About the service: Special Needs Care Limited is a supported living service which is registered to provide personal care for people with learning disabilities who live in their own homes within the local community. Support in everyday activities can be provided, which helps people to live as independently as possible. The service was providing personal care to approximately 80 people at the time of the inspection.

People’s experience of using this service:

People received safe and effective care from staff that were caring and focussed on upholding the rights of the people they supported. Care plans were person centred and covered all aspects of people’s lives, needs, preferences and daily routines. People’s needs had been fully assessed prior to the service providing support. Staff had a detailed knowledge of the people they supported and had developed positive relationships with them.

Safe recruitment practices were in place ensuring that vulnerable people were supported by suitable staff. Staff received training relevant to the needs of the people supported ensuring that support was effective. Sufficient staff were employed to meet the needs of the people supported and these were regularly reviewed. Staff were supported through regular supervision and team meetings.

Risks that people faced in the support they received and from their wider living environment were recognised and mitigated. People were protected from abuse through staff training and robust policies and procedures.

Medicines were safely managed. Where any errors had been identified, swift action was taken to ensure that people’s health was not harmed and staff competency was in place. The registered provider had systems in place to enable people being supported were not at risk of infection.

People were supported by staff who were very familiar with their needs. People were encouraged to use appropriate methods of communication so that they could make their needs known. People spoke positively about the staff and others who had limited communication responded to staff and appeared comfortable with them. Care plans sought to maximise people’s independence in their lives.

People were supported to pursue their chosen activities both within their homes and in the wider community. Appropriate support was provided for this.

People who used the service received support that was well organised and subject to checks to ensure that the quality of support met people’s needs.

The service met characteristics of Good in all areas, more information is in the full report.

Rating at last inspection: Good (report published 10 August 2016).

Why we inspected: We inspected the service as part of our inspection schedule methodology for ‘Good’ rated services.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This was an announced inspection, carried out on the 20 and 21 July 2016.

Special Needs Care Limited is a supported living service which is registered to provide personal care for people who live in their own homes within the local community. Support in everyday activities can be provided, which helps people to live as independently as possible.

There was a registered manager in post at the service. 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.

We last inspected this location in July 2014 and we found that the registered provider met all the regulations we reviewed.

People told us that they felt safe using the service. The registered provider had a robust process for in place for staff to report any concerns they had and to r ensure people were protected from abuse. Staff had been provided with safeguarding adults training and were able to clearly describe what was meant by abuse. Staff told us they would not hesitate to raise any concerns and they felt confident that they would be dealt with appropriately.

The risks relating to people's health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

Robust recruitment processes were followed and there were sufficient qualified, skilled and experienced staff on duty to meet people’s needs. Staff had enough time to enable them to spend quality time engaging with people.

There were safe systems in place for the management of medicines. Staff received appropriate training in the administration and management of medicines. People were supported to take their medication as prescribed. Staff ensured that there was an accurate record kept of medication administered to people. People’s medicines were securely stored in locked cabinets, which was accessed by designated staff.

Staff were well supported through regular supervisions and team meetings. The registered provider ensured that a thorough induction process was undertaken and staff had regular access to appropriate training to support them to be effective in their roles. The registered provider encouraged staff to access higher level qualifications in health and social care as part of their ongoing development.

The registered manager had a good knowledge of what their responsibilities were for ensuring decisions were made in people’s best interests. Staff were trained in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and showed a good understanding of the importance of involving people in decision making and seeking consent in their day to day support.

Staff were caring and they always treated people with kindness and respect. Observations showed that staff were respectful of people’s privacy and dignity and encouraged people to maintain their independence. Relationships with family members and friends were encouraged and promoted.

Staff were skilled in recognising and using peoples preferred method of communication. People who were not able to communicate verbally were able to make their wishes known to staff through the use of signs, noises and body language. Staff were responsive to people's communication styles and gave people information and choices in ways that they could understand. Creative approaches to communication were used to successfully support people through periods of change and bereavement.

People and their relevant others were involved in the development and review of their care plans. Information was personalised and focused on promoting people’s choice, independence and

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

The service provides support to people living in ten properties around Chester. We visited two of the properties where staff from Special Needs support people and spoke to relatives of people who received support in two other properties. We also received information from Cheshire West and Chester Council's contract reviewing officer, who had recently visited four different properties to review the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was safe. Care had been planned for each person after risk assessments had been completed. People who used the service and their relatives or representatives had discussed their needs with a senior member of staff who then planned their care, in consultation with them. People told us they felt safe. Recruitment practice was safe and thorough.Safeguarding procedures were robust and staff understood how to safeguard the people they supported. Staff knew what to do in emergency situations and were well supported by the senior team.

Is the service effective?

The service was effective. People told us that they were happy with the care they received and felt their needs were met. During the visits that we made to people’s homes, we observed the interaction between people who used the service and the care staff. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. Staff had received all of the training they needed to meet the needs of people who used the service. A relative said; "The staff are excellent, they go on a lot of courses and are very well trained".

Is the service caring?

The service was caring. Relatives told us that the care staff were very caring. A relative said "My daughter is very well looked after and all the people who live in the house with her seem very happy there". People’s preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people’s wishes. Staff knew people’s needs and we observed them interact with people in a pleasant and caring way. The manner in which staff talked about the people that they supported showed us that they cared about their wellbeing.

Is the service responsive?

The service was responsive to comments and suggestions made by people and to people’s changing needs. One relative said "We had long discussions about how the service could meet my son's care needs". The experience of people using the service was reviewed regularly. Changes were made in response to reviews or to requests. The service provided people with information about how to make a complaint and followed a policy when dealing with any complaints they received. A relative said "They respond very quickly if I'm not happy with anything".

Is the service well led?

The service was well led by an enthusiastic registered manager, who was supported by deputy managers, a training coordinator and ten teams of support workers, each led by a senior support worker. The service had a system in place to monitor and assess the quality of the service. Staff said they felt well supported by the organisation. All staff received regular supervision and an annual appraisal to review their performance and learning and development needs.

We visited the homes of three people who received personal care from the service. We spoke to three people who said that they were happy with the support they received. They said they liked the staff and had a good relationship with them. They said they took part in activities that they enjoyed and had their health needs well supported. Some comments made were:-

“I’m happy. It’s nice and quiet. I like the staff and the people who live with me.”

“The staff help me to go out and to cook.”

We spoke to three relatives who said they were kept informed about their relatives’ well-being, they were asked their views about the care and support provided and that their relatives were happy being supported by the service.

We spoke to four support staff who said they enjoyed working for Special Care Needs Limited and considered that the people who used the service were well supported.

We found that people were assessed before they began to use the service and they had care plans that identified their needs. People were supported with their nutritional needs. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We found that improvements were needed to the staff recruitment process in order to ensure people were protected from the risks of unsafe or inappropriate care or treatment.

We spoke to three people who used the service. They said they were happy living in their homes, liked the people they lived with and liked the staff.

Our observations indicated that the people who used the service appeared relaxed and happy with the staff supporting them. Staff were respectful towards the people who used the service and treated people in a friendly and dignified manner.

Relatives spoken with said that they were happy with the service and that a good standard of care was provided. They said they had attended meetings to agree the care provided. They said that the service encouraged new skills and independence and that people's needs were well met by caring and friendly staff. They reported that where there had been any issues with the service provided this had been addressed appropriately by the management team. Some comments made were:-

"It's an excellent service."

"We are absolutely delighted with the service."

"All in all a good service is provided and I am happy."

Surveys had been sent to the people who used the service within the last six months. The manager reported that some relatives had helped to complete them. The results showed that the people who used the service were overall happy with the care and support provided. Where responses indicated that follow up action may be needed the manager was able to demonstrate the action being taken.

We asked the commissioners of the service and the local safeguarding co-ordinator for information on how the service was operating. They said that concerns had been raised about the service which had resulted in meetings with the provider. The provider had indicated the action being taken to prevent a re-occurrence of the concerns.

We requested information from Cheshire West and Chester Local Involvement Network (*LINks). At the time of writing this report no information was received from this agency.

* LINKs are networks of individuals and organisations that have an interest in improving health and social care services. They are independent of the council, NHS and other service providers. LINks aim to involve local people in the planning and delivery of services.

Our inspection of 17th July 2013 found that improvements were needed to the staff recruitment process in order to ensure that the people who used the service were protected from the risks of unsafe or inappropriate care or treatment. We carried out this visit to ensure these improvements had been made. We found that appropriate action had not been taken.

We also carried out this visit in response to concerns reported to us around the care and welfare of people who used the service, the management of their medication and how they were safeguarded from abuse.

We found that potential staff visited the homes of the people who used the service to enable them to decide if they were suited to the role of support worker and to involve the people who used the service in the recruitment process. These visits were undertaken prior to carrying out checks of the potential staff's suitability and this process was not managed in a way to safeguard the people who used the service from possible abuse.

We visited two supported tenancies where seven people who used the service lived. We spoke with two people who used the service. They said they were happy with the support they received. We observed positive interactions between the people who used the service and the staff who supported them.

We spoke to six support workers who said they enjoyed working for Special Care Needs Limited. They said they were well supported and considered that the people who used the service were treated well and valued by the staff. We spoke to a service commissioner who reported no concerns with the operation of Special Needs Care Limited.

We found that people were provided with the support they needed and that they had access to appropriate health and social care professionals as required.

We found that the staff had received training around safeguarding vulnerable adults from abuse and the six support workers spoken with were knowledgeable about the procedure to follow.

We found that medication was managed safely.