procedures were robust and staff understood how to safeguard people they cared for. Systems were in place to make sure that managers and staff learnt from events such as accidents, incidents, complaints and whistleblowing investigations. This reduced the risks to people and helped the service to continually improve.

The service had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put into place to ensure that people's human rights are protected should their liberty be restricted in any way. Staff had been trained to understand when an application should be made and knew how to submit one.

The service protected people against the risks associated with the unsafe use and management of medicines.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

People who used the service told us they were treated with dignity and respect. Comments included, “I am always asked about what choices I want to make and I am always encouraged to make my own decisions.”

The service had sufficient staff to deliver care and support to adequately meet people’s needs. This meant the service had taken all reasonable steps to ensure people were protected from risk of harm. Sufficient, suitable staff were recruited appropriately to work with vulnerable people.

Is the service effective?

This service was found to be effective because we saw people were supported in a way that suited their personal needs and maintained their quality of life. People and their relatives told us they had been included in all decisions relating to the care they had received.

It was clear from our observations and from speaking with people and support workers they had a good understanding of people’s care and support needs and they knew them well.

People’s health and care needs were assessed and their care plans and assessments were reviewed weekly. This showed people were having care delivered effectively in accordance with their assessed needs.

Is the service caring?

We found the service was caring. People were supported by support workers who were understanding and sensitive to their needs. We were told by people and their relatives that support workers met their care needs in a way that was appropriate for them.

All of the people we spoke with were complimentary about the care provided by the service. People we spoke with gave examples of support workers going out of their way to meet their needs. For example, one person told us, “I never imagined I would have the ability to live in my own flat. My support workers have helped my confidence so much.”

Is the service responsive?

We found the service was responsive because the service had appropriate systems in place for gathering, recording and evaluating information about the quality and safety of the overall service.

Systems were in place to make sure the provider learnt from events such as accidents and incidents and this meant that risks were minimised. The service took account of complaints and comments to improve the service. We saw the complaints procedure which guided people on who to contact if they wanted to make a complaint. People we spoke with told us they knew how to make a complaint and they felt the service would be responsive if they raised a concern. People were assured the service acted upon complaints, which were investigated and action taken as necessary.

We found people’s personal care records were accurate and fit for purpose.

Is the service well-led?

We found the service was well led. Support workers and people who used the service told us they found the new manager very approachable. Comments included, "Our manager is very approachable" and “I am very well supported, our manager is always available for advice and support.”

Support workers told us they were clear about their roles and responsibilities. They demonstrated a good understanding of the ethos of the service. This helped to ensure people received a good quality service at all times.