We inspected the service on 23 November 2017. The inspection was announced.

This service provides care and support to people living in nine ‘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.

At our last inspection in August 2015, the service was rated 'Good'. At this inspection we found that the service remained 'Good’ in Safe, Effective and Caring and had improved to ‘Outstanding’ in Responsive and Well-led key questions.

The service had a registered manager in place at the time of our inspection. 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 remained safe because staff were aware of their roles and responsibility of how to support people to remain safe. The registered provider had systems and processes in place to support people from the risks of abuse and avoidable harm. Risks associated to people’s needs had been assessed and planned for and were reviewed to ensure staff had up to date information. People were supported to live in a safe environment. People received support from a team of staff that provided consistency and continuity. Safe staff recruitment checks were carried out before staff commenced employment and people who used the service and or relatives, were involved in the recruitment of staff. People received appropriate support with the administration, storage and management of their prescribed medicines. Staff were aware of the importance of infection control measures and had received appropriate training.

People continued to receive an effective service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported by staff that had received an appropriate induction and ongoing support and training. The registered manager used best practice guidance to develop and support staff to provide effective care and support. The principles of the Mental Capacity Act (2005) were followed when decisions were made about people’s care. People were supported to plan, shop and cook meals as fully as possible. Staff were aware of people’s nutritional needs and promoted health eating. Systems were in place to share information with external services and professionals when required. People received appropriate support to maintain their health. Staff worked with external healthcare professionals to achieve good health outcomes for people.

People continued to receive good care. Relatives spoke positively about the approach of staff whom they said were kind, caring and compassionate. People were involved as fully as possible in their care and support and staff respected their privacy and dignity. Independence was promoted and staff had a good understanding of people’s diverse needs, preferences, routines and personal histories. People were supported to access different types of advocacy support when required.

People received an outstanding responsive service. People were involved as fully as possible in their care and support. People’s support plans focussed on their individual needs, creating a per

We carried out an announced inspection of the service on 27 August 2015.

Reach Housing and Enablement Services provides support and care for people with a learning disability, autism, communication difficulty and complex behavioural needs, enabling them to live independent lives in their own homes. At the time of our inspection the service was providing the regulatory activity of personal care to 12 people.

Reach Housing and Enablement Services is required to 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. At the time of our inspection the service had a registered manager.

During our last inspection on 9 July 2014 we identified two breaches of the Regulations of the Health and Social Care Act 2008. This was in relation to assessing and monitoring of the quality of service provision and safeguarding people that used the service. The provider sent us an action plan detailing what action they would take to become compliant with these regulations. At this inspection we found the provider had made the required improvements. There were systems in place that monitored the quality and safety of the service. Additional audits and checks had been introduced and were working well. Staff had received further safeguarding training and additional systems had been introduced to monitor people’s safety.

At this inspection people we spoke with including relatives told us they felt staff provided a safe service and people were cared for appropriately. This included sufficient staff that provided consistent and effective care and support.

The provider ensured there were sufficient staff employed and deployed appropriately. People received support to meet their individual needs. Safe recruitment checks were in place that ensured people were cared for by suitable staff.

Staff were appropriately supported, which consisted of formal and informal meetings to discuss and review their learning and development needs. Staff additionally received an induction and ongoing training.

CQC is required by law to monitor the operation of the Mental capacity Act 2005 (MCA.) This is legislation that protects people who are unable to make specific decisions about their care and treatment. It ensures best interest decisions are made correctly and a person’s liberty and freedom is not unlawfully restricted. We found people’s human right were protected because the MCA were understood by the registered manager and staff.

People were supported with their dietary and nutritional needs and supported to access both routine and specialist healthcare services.

Staff received appropriate accredited training in the use of physical interventions. Risk plans were in place and were regularly reviewed. Behavioural management strategies provided staff with information about how to reduce anxiety that may cause risky behaviour.

People that used the service including relatives told us that they found the staff to be caring and compassionate. Additionally, relatives said that their family member was supported to lead full and active lives. This included participating in a variety of activities, interests and hobbies. Staff used effective communication and they understood people needs and what was important to them.

People’s support plans included information about what was important to them including preferences and routines. People and their relatives or representatives were involved in the development and review of support plans. Staff provided a service that was responsive to people’s individual needs showing a person centred approach to care and support.

Relatives and staff were positive about the leadership of the service and said the registered manager was very supportive, approachable and knowledgeable about people’s needs.

As part of the providers quality assurance checks they had been creative in how they gained feedback from people that used the service. People and staff were encouraged to be involved in the development of the service.

We carried out this inspection because we had received concerns about the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

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 who used the service, the staff supporting them and looking at records. We also spoke with the registered manager.

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

Is the service safe?

During our visit we met one person who used the service and spoke with the representatives of three others. We did this because the people who received personal care from the service could not share their views verbally with us. Everyone we spoke with said that their relative was safe and well looked after. They told us how they worked with the staff team to plan and review the service.

We spoke with staff who supported people who used the service and with team managers and the registered manager. They all told us they had the skills and knowledge to offer effective and consistent support.

We saw very detailed care plans were in place to identify how people’s needs should be met. Risk assessments supported activities and staff told us how they assessed how people were feeling before any planned activity went ahead. This meant they could reschedule if they had any concerns about how people would cope with it.

We found that there was confusion around some staff roles and responsibilities and this had negatively impacted upon the quality of the service provided. The policy to support professional boundaries was not being followed although staff told us that they were aware of it. This meant that people who received a service could not be clear about what support they could and could not expect.

Is the service effective?

We saw how the service had been developed around the needs of the people they supported. People’s health and care needs were assessed with the full involvement of relative and advocates when appropriate. This meant that people’s care and support needs could be met in ways that people preferred.

We saw records of how the agency worked with health and social care professionals as required. This meant they could be sure that they were providing consistent care and support.

Everyone that we spoke with was satisfied with the service that their relatives received. One relative told us, "I am extremely satisfied".

Is the service caring?

People who used the service were supported by staff who cared about them. We heard staff speak with people in a calm and reassuring way. They responded to requests for support in a timely manner. Staff told us how they supported people to make choices while not raising their anxiety levels. One relative told us, “The staff are brilliant. They are all so kind.”

Is the service responsive?

We saw how staff responded to people’s changing needs. We saw that they worked with health professionals and relatives to ensure that people’s needs were met consistently and appropriately.

We saw the registered manager had taken action when issues had been brought to their attention however the lack of regular monitoring of the service meant that they had not identified issues themselves and so not taken prompt action to reassure and support people who used the service.

Is the service well-led?

People who used the service lived in their own homes with varying levels of support. Some people required a high level of support to meet their personal care needs. These people were supported by a staff team that was managed by an onsite manager. Staff told us that these managers were effective and supportive. Some staff told us the registered manager was supportive however not all staff who worked for the service thought so. A lack of regular visits to services to assess and monitor the quality of the service provided meant that issues had not been identified and managed until they impacted upon people's quality of life. The registered manager had not worked effectively with social care professionals in relation to investigating concerns about the behaviour of named staff who worked for the service. They had not put sufficient safeguards in place to protect staff as professional boundaries were unclear.

Prior to our inspection we reviewed all the information we had received from the provider. As part of our inspection we spoke with two people who used the service. We also spoke with the registered manager, the training officer and five support workers. We spoke with two relatives about their views. We observed the support staff gave to people who used the service. We also looked at records, including care files of three people.

Where people did not have capacity to consent to their care the provider had acted in accordance with legal requirements and people received care and support which met their needs.

We found that appropriate arrangements were in place to manage people's medication and ensure they received medication they needed.

We saw there were systems in place to assess and monitor the quality of service provided and views of people who used the service and their relatives had been sought and acted upon.

We found the service to be well led and there were sufficient skilled and experienced staff to support people who used the service. A relative we spoke with told us, “The staffing levels are fine and if someone extra is needed it is never a problem, nothing is too much trouble. They know (name) so well, they are like a second family.”

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with four support workers, two members of the administrative staff and the registered manager. We also looked at some of the records held in the service including the care files for three people. At our visit to the office we spoke with two people who used the service and a relative and asked them for their views.

We found people gave consent to and were involved in making decisions about their care and support. A person who used the service told us, “Ten out of ten. I've moved on since I've been with Reach." A close relative said, “We are totally involved in everything that happens."

We saw that the provider had taken the appropriate measures to help protect people from abuse and staff were aware of their responsibilities in recognising and reporting any concerns.

Staff told us and records we saw showed they (staff) were well supported and trained to provide good quality care to service users.

We found the provider had good systems in place to regularly assess and monitor the quality of the service.