Leatherhead Support Service is a domiciliary care agency. This service provides care and support to people living in a ‘supported living’ setting, 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. People using the service lived in ordinary flats and bedsits. Leatherhead Support Service provides a service to adults with a visual impairment and other medical conditions.

The inspection took place on 7 January 2019 and was unannounced.

Not everyone using Leatherhead Support Service receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, 13 people were receiving a regulated activity.

People were protected from the risk of abuse as staff were aware of safeguarding practices. Risks to people were identified and managed appropriately, and accidents and incidents were recorded so lessons could be learnt and the quality of the service improved. Staff carried out safe infection control practices and medicines were stored and administered in line with best practice guidelines. There were a sufficient number of staff to meet people’s needs and staff had been recruited safely.

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 to make healthy informed choices around meals and to be as independent as possible.

People were able to express their views and supported to make decisions around their care. The service had been proactive in approaching people about their end of life wishes which had been recorded.

Care plans were person centred and recorded people’s aims which staff supported them to achieve. People received information in their preferred formats. We did not view any pre-assessments as there had been no new people joining the service since the last inspection.

Staff were up to date with mandatory training and received regular supervision. Communication between staff was effective. Staff respected people’s privacy and dignity. People were treated in a kind, caring and respectful way by staff.

People had access to healthcare professionals and specialist teams who were part of a person’s review process. Feedback was gained from people, relatives and staff on a regular basis and they in turn felt the manager was approachable. The service had made alterations to the deployment of staff to ensure that they could meet the changing needs of the people who used it.

The service had received compliments from relatives. People and relatives knew how to raise a complaint if needed. Robust quality audits carried out by people and staff identified any issues in the service and these were resolved in a timely manner. There was close partnership working with stakeholders and other organisations. The manager knew of their responsibility to make the Commission aware of all notifiable incidents.

The Leatherhead Support Service supports 29 people in 16 self-contained single flats and eight double occupancy flats. People had access to the adjacent SeeAbility resource centre, which provides a range of learning and leisure opportunities. The service provided support for people in tasks such as cooking, shopping and personal correspondence. There were ten people at the time of inspection who received support with their personal care.

The service supported people with who had a visual impairment and who may also have had a learning difficulty, physical or mental health disabilities and health conditions associated with ageing.

The registered office was on the same site as where people lived. This meant that the management and the carers were based on site.

The service has a registered manager, who was present on the day of the inspection visit. 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 and associated Regulations about how the service is run.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

There were sufficient staff to keep people safe. There were robust recruitment practises in place to ensure that staff were safe to work with people.

Staff had written information about risks to people and how to manage these. Risk assessments were in place for a variety of tasks like personal care, activities and the environment and were updated frequently.

People’s human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 was followed. Staff assumed capacity for people to make decisions regarding their care, unless proven otherwise.

People had sufficient to eat and drink. People were supported to prepare, menu plan and cook healthy meals in their own flats.

People were supported to maintain and improve their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. There was a training programme in place and training to meet people’s needs. Staff received regular supervision.

Positive and caring relationships had been established. Staff interacted with people in a kind and caring manner.

People, staff and other professionals were involved in planning people’s care. People’s choices and views were respected by staff. People’s privacy and dignity was respected.

People received a personalised service. Staff knew people’s preferences and wishes and they were adhered to. People were supported to develop and maintain their daily living skills to promote their independence.

People told us that they led in their care. Their care plans were very person centred and contained clear, detailed information telling staff what support people wanted and how they wanted it.

The service was very well led. The service listened to people and staff views. The management welcomed feedback from people and acted upon this if necessary. The management promoted an open and person centred culture.

The registered manager actively sought, encouraged and supported people’s involvement in the improvement of the service. People were involved in the recruitment and selection of staff.

There were robust procedures in place to monitor, evaluate and improve the quality of care provided. The registered manager was continually looking for ways to improve the service.

Staff were motivated, passionate and aware of their responsibilities. The registered manager understood the requirements of CQC and sent appropriate notifications.

People told us that they were happy with the service received. One person said, "Staff are very professional, kind and caring, if they can help you, they will”. Another stated, " The staff are respectful of my home and wishes. They are all very good and know what they are doing". We found that people’s needs had been assessed and were being met in ways ensuring their safety and wellbeing.

People felt the service met their care and support needs and told us that staff acted with their consent. One person commented, "They don't do anything without getting my agreement first." Another stated, "Staff encourage me to make my own choices. Changes to my support plan are agreed with me first."

We found that staff had received training to ensure their competence in supporting people with their medication; also, to help them manage complex health conditions. Records showed they had received training and refresher training relevant to their roles. We saw that the learning and development needs of new staff had been identified. Staff said communication systems worked well. They felt supported by good management, supervision and appraisal systems.

We found quality assurance systems to be effective. They underpinned continuous service development and improvement. Information about people's experiences had been sought and used to monitor risk and the quality of service provision. Emergency procedures were in place.

People using the service told us that permanent staff were polite and helpful. They said that staff treated them with respect and provided support in the way that they needed. One person said, “They’re good, they do a lot for us. I like them.” People told us that staff helped them manage the aspects of their lives in which they needed support. One person said, “They help me with my laundry, making the bed and doing my ironing. I love my flat and they help me keep it clean and tidy.”

All the people we spoke with told us that they had been given information about abuse and how to raise a concern if they needed to. They said that they had opportunities to give their views about the service they received and that their opinions were listened to and acted upon. They said that they were encouraged to contribute to their reviews and to talk about any changes they wanted. Some of the people we spoke with said that they had voiced concerns in the past about the support provided by agency staff when permanent staff were not available. The provider was able to demonstrate how they had responded to these concerns and improved the outcomes for people who used the service.