The inspection took place on 30 and 31 October 2018 and was announced.

St Anne's Bradford Supported Living Services is a domiciliary care service. The service supports adults with learning disabilities to live in their own home. At the time of this inspection 31 people were using the service supported in 15 houses across the Bradford area.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last inspection in July 2017 we rated the service as ‘requires improvement’ overall. We found the provider was in breach of Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s medicines were not always managed safety and quality assurance systems were not operated effectively. Following the inspection, the provider put an action plan in place to address these shortfalls. During this inspection we found the required improvements had been made. The provider was not in breach of any regulations.

The service had three registered managers. 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 told us they felt safe and if they were worried they would talk to a support worker or a member of the management team.

Medicines were managed safely.

Risks to people safety and welfare were well managed. There was clear guidance for support workers about how care and support should be delivered.

Support workers knew the needs and wishes of people at the service. Support workers spoke respectfully and kindly about the people they supported and it was evident they cared about them and their wellbeing. We observed person centred and caring interactions between people who received support and staff.

People were supported to have a varied and nutritious diet and encouraged to choose healthy eating options.

People were happy with the care and support they received. They were encouraged to make day to day choices and had control over their lives.

People were supported to get involved on the running of their houses and the service overall. They were supported to share their views though meetings and surveys.

People were supported to take part in range of activities of their choosing at home and in the community.

There were enough support workers deployed to make sure people got the right support. Support workers worked in teams which helped to make sure people were supported by staff they knew and felt comfortable with.

All the required checks were done before new support workers started work. People were given the opportunity to get involved in the recruitment of new staff.

Support workers told us they felt well supported by the management team. They received the training and support they needed to carry out their duties.

People were comfortable talking to support workers and members of the management team and said they would discuss any issues or concerns.

The provider had effective systems in place to monitor the quality and safety of the service.

This inspection took place on 14, 15 and 19 June 2017 and was announced. At the last inspection in March 2016 we rated the service as requires improvement. We found the provider was not in breach of regulation although the care documentation was not always completed in a person centred way or kept up to date. The management arrangements were not effective because the registered manager did not have line management responsibility for the whole service. At this inspection we found they had taken action to address both areas, however, we found medicines were not managed safely and governance arrangements were not operated effectively.

St Anne's Bradford Supported Living Services is a domiciliary care service. The service supports adults with learning disabilities to live in their own home. At the time of this inspection 30 people were using the service in 16 houses around the Bradford area and surrounding districts.

The service had three registered managers. 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 told us on the whole they felt safe and if they were worried they would talk to a member of staff or a member of the management team. Two people felt unsafe when another person they lived with got angry.

Medicines were not managed consistently and safely and staff did not always receive medicine related training or a competency assessment.

Risk was usually well managed and care and support was planned. Staff had guidance around how care should be delivered. People told us they were happy with the meals and support they received to help make sure they stayed healthy. Meals were not sufficiently monitored so the provider could not be confident people’s nutritional needs were being met. The provider wrote to us after the inspection visit and told us they had taken swift action to address this.

People were happy with the care and support they received. They were encouraged to make day to day choices and had control over their lives. The provider was introducing decision making assessments and support plans. People got involved in the running of the home and enjoyed person centred activities, which often involved engaging in the local and wider community.

Staff felt supported by colleagues and management. However, training and supervision was not always kept up to date. The provider had picked this up through their monitoring systems and action was being taken to make sure staff received appropriate support.

People received support from a consistency workforce and their agreed one to one staffing. Recruitment procedures were robust and ensured suitable workers were employed.

People were comfortable talking to staff and members of the management team and said they would discuss any issues or concerns. The provider encouraged people to share their views through surveys. Promoting regular tenant meetings was an on-going action plan.

The provider had some effective quality management processes however, these were not applied consistently across the service and some of the issues identified at the inspection had not been picked up by the provider. The registered managers took swift action in response to the issues we raised. We received positive feedback about the management team.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. These related to safe care and treatment and person centred care. You can see the action we have told the provider to take at the end of this report.

The inspection was announced, the provider was given 24 hours’ notice. At the time of the inspection the service was supporting 32 people with personal care.

The last inspection took place in December 2013 and the provider was compliant with all the standards inspected.

St Anne's Bradford Supported Living Services is a domiciliary care service. The service supports adults with learning disabilities to live in their own home. In addition, through a floating outreach service they support adults with learning disabilities, head injuries and /or mental health issues with individual packages of care ranging from a small number of hours per day or per week through to 24/7 depending on the individuals assessed needs.

The service had a registered manager. 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 told us they felt safe and could speak to any of the staff if they were worried about anything. The manager understood their responsibilities for safeguarding people and staff were trained to understand and recognise abuse. They knew who to report concerns about people’s safety and welfare within the organisation and to external agencies if necessary.

Sufficient numbers of staff were deployed to provide people with the care and support they needed. The required checks were done before new staff started work and this helped to keep people safe. Staff were provided with training and support to help them carry out their roles. However, some staff felt the training was somewhat limited.

Where people were supported with their medicines this was done safely. There were safe systems in place to support people with managing their finances.

Risks to people’s safety and welfare were identified and managed. Risk assessments clearly identified the risks to people and what could be done to mitigate the risks and keep them safe whilst promoting independence. Staff were provided with information about how to deal with emergencies and senior managers were on call outside of office hours to provide support.

Meals at the supported living houses were prepared and cooked by staff with the involvement of the people who lived there. We saw people’s nutritional needs and preferences were taken into account.

We found the service was working in accordance with the Mental Capacity Act 2005 and this helped to make sure people’s rights were protected. When there was any doubt about a person’s capacity to understand a particular decision the correct process was followed to make sure any actions taken were in their best interests.

‘Health Action Plans’ were in place to help support people to lead a healthy lifestyle. These included information about health care professionals involved in supporting people and details of how people were able to communicate health care issues and emotions. The service worked with other health and social care professionals to help achieve positive outcomes for people.

To promote person centred care the provider was in the process of training all staff on Positive Behaviour Support (PBS). This is a care model promoted by BILD (British Institute of Learning Disabilities) as the preferred approach when working with people with learning disabilities who exhibit behaviours described as challenging.

People told us staff respected their privacy and dignity and provided them with the support they needed. Staff demonstrated a caring attitude and we saw the interactions between staff and people who used the service were friendly and warm. People were supported to maintain relationships with family and friends and take part in a range of social activities of their choosing.

People were involved in decisions about all aspect

We talked with three people in their home; they told us they liked living in the house and had not complaints. We saw they were aware of and involved in the planning of how they wanted their care and support provided. Two told us the staff were “Okay” and we saw they appeared to like the staff and there was humour involved when the people who used the service and the staff interacted.

We talked with two relatives, one told us “Without the service we would not have known what to do, my relative has got really better since they moved into the house They told us they would recommend the service. Another told us their relative was involved in their care and the care was now person centred and the staff planned for any changes to their relatives care needs.

We saw fourteen people had completed a client satisfaction survey in 2012, when asked if they thought the staff listened to them and if they had a choice in how their support was provided all stated “Yes” to both questions. This showed us that peoples care was individualised to meet their specific care and support needs.

We found staff sought people’s agreement and people were provided with the opportunity to make decisions about their care and treatment. People’s care and treatment needs were assessed before a service was offered and people had experienced care and support which had met their needs. St Anne's Bradford Supported Living Services also had effective systems in place which identified, assessed and managed the risks to the health, safety and welfare of people who used the service and others such as members of staff.