Support Horizons provides care to people living in a variety of ‘supported living’ settings. Not everyone using the service receives regulated activity. The Care Quality Commission only inspects the service being received by people provided with personal care, help with tasks related to personal hygiene and eating. The service supported nineteen people, within the scope of our registration at the time of this inspection. The service also provides support to other people which does not fall within the remit of the Care quality Commission, where support does not include personal care. The Care Quality Commission (CQC) does not regulate premises used for supported living, this inspection looked at people’s personal care and support. The service is a ‘Community Interest Company’. This means it is operated for the benefit of the people supported and any surplus capital is reinvested to benefit them. People and their representatives make up half of the board of directors.

At the last inspection, the service was rated Good in all domains. At this inspection we found the service remained Good in all domains and was rated Good overall.

People felt safe and well supported by the service. They said staff treated them with respect, looked after their rights and protected their dignity. People felt involved in their care planning. They said staff sought their consent and enabled them to make day to day decisions about their care and activities. People got on well with the care staff but some had experienced issues with office staff. They felt staff were competent and looked after their health and dietary needs. People said they could complain if they were unhappy about something and issues had been addressed. People’s vies about the service had been sought and improvements had been made.

Identified risks were assessed and mitigated without restricting people’s freedom. Individual care needs were assessed and identified and detailed care plans enabled person-centred care. People‘s health and nutritional needs were supported and their medicines were managed safely on their behalf, where necessary.

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 treated with kindness and patience by staff who knew them well and understood their diverse needs and communication. A range of appropriate communication aids were used where needed to help people to express their wishes and choices. People were supported to have access to appropriate activities and the community and their spiritual needs were met.

Staff received a thorough induction, core training and attended periodic training refreshers to maintain their knowledge and practice. They were supported through individual supervision and appraisal. Staff understood the values and aims of the service and felt these were conveyed to them consistently and effectively.

The management team exercised effective oversight of the service. A computerised management system allowed monitoring and analysis of key aspects of the service and regular meetings and reporting ensured relevant information was shared.

Further information is in the detailed findings below

This inspection took place on 30 November 2015 and was announced to ensure the registered manager was available.

A registered manager was 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.

At our last inspection on 3 and 4 September 2014 we identified non-compliance against Regulations 18 (Consent to care and treatment), and 20 (Records) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

From April 2015, the 2010 Regulations were superseded by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the provider was meeting the requirements of the comparable current regulations. Regulation 11 (Consent) and 17 (Good governance). We found that the service had taken action to address the previous concerns although some further improvements to records of staff supervison and appraisals were needed and action was being been taken to address this.

Support Horizons is a domiciliary care agency providing care and support to 16 people living in supported living houses, with others receiving support or with family. Some people received 24 hour support, others were supported to access events and activities in the community on a sessional basis. As a ‘Social Enterprise’ organisation the service involved a proportion of people who had previously used similar services, some of whom sat on the board and its sub-committees. Some ex-service users also took part in staff recruitment.

The service provided flexible support to people with needs relating to learning disability or whose needs were on the autistic spectrum. Some people had additional physical disabilities. The service additionally worked with people who did not require support with personal care, which fell outside of the scope of our inspection.

People were supported with personal care needs whilst accessing a range of events and activities in the community which they would not be able to attend without support. The service worked effectively to encourage people to develop their skills and confidence and broaden their range of experiences.

Staff were subject to an appropriate recruitment process to ensure their suitability. They were provided with effective induction, training and ongoing support.

The service deployed staff effectively and matched them wherever possible to the needs and interests of the people they were supporting.

People and relatives were happy that the service was very caring and met people’s needs effectively. They felt people’s rights and freedom were upheld and enhanced.

The service was effectively managed and monitored by the registered manager, senior management and the board of trustees. The organisation’s leadership provided clear expectations of staff in terms of service delivery and quality.

The service sought and acted upon the views of people, their relatives and the staff in seeking to continuously improve. People and relatives felt they were listened to.

People we spoke with told us they were pleased with the care and support they, or their relative, received. One person told us the "service is a good quality standard". A relative told us they were "very happy with the service".

Support plans reflected the needs of the people using the service and were reviewed regularly. People were involved in planning their care and could make changes when necessary. One person told us "they're flexible" and a relative told us "they listen to you and they change things".

There were appropriate arrangements in place for safeguarding vulnerable adults. All staff had received training and were clear about their responsibilities and the action they would take if they had concerns.

There were effective recruitment and selection processes in place. Appropriate checks were carried out before staff began to provide support to the people who use the service.

The provider had systems in place to monitor the quality of the service provided. These included management audits of activities and support as well as an annual survey of all the people who use the service.

People told us they were happy with the services provided. One person said, “Fantastic support from staff”. People told us they were involved in the development and agreement of their support plan. They told us they were given opportunities to contribute their views about the quality of the services provided.

We spoke with relatives of people who use the service. One person said, “We agreed the care package via social services, I believe my relative is more than happy with the services provided”.

We looked at people's support plans and supporting documents which were held electronically in the agency’s office. We saw improvements were underway to improve information within those records. Support staff and people who use the service told us a file with information to support the person was kept in the person’s home, which included daily records of services provided.

The provider had made improvement to ensure staff received appropriate professional development and support to meet the assessed needs of people who use the service. Staff we spoke with were knowledgeable of people's specific health and personal care needs and how they wanted those needs to be met.

We found people had access to the agency’s complaint procedure and knew how to complain if they had a concern. One person said, “Yes I would have confidence to contact the agency if I had a concern”.

One relative told us, “the person that comes to us is absolutely fantastic; we have never had cause for complaint, always reliable, always on time.”

One person told us the staff are “caring, polite and kind, most speak appropriately”.

Another person told us their support worker was, “very communicative, always on time, reliable, flexible, exactly what you need.”

The inspection team consisted of an adult social care inspector. On the day of our inspection thirteen people received personal care provided by the service, such as personal care. The service additionally supported over 100 people with domiciliary support, which the Care Quality Commission (CQC) does not inspect. We spoke with two people supported by the service and one person’s relative, and observed how staff supported another person in their home with their permission. We also spoke with seven care workers, the registered manager, the managing director and operations manager.

We looked at documents including people's care plans and management reports. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: is the service caring, responsive, safe, effective, and well led?

This is a summary of what we found.

Is the service safe?

The service was safe. We observed that people were relaxed and comfortable with staff supporting them, and were pleased to see office staff. This demonstrated that they felt safe with staff. One care worker told us “We help people feel safe and valued”.

Risks affecting people’s safety had been identified, and actions taken to reduce the risk of harm. Staff had been trained in emergency first aid and the use of specialist equipment to promote people’s safety in their home and the community.

Records had been stored appropriately to ensure that confidential data was protected. Only those staff identified with a requirement to access personal information were able to view electronic or hard copy records. However, information stored in the office did not always match that stored in people’s homes. Staff told us that information sent to them by the office when they supported people for the first time did not always give an accurate picture of the person’s needs. This meant that people were at risk of receiving inappropriate or unsafe care.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people’s care records effectively reflect their identified needs.

Is the service effective?

The service demonstrated some effective systems. One person told us “I love the fact that [the service] is not for profit. It focuses on enabling less able people to do things, and they enable us to do what we want. [The service] is flexible and friendly. I think they are fabulous”. Staff told us how people supported by the service led training sessions to inform staff of effective methods to use to ensure people were listened to and valued. Staff said “It helps us to understand their perspective”.

People's consent had been sought when providing care and support. Staff understood gestures and other signs that indicated people consented to care and support if they were unable to verbally communicate. However, where people lacked the capacity to make a specific decision we did not see evidence that an assessment of this had been completed. There was a lack of evidence to demonstrate that others, such as relatives, had the legal right to act on their behalf. Some staff had not completed training in the Mental Capacity Act 2005 (MCA), and most of those we spoke with did not demonstrate an effective understanding of the MCA.

We have asked the provider to tell us what they are going to do to meet the requirements of the law to demonstrate that people have legally consented to care.

The requirements of the Deprivation of Liberty Safeguards (DoLS) were being met. The managing director was reviewing whether any applications needed to be made in response to a new legal ruling made in relation to the DoLS.

Staff received training to ensure they had the skills required to support people effectively. A new training and supervision programme was in the process of roll out at the time of our inspection. Staff told us they felt supported, and the training provided meant they were equipped to support people.

Is the service caring?

The service was caring. One person told us staff “Help you a lot. I like all the staff”. We saw that they trusted the care worker supporting them, and sought their company for reassurance.

We observed care workers supporting people in their home and the community. Staff were attentive to people’s needs and wishes, and supported people with kindness and respect. We saw that staff understood the gestures and signs people used if they did not use verbal communication. They encouraged people to make choices, and valued their comments and actions. They enabled people to have control over their lives. One care worker told us “I love how this service aims to meet and exceed people’s wishes. We treat people and each other with trust and friendship”.

Is the service responsive?

The service was responsive to people’s wishes. We saw that people could request the types of staff they wanted supporting them, including staff gender and interests. One person told us “If I don’t like a person they send to help me, they don’t send them again”. A relative told us the service was “Highly responsive to day to day requests, and when X had a fall they set up a protocol to protect them as their needs had changed. Anything you encounter you work out with them”.

The service was responsive to changes in people’s care needs. People’s support plans had been updated and risks reassessed as their needs changed. Staff and health professionals told us the service was improving documentation to reflect people’s current needs and wishes.

Is the service well led?

The service was well led. A relative told us “They keep it local and know us. They are a breath of fresh air”. Staff told us the management and office staff provided guidance when required, and were always available and accessible.

Feedback had been sought from people and staff, and acted on the responses provided to drive improvements. People were members of the self-advocacy board, which meant they directed the focus of the service.

The managing director and registered manager carried out monthly audits to monitor the quality of the services provided. When areas requiring improvement had been identified, actions had been taken to address the issues and improve service quality.