This inspection site visit took place on 21 May 2018 and was announced, with calls to relatives taking place on 25 May 2018. We gave the service 48 hours’ notice of the inspection visit because we needed to make sure someone was in.

At our last inspection on 8 September 2016 we found improvements were needed in how incidents which had occurred were recorded and reported and how action was taken to prevent further incidents. At this inspection we found the provider had made the required improvements.

This service provides care and support to people living in eight ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

There was a registered manager 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.

People were protected from abuse and risks were assessed and planned for to keep people safe. Premises and equipment were maintained to minimise the risk of infection. People were supported by sufficient safely recruited staff. Medicines were managed and administered safely. The registered manager had systems in place to learn when things went wrong.

People’s needs were assessed and effective care plans were in place. Staff received training to support people with effective and consistent care. People were able to choose what they had to eat and drink and were supported safely. People had support to maintain their health and wellbeing. 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 supported by staff that were kind and caring and had good relationships with people. People had their communication needs assessed and care plans were in place which supported people to make choices and retain their independence. People were treated with dignity and respect.

People’s preferences were understood by staff, assessments and care plans considered diverse needs and how to meet them. Reviews of people’s care needs were undertaken and people were supported to follow their interests. People could make a complaint and there was a system in place to investigate these. People had their wishes for end of life care considered.

People and their relatives were involved in the service and were asked for feedback. We found systems in place to check on the quality of the service people received and the provider used information from these to make improvements. The registered manager had systems in place to monitor the delivery of people’s care.

This inspection took place on 8 September 2016 and was unannounced. At our previous inspection in July 2015 we had concerns that peoples risk assessments and care plans were not being followed. We also had concerns that the provider's systems to monitor the quality of the service were ineffective. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements.

The service provides personal care for up to eight people with a learning disability in their own homes. At the time of the inspection eight people were using the service.

There was 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.

At this inspection we found that some improvements had been made in the areas of concern and the provider was no longer in breach of any Regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However further improvements were still required to ensure people received safe, effective, responsive and well-led care.

We found that incidents were not always reported in accordance with the provider’s policies and procedures, and the management team had not identified this through their audit systems which showed some audits were ineffective.

People's risks were assessed and managed to help keep people safe. There were enough staff to meet people's needs. People told us and we saw that requests for support were responded to promptly by staff.

People’s medicines were stored and managed safely, and staff understood and acted on any signs that may indicate that people were unwell.

Staff were suitably trained to meet people's needs and were supported and supervised in order to deliver care to people effectively. Staff understood how to support people to make decisions and when they were unable to do this, support was provided in line with the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

People were provided with enough food and drink to maintain a healthy diet. People had choices about their food and drink and were provided with support when required to ensure their nutritional needs were met.

People's health was monitored and access to healthcare professionals was arranged when required.

People were treated with kindness and compassion and were encouraged to make choices about their care and how they wanted to spend their time, and their privacy and dignity was respected.

Relatives and staff felt the registered manager was approachable.

This inspection took place on the 8 July and was unannounced. This was ‘The Crescents’ first inspection since being registered in October 2014.

The Crescent is a supported living facility and offers personal care to up to eight people with a learning disability in their own homes. There were eight people using the service at the time of the inspection.

The service is required to have a registered manager. The manager had been in post for three months and had not yet registered with us. 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 systems the provider had in place were not always adhered to, to ensure that care being delivered to people was safe and of good quality. People were not always protected from the risk of abuse. Risk of further abuse was not reduced following incidents. Relevant people were not always kept informed of serious incidents that affected their relative.

People were supported to take reasonable risks to increase their independence. Risk assessments supported staff to keep people safe whilst promoting their independence.

There were sufficient numbers of staff to care for people safely. Staff had been trained and understood their role.

People’s medicines were stored and managed safely. The provider had implemented a new system to protect people from medication errors.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs) and to report on what we find. The manager told us that there had been several DoLS referrals made to the local authority to ensure that people were not being unlawfully restricted of their liberty.

People’s health care needs were met. People received regular health support from external agencies. Staff supported people to attend health care appointments.

People were supported to maintain a healthy diet. When people had specific nutritional requirements staff had been trained to provide their food and drinks in a way that supported them.

Records, observations and discussions with staff demonstrated that people using the service were at the centre of the care being delivered. Regular reviews took place to ensure that when people’s preferences had changed this was identified and acted upon.

You can see what action we told the provider to take at the back of the full version of the report.