The inspection took place on 19, 20 and 24 September 2018. The provider was given notice as the location provides a domiciliary care service and we needed to be sure that a member of the management team would be available on the day. The previous inspection was carried out March 2016 and there had been no breaches of legal requirements at that time. We had no previous concerns prior to this inspection.

Silva Care Ltd provides personal care and support to people with a learning disability in their own homes and in shared supported living services. A supported living service is one where people receive care and support to enable them to live independently. People have tenancy agreements with a landlord and receive their care and support from Silva Care Ltd.

As the housing and care arrangements are separate, people can choose to change their care provider and remain living in the same house. Silva Care Ltd also provides short breaks in five properties across Bristol. Each property can accommodate between three and four people. People can receive personal care from Silva Care Ltd or from their own personal assistant. They also provide outreach services supporting people with learning disabilities to access day care services. This part of the business does not fall within the scope of registration.

There was a registered manager in post, they were also one of the directors for the company. We have referred to them as the registered manager throughout this report. 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 registered manager told us they were supporting at least 45 people per day in the supported living/short stay services and another eight people with support in their own home. The service employed 256 staff working across the company. Of the 256, 153 staff were working in services that were regulated by the Care Quality Commission.

The registered manager told us the ethos of the services was to ensure that the stay was not just about giving family carers a break it was also very much about the person having a good time and have opportunities to go out, socialise, meet up with friends, and develop and maintain independence skills. The staff all conveyed these principles telling us how they put this into practice. There was a ‘can do’ attitude to supporting people lead the life they wanted.

People were receiving care that was extremely responsive and effective and tailored to their needs. Care plans were in place that clearly described how each person would like to be supported. People had been consulted about their care and support. The care plans provided staff with information to support the person effectively. Other health and social professionals were involved in the care of the people and there was very much joint working with them and family. Safe systems were in place to ensure that people received their medicines as prescribed.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management and safe recruitment processes.

Staff received training and support, which was relevant to their roles. Systems were in place to ensure open communication including team meetings and one to one meetings with their manager. Staff were committed to providing a service that was tailored to each person they supported enabling them to plan and achieve life goals Such as seeking employment, gaining skills to enable them to live independently or participating in a certain social event.

People were involved in the day to day running of the ser

The inspection took place on 8, 9 and 10 March 2016. The provider was given notice as the location provides a domiciliary care service and we needed to be sure that a member of the management team would be available on the day.

Silva Care Ltd provides personal care and support to people with a learning disability in their own homes and in shared supported living services. A supported living service is one where people receive care and support to enable them to live independently. People have tenancy agreements with a landlord and receive their care and support from Silva Care Ltd.

As the housing and care arrangements are separate, people can choose to change their care provider and remain living in the same house. Silva Care Ltd also provides short breaks in five properties across Bristol. Each property can accommodate between four and five people. People can receive personal care from Silva Care Ltd or from their own personal assistant. They also provide outreach services supporting people with learning to access day care services. This part of the business does not fall within the scope of registration.

The registered manager told us the ethos of the services was to ensure that the stay was not just about giving family carers a break it was also very much about the person having a good time and have opportunities to go out, socialise, meet up with friends, and develop and maintain independence skills.

There was a registered manager in post, they were also one of the directors for the company. 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.

People were receiving care that was responsive and effective and tailored to their needs. Care plans were in place that clearly described how each person would like to be supported. People had been consulted about their care and support. The care plans provided staff with information to support the person effectively. Other health and social professionals were involved in the care of the people and there was very much joint working with them and family. Safe systems were in place to ensure that people received their medicines as prescribed.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management and safe recruitment processes.

Staff were genuinely caring and supportive and demonstrated a good understanding of their roles in supporting people. Staff received training and support that was relevant to their roles. Systems were in place to ensure open communication including team meetings and one to one meetings with their manager. Staff were committed to providing a service that was tailored to each person they supported.

People were involved in the day to day running of the service. People were valued and supported to be as independent as possible. People’s rights were upheld, consent was always sought before any support was given. Staff were aware of the legislation that ensured people were protected in respect of decision making and any restrictions and how this impacted on their day to day roles.

People’s views were sought through care reviews, meetings and surveys and acted upon. Systems were in place to ensure that complaints were responded to and, learnt from to improve the service provided. The service was committed to involving relatives in the delivery of care with good communication in place to ensure care was consistent when people moved from one service to home or to another service.

Regular coffee mornings were organised so family and friends could visit the services. The re

In this report, one of the registered managers, Linda Issac was not managing this regulated activity. Their name appears because they were still a registered manager on our register at the time.

We spoke with the registered manager who explained how they encouraged people that they provided services for to be involved in decisions about the service provision. They explained that their ethos was centred on empowering people to have greater independence.

The regulated activities we inspected were for personal care to people in shared houses (supported living), people in their own homes and in respite care services, and at the time of inspection, the service was providing this support to thirty three people.

We saw that people were actively encouraged to participate in a wide range of activities, and that 'taster' sessions were arranged

to help people make choices about future participation and involvement.

For each person receiving a service, there was a dedicated staff team to ensure continuity of care and a key worker system had been introduced recently, to ensure that care plan updates and risk assessments were completed as required, and to liaise with people and their families.

We spoke with a health professional who commented that the staff were "excellent and have a good understanding of the people they care for". Staff confirmed that they were well supported by their managers, and a relative said that the service was "brilliant".

We met with the four directors of the service. They told us how important it was for them to be able to provide a flexible service that met people’s needs.

We spoke with people who used the service in shared accommodation and in their own homes. People said they liked living in the shared house. People who received a service in their own home described the service as “absolutely wonderful, I can’t fault them” and “brilliant”. One person we spoke with said “I can’t praise them enough”.

Staff we met and others we spoke with by telephone were happy working for the agency. They told us how they could judge whether people were happy by their facial expressions and behaviour, about the care they provided and how they felt supported and had relevant training.

People were able to choose how they spent their time and if unable to give consent to care and treatment were supported appropriately. Care and treatment was based on people's assessed needs. Choice and independence was respected and influenced the way people were supported. Records underpinned the assessment and care planning process and people were involved in the development of their plans. There was good management of medicines and staff were trained to administer medicines safely. People's complaints were listened to and acted upon.

Staff were recruited based on the principles of equal opportunities with appropriate checks having been carried out before they started employment.

We spoke with people who used the service in their home who confirmed that the staff were very respectful towards them and that they felt consulted and involved in their individual care packages. They told us that the things that were important to them in relation to their care and support were established as part of their assessment. And that the support to meet those needs was provided in a sensitive caring manner.

People we visited in their own homes told us that they were happy with Silva Care care workers. One person told us “I have no complaints. The staff are very professional. They roll me properly. They hoist me properly. They always double check there are no creases in my bed so I am left comfortable. They always check the hoist. They are very safety conscious. The staff always check my skin to ensure that I do not get any pressure sores and contact the District Nurses if they have any concerns”. Another person told us that they were well looked after. “I am very happy with the care provided by Silva care staff. They are brilliant. I know the carers who visit me and I know I can rely on them to help me with my personal care needs”.

We visited four people who received a service and spoke to one relative who all confirmed that the staff were well trained and professional.

One person we spoke with said “I am very happy with care workers. They care for me well. They are never sharp or nasty. You could not fault them as there is nothing bad about them”.

When we visited another person at home we saw and heard the care worker speaking in a respectful, kind reassuring way. We heard them asking about what meal the person would like and observed them taking time to assist the person with every day activities in an unhurried way”.

We found Silva Care were compliant with the six outcome areas we looked at during this unannounced planned review.