Supported Lives provides a domiciliary care service, providing support to people in their own homes. In addition, it provides service to people living in three supported living settings. In these instances people's care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people's personal care and support. These services are provided to people with learning disabilities in the Bradford and Calderdale area. The provider of the service is called Potens.

Not everyone using Supported Lives 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 provide regulated activity we also take into account any wider social care provided.

We undertook the inspection between 12 and 25 July 2018.

The inspection was announced. We gave a small amount of notice of our visit to the providers’ office because we wanted to make arrangements to telephone people who used the service to ask them for their views. At the last inspection in October 2018 we found widespread failings and rated the service as Inadequate. We identified seven breaches of regulation in relation to Safe Care and Treatment, Safeguarding, Dignity and Respect, Person-centred care, Staffing, Receiving and Acting on Complaints and Good Governance. At this inspection we found the service was no longer in breach of any regulations.

We found the service was now more organised. Documentation relating to people’s care and support had been updated and there was now a clear management structure which was more effective in checking, monitoring and improving the service. The new manager had a good oversight of the service and of the people who used it.

People and relatives’ feedback was mixed about the quality of the service, although overall people said things had improved since the last inspection. There had been a number of management changes over the past year and people and relatives said they would need consistency in both support staff and management before they were fully assured that the service had changed for the better.

People and relatives said people were safe using the service. Concerns raised were taken seriously and fully investigated. Risks to people’s health and safety had been assessed with clear plans of care put in place for staff to follow. The manager had a good oversight of the risks people were exposed to and how to control them.

Medicines were managed safely overall. Clear medicine records were kept which were audited and checked on a regular basis.

Overall there were enough staff to ensure people received regular care and support. Additional staff were going through the recruitment process to increase the size of each person’s support team to further increase reliability and availability of staff.

Some relatives told us there were still too many different staff supporting their relatives. Whilst each person had a relatively small group of support staff, there had been a number of staff changes over recent months resulting in this inconsistency.

Staff told us they now felt well supported and settled in their role. Staff received a range of training tailored to the needs of the people they were supporting.

People were offered choices and consented to their care and support arrangements. Where people lacked capacity, the service worked within the legal framework of the Mental Capacity Act (MCA).

People and relatives said staff were kind and treated them well. Staff we spoke with had a good understanding of the people they supported. People’s independence and self-confidence was promoted by the service. People’s views and opinions were valued.

People’s needs were assessed and clear and detailed plans of care put in place. The service worked with healthcare professionals to mee

Supported Lives provides a domiciliary care service, providing support to people in their own homes. In addition it provides service to people living in three supported living settings. In these instances people’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support. These services are provided to people with learning disabilities in the Bradford and Calderdale area. The provider of the service is called Potens.

Not everyone using Supported Lives 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 provide regulated activity we also take into account any wider social care provided.

We undertook the inspection between 20 October 2017 and 3 November 2017. The inspection was announced which meant we gave a small amount of notice of our visit to the providers office to ensure a manager would be present. At the last inspection in September 2016 we rated the service ’Good’ overall. At this inspection we found the quality of the service had deteriorated. Feedback from relatives and staff was poor. They said that the service was no longer reliable, calls had been cancelled and management did not get back to them about their concerns and complaints. People said the staff delivering care and support were kind and caring.

Medicines were not managed safely as there was no proper oversight of the medicines management system to ensure staff were working safely and adhering to best practice.

Whilst people and relatives said people were safe in the company of regular staff, we received complaints that people’s care was provided by staff that were unfamiliar with people’s needs. We received complaints this caused upset and worry to people and their relatives.

Safeguarding procedures were in place. We saw evidence they had been followed. However, concerns about staff conduct had not been properly logged and investigated. Risks to people’s health and safety had been assessed but many assessments were out of date. Staff and management told us they thought they did not reflect people’s current needs. Incidents were not consistently recorded and properly investigated.

There were insufficient staff deployed in the right places to ensure a consistent and reliable service. People, relatives and staff reported missed and cancelled calls and some staff arriving without the necessary skills to deliver appropriate care. There was a lack of staff available to undertake duties such as supervision, spot checks and care reviews.

People said regular staff had the right skills and knowledge to care for them. However we saw there was no effective system in place to monitor staff training and ensure it did not expire. We saw a number of staff were not up-to-date with their required training. Staff said they did not feel supported by management. There had been no recent support mechanism such as meetings, supervisions or appraisals.

People and relatives reported appropriate support at mealtimes, although we saw issues with the reliability of the service had impacted on the consistency of this support.

We concluded the service was compliant with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) although where people lacked capacity more information needed to be recorded to robustly demonstrate this.

People said the staff delivering care and support treated them well. We saw some good relationships had developed between people and regular staff. Staff demonstrated they cared about the people they were supporting. However we found the service as a whole did not treat people well as people had been let down with cancelled visits and not being informed who would be offering care and support. People were

Rebecca House is registered with the Care Quality Commission (CQC) to provide personal care and support to people within their own homes and in their local community. The service provided includes personal care, cooking meals and daily activities. These services are mainly provided to people with learning disabilities. The agency is situated in Bradford town centre.

This inspection took place on 27 October 2016 and was announced. The service was last inspected February 2014 and was found to be compliant with the regulations inspected at that time.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were not always provided in enough numbers to meet the needs of the people who used the service. This meant people had not received the support they needed to pursue their chosen activities, and had created unnecessary distress for one person and their family. We have made a recommendation about this.

Staff knew how to report any safeguarding issues they may become aware of or witness. They knew they had a duty to protect people and had received training in how to recognise abuse and how to report this to the proper authorities. Staff had been recruited safely and checks had been done to ensure people who used the service were not exposed to staff who had been banned from working with vulnerable people.

People who used the service were cared for by staff who had received training in how to effectively meet their needs; this training was updated as required. Staff were supported to gain further qualifications and experience. Legislation was used when people needed support to make informed decisions; actions were taken to protect people and to make sure decisions made on their behalf were in their best interest.

People were cared for by staff who were kind and caring. Staff understood people’s needs and supported them to lead a fulfilling life. People were involved with their care planning and staff respected their dignity and rights to lead a lifestyle of their choosing. Staff understood the importance of maintaining confidentially and respecting people’s right to privacy.

The registered provider had a complaints procedure in place, which people who used the service could access and all complaints were investigated. Any learning from the investigation of complaints was shared with the staff. On the whole people were supported to undertake activities which maintained their independence and develop their life skills. People were also supported to undertake leisure activities as well.

The registered manager undertook audits of the service and put in place action plans to rectify any shortfalls. People and other health care professionals were consulted about the service and their responses were collated and published. Staff meetings were held to disseminate knowledge and to pass on information about any recent changes to the service.

We visited the administrative office of the organisation where we reviewed documentation and spoke with the manager, the operations director, team support coordinator and support workers. Later we spoke with people who used the service and their relatives over the telephone.

People we spoke with told us they were satisfied with the service and they felt that their dignity was respected. One person we spoke with said, “They are absolutely fantastic” another said, “They are so efficient”. Staff we spoke with said people were treated with respect and their privacy and dignity was respected at all times.

Support workers told us that staffing levels were appropriate and staff were supported through their training. The staff we spoke with were complimentary regarding the training that had been provided. One member of staff told us, “You are in a good place here” another said, “I like the varied jobs that I get to do”.

This provider had systems in place to monitor people’s comments and complaints and their satisfaction with the quality of the service.

The manager explained the arrangements in place for the storage, security and retention of information obtained about people who used the services.

Some people who used the service had complex needs and were unable to tell us about their experiences. Therefore, we used a number of different methods to help us understand the experiences of people who used the service, such as reviewing care records and speaking to relatives.

We spoke with three relatives of people who used the service. They all told us staff listened to them and they could make changes to the care and support their relative received at any time.

All three people said their relatives received the care and support they needed. One person said the care was “absolutely fabulous” and another person said it was “brilliant”.

People told us they felt their relatives were safe when they were with their carers. One person said, “I feel secure and don’t have to worry when they are out with their carer”.

People said staff were generally caring, approachable and knew how to meet their relative’s needs. One person said, “you really can not fault staff, they are so friendly and patient”.

However, despite the positive comments people made, we found evidence the provider did not have an effective system to regularly assess and monitor the quality of service people received. We also found evidence people were not always protected from the risks of unsafe or inappropriate care as the documentation was inconsistent and unclear.