What life is like for people using this service:

People told us they felt safe. They were protected from potential abuse and discrimination. Risks to people were identified, assessed and action taken to reduce these or remove them. People lived in a clean and safe environment. Medicines were managed safely and staff provided the support people needed to take their medicines as prescribed. Enough suitably recruited and skilled staff were deployed to meet people’s needs.

People’s health needs were assessed and people had access to a variety of healthcare professionals to support them. People were provided with the right amount and type of food to meet their health needs, and people were supported to do their own food shopping and prepare their own meals. People’s religious preferences were being met. At the time of our visit there were no diverse cultural needs requiring support, but staff explained that this would not be a problem if there were; these would be respected and met.

The principles of the Mental Capacity Act 2005 were followed. People were supported to make independent decisions and their care was delivered in the least restrictive way possible. The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

For people living in their own home or in shared domestic settings, this would be authorised via an application to the Court of Protection (COP).

Staff were kind and caring towards people. They maintained people’s dignity and privacy. People’s choices, preferences and wishes were known to the staff who had taken time to find these out. Care plans gave staff guidance on how to meet people’s needs. Further detail about people’s care needs was also communicated to staff by means of staff handover meetings and daily notes.

The service had a registered manager in position. 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.

Rating at last inspection:

The last inspection was in August and September 2016 when the service was rated as ‘Good’ overall. At our previous inspection, the Responsive domain was rated as ‘Requires Improvement’ because some people were not supported to reach their full potential. Goals in people’s support plans were not updated or reviewed for long periods of time to show any outcomes or completion dates. The service had made improvements and this is now rated as Good.

The service remains ‘Good’ overall.

Why we inspected:

This inspection was partly prompted by quality concerns from a visiting health professional and this indicated potential concerns about the management of risk in the service. We looked at the concerns identified and all the associated risks.

About the service:

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

Not everyone 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.

Further information is in the detailed findings below.

This inspection was announced and carried out on the 31 August and 1 September 2016. We gave the provider 48 hours’ notice of the inspection to ensure that the people we needed to meet with were available. The last inspection was in August 2014 and one breach of a legal requirement was found at that time. This was regarding the risks associated with the unsafe use and management of medicines. The provider had provided an action plan and had resolved the issues. Medicines were checked and were safe.

Royal Mencap is a domiciliary care service that provides personal care to people with a learning disability to enable them to live as independently as possible either on their own or sharing houses with others. People have a tenancy agreement for their housing and receive their care and support from Royal Mencap. The support hours provided varied depending on the person’s needs. At the time of the inspection six people were using the service in two shared houses.

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.

There had been a change in management in the last six months and a new service manager had been appointed in March 2016 to support the registered manager. An assistant service manager had also been appointed and started employment in June 2016. People, staff and relatives told us the service had changed a lot since the new managers had been recruited and that previous to this they felt the service was not working. Everyone we spoke to said they felt more able to share concerns and were confident they would be listened to. The service manager told us about changes they had made following feedback from people and staff. The service manager was open with us about elements of the service that still needed improving. The initial focus had been on making the service safe and now the quality of care and staffing issues were being addressed.

From looking at the accident and incident reports we found the registered manager was reporting to us appropriately. The provider has a legal responsibility to report certain events that affect the wellbeing of the person or affects the whole service.

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment.

There were enough staff on duty to meet people’s needs and staff had time to sit and talk with the people they were supporting. The number of staff needed for each shift was calculated by taking into account the level of care commissioned by the local authority and knowledge of the activities that took place each day.

Staff received appropriate training which was relevant to their role. Staff received regular supervisions and appraisals; however some newer members of staff said they would like to have had more face to face meetings. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) but many of the staff team had not received any training in this. This training had been booked for October 2016 where we were assured everyone would attend.

The service was caring. People and their relatives spoke positively about the staff. Staff demonstrated a good understanding of respect and dignity and were observed providing care which promoted this.

The service was sometimes responsive. People using the service and staff had raised concerns and these had taken a significant amount of time to be dealt with appropriately. Relatives said the change in management had made significant improvements by the service manager communicating more with people and their relatives. The compatibility of people living together had changed

We met with people in their own homes in order to ask about their support and gauge their opinions about this service. We also spoke with managers and staff during our visit.

People told us that staff them knew them well and treated them well. One person told us that "the staff are very nice". Another person said staff were "kind and helpful".

People were positive about the support they received from the service. People told us they were able to live their lives as they wished and were helped to do so by staff who supported them.

People said that they felt safe and knew what to do if they had any worries. One person told us "I'd talk to staff".

The service actively listened to the views of people and their relatives

We spoke with three people using this service and two staff during our inspection. People told us that they were pleased with the service that they were receiving. One of the people we spoke with told us “I am happy with my care and happy with staff”.

The care plans were comprehensive and user friendly. They contained enough information to allow staff to provide care in line with the needs and preferences of the person. We saw evidence of staff consulting with people to gain their consent and encourage independence. Tenant reviews were used to get regular feedback from people using the service.

People told us they felt safe and staff felt able to report any safeguarding concerns as required. Staff knew the local safeguarding processes and had followed these when required.

Staff told us that they felt well supported and had access to high quality training. Staff records showed that all staff had up-to-date training in all mandatory training topics. One member of staff said they “had a lot of training” and that it was “generally very good”.

The provider had good quality management systems in place that seemed comprehensive and user friendly. Complaints and incidents were seen as a learning opportunity and were acted on appropriately.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. This was an announced inspection.

Royal Mencap Society - Suite 6 Canterbury Business Centre is a domiciliary care service providing support to people with a learning disability to enable them to live their lives as independently as possible. Support includes help with personal care and skills such as shopping and banking. The support hours provided varied depending on the person’s needs. At the time of our inspection, 21 people were being supported with personal care, some in a supported living type service. A registered manager was employed by this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People’s safety was being compromised in a few areas including the way medicines were not being stored and recorded. This was a breach of our regulations. You can see what action we told the provider to take at the back of the full version of this report. A few health action plans were missing relevant information. Risks were managed in a way that balanced people’s right to make choices with their right to be safe and people were encouraged to make informed choices about risks.

People using the service and their relatives were positive about the service they received. People were treated with kindness and respect. We saw relaxed and friendly conversations taking place. Staff told us they would challenge poor practice. They had helped to empower people using this service and their relatives to do the same. Staff were well trained and supported to provide good quality care. People were encouraged to take part in the care planning process and to actively feedback on the support they received.

Sufficient numbers of staff were available to keep people safe and meet their needs. The use of agency staff had, however, reduced staff consistency and this had in turn negatively impacted on people’s care. Some people were not being supported to reach their full potential. The goals in some people’s support plans were not focussed on their priorities and others had no record of review or progress for over 18 months. Staff told us they aimed to help people live as independently as they were able. Some people told us about the paid work they were doing, the new skills they had learned and the important relationships they had with other people. People also had plans for the future which they looked forward to achieving.

The registered manager and provider had governance systems in place to monitor the quality of the service provided. These systems had, however, not identified the concerns we found around medicines management and supporting people to achieve their goals. There was a learning culture where staff and people were encouraged to comment on the running of the service. Permanent staff received the line management and support they needed to care for people competently. Staff without permanent contracts did not receive the same line management input from their managers which could make it more difficult to identify and address poor practice.