This inspection site visit took place on 4 and 6 September 2018. Both inspection visits were announced. The purpose for our second site visit was to review care records which were not available on day one.

This was the first inspection of Real Life Options - West Midlands Supported Living and Outreach Services since the change of location address from which the service operated.

The service is registered to provide personal care support to people in their own homes. At the time of our inspection 15 people used the service, seven of whom received support with personal care. The service employed 18 care workers, including a team co-ordinator and is located in Coventry in the West Midlands.

Real Life Options - West Midlands Supported Living and Outreach Services provides care and support to people who require their support at pre-arranged times and to people living in two ‘supported living’ settings who require 24hour support, so that they can live 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 service had a 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.

The provider and registered manager did not have sufficient oversight of the service and had not consistently met their regulatory responsibilities to ensure the quality and safety of the service provided was maintained and improved.

Risks associated with the delivery of people’s planned care had not always been assessed to ensure care workers had the information needed to keep people and themselves safe. The provider conducted pre-employment checks prior to care workers starting work, to ensure their suitability to support people in their homes.

The management team and care workers understood how to protect people from abuse and their responsibilities to raise any concerns. People felt safe with the care workers with whom they had built relationships. There were enough care workers to provide people’s planned care visits at the times they expected and for the length of time agreed to meet their needs.

The provider had not ensured people’s medicines were consistently managed and administered safely and in line with their procedure. Care workers competency to fulfil their role was regularly checked by a member of the management team. People received the support needed to maintain their health and well-being, including timely access to health and social care professionals.

Care workers completed an induction and training the provider considered essential when they joined the service. However, some care workers had not completed the expected Care Certificate in line with nationally recognised guidance. On-going training to ensure care workers updated and refreshed their skills and knowledge was not up to date.

The registered manager understood their responsibility to comply with the relevant requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible.

People’s care records were not always up to date or accurate. This meant care workers did not have the written information they needed to keep people and themselves safe, including in an emergency. However, care workers demonstrated a good understanding of the needs and preferences of the people they supported.

Care workers respected people’s privacy and dignity and, where possible, promoted their independence. People received their care and support f