The Halow Care Agency provides personal care and support to children and young adults. Services provided include support to young people in shared supported living houses or their own homes. This includes support to young people to access the community, develop life skills and achieve their goals. Staff known as buddies provide the personal care and other support.

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. At the time of the inspection there were 12 people using the service in supported living and 45 people using the buddy service although not everyone received the regulated activity personal care in their own homes.

People using the service had a learning disability or autism. The support service has been developed and designed in line with the values that underpin the Commission’s 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. The Halow Care Agency is a not for profit social enterprise, one of a number of services provided by a charity the Halow Care Community Interest Project. People using the Halow Care Agency have access to other project services that focus on social activities, employment preparation and life skills services providing wider opportunities and support for young people with learning disabilities and autism. CQC does not regulate these other related services but only the Halow Care Agency when personal care is provided.

At our last inspection in October 2016 we rated the service Good overall but found a breach of regulation in Well Led as there was a lack of effective systems to monitor the quality and safety of the service.

At this announced inspection on 8 and 9 November 2018 we found a breach of regulation in respect of training provided as buddies were not always provided with the specific training needed to meet people’s needs.

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

There had been some improvements made to the quality assurance and governance and a system for quality monitoring had been put in place. However, there were some aspects of the quality monitoring that needed improvement to ensure they were effective.

At this inspection there was not a registered manager in place as the previous registered manager had left the service at the end of May 2018.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. A new manager had been appointed who already worked within the project. They had previous experience of being a registered manager and had applied to CQC to register as the registered manager and their application was in progress at the time of the inspection.

Medicines were safely stored and administered. The medicines policy was out of date and did not reflect some aspects of medicines management. This was updated following the inspection.

We have recommended that the provider consults appropriate and up to date guidance on the management of medicines.

People told us they felt safe and were supported to be safe in the community. Staff received safeguarding training and showed an understanding of how to protect people from abuse or harm.

Risks to people were assessed and guidance provided to staff to reduce risk. There were processes in place to identify and share learning from accidents and incidents. Staff understood how to reduce the risk of infections

There were enough buddies to meet people’s support

The inspection of the Halow Care Agency was undertaken on 29 September and the 5 and 7 October 2016. We gave 24 hours' notice of the inspection to ensure the registered manager and other senior staff were available at their office to talk with us.

At our last inspection in March 2014 the provider met the regulations we inspected.

The Halow Care Agency supports young people and adults aged 16 to 35 years of age who have a learning disability and are living within the county of Surrey. Services provided include shared supported living houses and staff known as buddies proving domiciliary care and support to young people to access the community, develop life skills and achieve their goals. There were approximately 42 young people using the service and support or personal care was not being provided to anyone under the age of 18 at the time of our inspection.

The service had 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.

Throughout this report people who use the service are referred to as young people and the staff who provide support are referred to as buddies.

Young people using the service told us they felt safe and that buddies treated them with dignity and respect. They were happy with the support provided which met their individual needs.

The service empowered young people to take control of their own care and support. People were supported to plan and achieve their personal goals including building their independent living skills. Buddies said, and we saw that, the service was focused on putting young people at the centre, and in control, of their support.

People were supported by buddies who were trained and well supported in their job roles. Each buddy had been safely recruited, had access to regular training and supervision and felt well supported by the management team. The staff said they felt valued by the organisation.

Medicines were administered in a safe way. Buddies received training and a new competency framework was in place to make sure they understood and followed safe procedures for administering medicines.

Buddies and other staff had received training in the Mental Capacity Act (MCA) and understood the importance of gaining people's consent before assisting them.

The systems in place to monitor the quality of the service required improvement. Quality assurance processes were not fully embedded and consistent. The provider organisation did not have the necessary systems and governance in place to ensure full oversight of the service and drive improvement where required.

The Halow Care Agency had assessed the needs of people and obtained consent to care and treatment when accepting a person who used the service.

Although the service mainly offered social support, there was the possibility that personal care would be delivered to people who used the service. We found that the plans of care maintained for each person who used the service were detailed.

The provider had made suitable arrangements to ensure that people who used the service were protected from abuse. The relative of one person who used the service said "I feel 100% certain that X is safe when with their buddy from Halow."

The provider had ensured that all staff, and volunteers employed by the service had been subject to the checks as described in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Staff were supported to deliver care and support through a programme of regular supervision and appraisal as well as through the provision of relevant initial and refresher training.

The Halow Care Agency had in place suitable arrangements which allowed the registered manager to monitor the quality of the service provided to people who used the service.

We found that, although records were securely and safely stored there was no evidence that people's support plans had been subsequently reviewed. One person's relative told us "I don't really have a lot of contact with Halow unless there is something I want to bring up."

Following discussions with the provider, throughout this report people who use the service are referred to as young people; and the staff who provide the one to one support are referred to as 'buddies'.

We found evidence that the service was run in the best interests of the young people and that it provided a flexible reliable service. Relatives told us that they found the support provided to be positive and that it met the needs of their member of family. Evidence showed that the emphasis of the service was to enable and empower each young person to maximise their potential and to make decisions and choices about their lives and future.

Records viewed showed that support plans covered all aspects of the young person's individual circumstances. Satisfaction questionnaires were very positive and suggested that people were happy with the service and that they liked the 'buddies' who provided day-to-day-support.

Further improvements were required to ensure that staff received up to date training and opportunities for regular supervision and an annual appraisal.

People who used the service told us prior to using the service the manager visited them and an assessment of their care and support needs was carried out. They agreed a plan of care which they had to sign or their relatives signed if they were unable to sign. People said their plan of care was based on what they told the manager they wanted.

People said the manager introduced the careworker (buddy) and worked with the careworker for the first visit, to ensure the careworker understood the care and support needs of the person. People told us the manager made regular telephone contact with them to ask how things were going. Also the manager visited unannounced to observe and work with the careworker. People told us they had a good working relationship with their careworkers.

People told us they felt safe and well looked after by staff. They described their relationships with staff as good.