This inspection took place on 2 September 2016 and was unannounced.

SeeAbility Horley Support Service provides domiciliary and specialist support to young people with visual impairment and complex needs. The service is provided at Bradbury House, which is a building that provides supported living accommodation. Staff also provide an outreach service to people living in the community.

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.

Staff understood their role in safeguarding people. They had received training and demonstrated a good understanding of how they would protect people from abuse of potential harm. Staff routinely carried out risk assessments and created plans to minimise known hazards whilst encouraging people’s independence.

Policies and procedures were in place to keep people safe in the event of emergencies. People had individual plans to keep them safe in the event of an emergency and there were contingency plans in place.

The registered manager had a system in place to ensure appropriate numbers of staff were working to meet the needs of people. Checks were undertaken to ensure staff were suitable for their roles.

People were administered their prescribed medicines by staff who had received medicines training. Medicines records were up to date to ensure medicines were administered safely.

Staff training was tailored to the individual needs of the people that they supported. Staff told us that they had good access to training and people and relatives told us that staff were effective in their roles.

Staff provided care in line with the Mental Capacity Act (2005). Records demonstrated that people’s rights were protected as staff acted in accordance with the MCA when being supported to make specific decisions.

Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve outcomes for people.

People were supported to eat in line with their preferences and dietary requirements. People were involved in preparing their meals and staff encouraged people’s independence in preparing meals. The kitchen area was suited to people living with a visual impairment and contained assistive technology to allow people to be independent.

Staff treated people with dignity and respect. All caring interactions that we observed were positive and staff demonstrated a good understanding of how to respect people’s dignity.

Information in care plans reflected the needs and personalities of people. Staff had a good understanding of people’s needs and backgrounds as detailed in their care plans. People had choice about activities they wished to do and staff encouraged people to pursue new interests.

People were given the opportunity to provide feedback on the care they received through residents

meetings and keyworker sessions. Issues raised by people were responded to by management.

The registered manager had systems in place to monitor and ensure quality at the service.

Staff told us that they were well supported by management and had regular supervision.

People and relatives told us that they had a positive relationship with the registered manager.

We carried out an unannounced comprehensive inspection of this service on 8 July 2014 when we found breaches of legal requirements. Following this inspection the provider wrote to us to say what they would do in order to meet legal requirements in ensuring people were treated by staff in a respectful and dignified way and that the service was well-led by the registered manager.

We undertook this unannounced focussed inspection on 4 March 2015 to check the provider had followed their plan and to confirm they were meeting the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for SeeAbility – Horley Support Service on our website at www.cqc.org.uk.

People were seen chatting to staff in a relaxed, friendly manner and staff were engaged in activities and interaction with people in a way that told us staff knew people well.

Staff were heard to speak to people in an appropriate manner during our visit and the registered manager told us (and staff confirmed) they had received recent dignity training.

The registered manager said they had organised several training events for staff to remind them of the importance of engaging with people in a meaningful way.

The provider had taken all necessary actions to ensure they had addressed the breaches in regulation and we found them to be compliant in all areas.

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 unannounced inspection.

The service had a registered manager. 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.

SeeAbility – Horley Support Service, is a supported living service which provides specialist support for up to six young people with a visual impairment and complex needs. The service enables people to maintain and develop their skills and to become independent where possible. This could range from doing their own cooking, making decisions on activities, or working in a part time job. People had tenancy’s for their room and shared a communal lounge and dining area, as well as a kitchen. There were six people being supported by the service on the day of this inspection.

People and their relatives told us they felt they were safe in the hands of the staff. Records showed staff had received safeguarding vulnerable adults training and staff were able to tell us what they would do if they had any concerns. Staff were also able to satisfy us they had a good understanding of the Mental Capacity Act 2005 and knew when it would be appropriate to hold a ‘best interest’ meeting.

Support plans contained individual risk assessments in order to keep people safe and we observed during our visit there were sufficient numbers of staff on duty in order to support people when they needed it. Staff told us they felt they, “Work well as a team” to support people and keep them safe.

People were encouraged to make their own decisions about their food. Everyone participated in being involved in cooking or preparing their meals. Staff promoted a healthy eating regime for everyone and fresh fruit and drinks were available. One person said, “I like helping with the cooking.”

People had access to other health care professionals as and when required. This was recorded in their support plans. We saw, where appropriate, guidance from health professionals was followed by staff.

Those who could, told us they felt staff treated them with respect and dignity and they could have privacy whenever they needed it. However, we felt through observation staff did not always take the time to communicate with people in a meaningful way. We observed occasions when we felt staff did not understand or promote respectful behaviour or social interaction.

We spoke with a professional from a registered charity. They told us there was a good commitment from staff to ensure that when individuals received support from them (the charity), staff continued this support to ensure consistent and co-ordinated care.

People made decisions about their own care and treatment. For example, whether or not they wished assistance with personal care, or undertaking an activity. This was recorded in the records and people confirmed this. One person said, “I make decisions about what I want to do.” Relatives told us they were involved in reviewing the care and support provided to their family member.

Each person had a keyworker, and co-keyworker. This meant people were supported by staff who had the appropriate knowledge about each individual. One relative told us, “The staff know (my relative) very well.” Staff were encouraged to progress professionally and attend training appropriate for their role.

Everyone had an individual activity plan. This ensured they also had access to the community, friends and relatives. Two people worked at a local charity shop during the week. One of them told us, “I like working at (the shop) best.” There were also several volunteers involved with the service and activities were individualised to suit people’s needs and preferences.

People were given information on how to make a complaint. The registered manager told us there had been no complaints in the last 12 months. There was an accident and incident log which recorded details of any incidents, together with the outcome and action taken.

Those who could, told us they were encouraged to feedback their views of the support they received. This was done either through the formal annual survey or by speaking to the registered manager. They said the registered manager was very approachable and supportive and would act on any issues raised with them. Regular audits were carried out, which included a quarterly regional manager visit. This showed us the provider checked they provided support in an appropriate and safe way and where necessary, improvements were made.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We observed staff speak to people in a friendly and respectful manner. Staff demonstrated a good understanding of people's needs and their means of non verbal communication. At this inspection we saw that staff spent time interacting with people and they were supported to participate in a range of activities and social events.

Person centred care plans had been developed which were detailed and provided clear guidance for staff to follow which enabled them to deliver people's care. A person we spoke with said that they liked living in the service. We spoke with three people's relatives. They told us that they were happy with the care and support provided. They said that they were involved and kept update about their relatives care. Comments included, "I am very happy with the care", "the staff are good" and "Excellent Care".

Procedures were in place for safeguarding vulnerable adults from abuse and staff received up to date training.

The provider had systems in place to monitor the quality of the care and support that people received. The views of people and their representatives were gathered.

Staff we spoke to said that enjoyed working in the service and they felt supported by the manager.

Systems were in place to ensure that people received their medicines in a safe way.

“We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences.

We spoke with three people, who used the service. They all told us that they were very happy with the care and support that they received. They all said that the staff were kind. Two people said that the staff were always available to support them with their personal care.

We spoke with a relative of a person who used the service. They said that the staff had the right skills they were polite and they were satisfied with the care provided.