This inspection took place on 29 June 2017 and was announced. The inspection was carried out by one adult social care inspector. We gave the provider 48 hours’ notice of the inspection to ensure people we needed to speak with were available. The service supports people with a sensory disability and other complex needs. People live in self-contained flats, in supported living accommodation. At the time of the inspection the service was providing the regulated activity of personal care to ten people.

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.

At our last inspection in April 2015 we rated the service overall as Good. However, at that inspection we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the records were not fully effective in supporting staff to monitor people’s health needs around fluid and nutritional intake.

Following that inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of that regulation. At this inspection we saw the provider had taken the action they had identified in their action plan. As a result improvements had been made and the service was no longer in breach of this regulation.

As a result of this inspection we have rated the service Good.

Why the service is rated Good

The registered manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, plans were in place about how to manage, monitor and review these.

People were supported by the service’s recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

Staff had the knowledge and skills they needed to carry out their roles effectively. They were supported by the provider and the registered manager at all times. Staff had completed nationally recognised qualifications in health and social care and others were in the process of completing these.

People received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care arrangements amended to meet their changing needs. The service was flexible and responded very positively to people’s requests. People who used the service felt able to make requests and express their opinions and views.

People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions Mental Capacity Act (MCA) 2005 best interest decisions had been made.

People benefitted from a service that was well led. The vision, values and culture of the service were clearly communicated to and understood by staff. The registered manager had implemented a programme of ‘planned growth’ that had been well managed and they were committed to continuous improvement. The registered manager demonstrated strong values and, a desire to learn about and implement best practice throughout the service.

The registered manager demonstrated a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service.

Further information is in the detailed findings below.

The inspection took place on 16 April 2015. 48 hours’ notice was given to the provider in order that arrangements could be made to speak with people who used the service. The last full inspection took place in June 2013 and five breaches of regulation were found. This included a warning notice being issued in relation to records. The warning notice was followed up in August 2013 and the regulation found to be met. A further visit took place in February 2014 and the regulations were found to be met.

The service supports people with a sensory disability and other complex needs. People live in self-contained flats, in supported living accommodation over two locations in Filton and Henbury. We visited the office at the Henbury location but spoke with people who lived across both sites.

There was a manager in place at the service who was in the process of registering with the Commission. 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.

Overall the service provided good care and support; however we found that record keeping could be improved further to ensure that people’s health needs were effectively monitored. Particularly in relation to monitoring of people’s food and fluid intake.

There were significant staff vacancies at the time of our inspection and plans for recruitment were on going. The manager was minimising the effects of staff vacancies on people, by using regular bank and agency staff.

People received care from staff who were kind and caring in their approach. People were supported to be independent where possible and were treated with dignity and respect. People were involved in the planning of their own care through attendance at planning meetings.

People’s rights were protected in line with the Mental Capacity Act 2005. Staff attended best interest meetings when making significant decisions about a person’s health or treatment. Visual materials were used to support people as far as they were able in understanding and participating in the decision.

Staff understood people’s individual needs and preferences and these were clearly documented in people’s support plans. People cultural needs were considered when recruiting staff to support them. Any concerns or complaints that people had were logged and responded to.

Staff were well supported in their roles through supervision and training and all felt confident about raising issues of concern. Senior staff were open and transparent about the issues that had faced the service and what needed to be done to improve the service further. This was set out in a clear action plan for improvement. We saw that items on the action plan were being worked towards at the time of our inspection. This showed that the service was well led and proactive in seeking to improve.

We inspected SeeAbility Bristol Support Service on 6 June 2013 and found non –compliance in the area relating to care and welfare, the management of medicines, safeguarding people from abuse and assessing and monitoring the quality of service that people received. This was a follow up inspection to check compliance against these areas. We spoke with the manager and two members of staff during the inspection. We also spoke with three people who used the service.

People told us they felt they were involved in planning their care. One person told us “I am very much involved in writing my care plan. Staff worked with me to develop my care plan. This is to make sure I have the right staff who know how to support me”.

The records we saw for assessing risks had been regularly reviewed. This meant that the information about the welfare and safety of people using the service was accurate. The provider had made changes in the way safeguarding incidents were reported to ensure they were improved and monitored. We saw that the local authority had been notified of incidents that impacted on the health and safety of the people who used the service.

We found that people were protected against the risks associated with medicines. We spoke with three people who used the service. They were satisfied with the service they received in regards to their medication administration.

We also saw that the views of people using the service were considered and acted on.

We undertook an inspection on the 7 and 10 June 2013 where we found the provider was not meeting one of the ‘Essential Standards of Quality and Safety’. Following which we served a warning notice to the provider on outcome 21, ‘Records'. We informed the provider they had to be compliant with this essential standard by 9 August 2013.

The provider sent us a copy of their action plan and kept us informed of their ongoing progress in respect of meeting the action plan. This included sending us supporting documents to demonstrate compliance. The purpose of this inspection was to check that the necessary improvements had been made.

We spoke with the registered manager who told us about the progress they had made to improve the service since our last inspection. We were told that the service had employed a fulltime administrator. They were also in the process of recruiting an additional full time deputy manager for a period of six months to provide additional support to the management team.

Staff told us that the service had improved since the return of the registered manager. This was confirmed by speaking with people who used the service. Senior staff told us that they felt that they had the right support and resources in place to ensure further improvements in the service they provided.

All the records we viewed during our inspection were accurate, up to date and fit for purpose.

People lived in their own fully equipped flats within the service.

We spoke with three people, looked at three care records and made observations throughout the day.

People who used the service told us that they were treated with respect. Each person we spoke to said they were happy to live there. One person said he “never wanted to leave”. People were encouraged to be responsible for upkeep of their flat and did all their own cooking and cleaning with support from their staff team.

We saw that staff were polite and professional. They respected people's privacy and dignity at all times. All information was clearly communicated in order to provide good continuity of support. We saw that everyone’s care records were an accurate reflection of people's support needs and how those needs were met.

People were involved in recruiting and training their own support teams. One person said they were “listened to”. Another person told us that they were given “time to make their own decisions” and that they were able to talk to staff if they had concerns.

All staff received safeguarding training and people in the service felt safe.

People told us that they were very happy with the support they were receiving. People told us that staff were good and that they felt safe in their houses. They said that they would talk to the manager and staff if they were not happy.

People who use services told us that staff were good and that they were treated with dignity and respect and had a choice to undertake any activity of their choice. People said they were registered with a General Practitioner for their health needs and were supported to be as independent as possible.

People told us that their overall experience of the service was very good and that the agency looked after people very well. We observed staff interacting with people who use services in an informal and respectful way.

People told us that they were very happy with the support they were receiving. People told us that staff were good and that they felt safe in their houses. They said that they would talk to the manager and staff if they were not happy.

People who use services told us that staff were good and that they were treated with dignity and respect and had a choice to undertake any activity of their choice. People said they were registered with a General Practitioner for their health needs and were supported to be as independent as possible.

People told us that their overall experience of the service was very good and that the agency looked after people very well. We observed staff interacting with people who use services in an informal and respectful way.

The service provided support to people who lived in their own flats across two sites. During our inspection we visited the support office and spoke to people using the service and staff. During the course of our inspection visit two people began to receive a service from the agency making the total number of people supported by the service sixteen.

During our inspection we looked at three people's care records. We saw that records of assessment were not present in two of the viewed care records. Senior staff told us that assessments were carried out on everyone who was referred to the service. The service was unable to provide us with the assessments for these two people. This meant that it was not clear as to whether the service was meeting all of these people's assessed needs.

We found that there weren't safe systems in place for managing people's medication. Staff were not following the guidance in the provider’s medication policy.

Staff and people using the service were provided with information on how to raise safeguarding concerns. However, our review of people’s records found that some incidents that should have been reported to the local safeguarding authority were not.

We found that systems in place for monitoring the service were not always effective.

Records were not completed in many areas of the service. This meant that people were at risk of receiving inappropriate care and support due to records not being completed appropriately.