The inspection of the Old Manse took place on 24 March 2017 and was announced. As the service is a supported living scheme we gave the provider 48 hours’ notice of the inspection to ensure that staff would be available in the office to assist us with the inspection.

The Old Manse is a supported living service and provides personal care and support for adults and elderly people with learning disabilities and autism at three different sites in the Hindhead area. One was a shared house, one site was purpose built flats and one was a large building with individual bedrooms with shared communal living. The service enabled people to maintain and develop their skills and independence. At the time of our inspection there were nineteen people living there.

The service did not have a registered manager in place. 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. We can confirm that the provider has submitted an application to be registered as a manager with the Care Quality Commission (CQC).

People and their relatives told us they were safe at the service and with the staff who provided care. Staff had a clear understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from harm.

There were sufficient numbers of staff deployed to meet people’s needs safely. Recruitment practices were safe and relevant checks had been completed before staff started work. The provider ensured staff had the skills and experience which were necessary to carry out their role. Staff had received appropriate support that promoted their development. The staff team had an in depth knowledge about people’s care needs. People told us they felt supported by staff.

Medicines were managed, stored and disposed of safely. Any changes to people’s medicines were prescribed by the person’s GP or psychiatrist and administered appropriately.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The service had a contingency plan that identified how the service would function in the event of an unforeseeable emergency such as fire, adverse weather conditions, flooding or power cuts.

Staff were up to date with current guidance to support people to make decisions. Staff had a clear understanding of Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) as well as their responsibilities in respect of this. Where people had restrictions placed on them these were done in their best interests using appropriate safeguards.

People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and healthcare professionals were involved in the regular monitoring of their well-being. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff treated people with compassion, kindness, dignity and respect. People’s preferences, likes and dislikes were at the centre of the service and support was provided in accordance with people’s wishes. People’s privacy and dignity were respected and promoted when personal care was undertaken.

People’s care and support were planned proactively in partnership with them. People’s needs were assessed when they entered the service and on a continuous basis to reflect changes in their needs. Staff understood the importance of promoting independence and choice. Staff had developed a good understanding of each person and then supported them to build their skills and confidence an

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This inspection was announced. 48 hours notice of the inspection was given because the service is small and the registered manager is often out of the office or providing care. We needed to be sure that they would be in. The last inspection was undertaken on 10 January 2014 and no concerns were identified.

The Old Manse is a supported living service and provides personal care and support for adults and elderly people with learning disabilities and autism at three different sites in the Hindhead area. One was a shared house, one site was purpose built flats and one was a large building with individual bedrooms with shared communal living. The service enabled people to maintain and develop their skills to maintain their independence.

On the day of our inspection there were 15 people using the service. There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt safe and well looked by staff who attended to their needs. They said they knew which staff was coming to support them with their personal care and they would be informed if there was a change of staff due to sickness or annual leave.

We saw that staff had received training in relation to keeping people safe from abuse and staff spoken with had a clear understanding of the processes to be followed should they suspect or witness abuse. Staff told us they would not hesitate to follow the provider’s whistle blowing policy to report any bad practice they saw.

Staff were knowledgeable about the Mental Capacity Act 2005 and knew when it would be appropriate to arrange best interest meetings for people should they be required. Staff were up to date with current guidance to support people to make decisions. Any restrictions placed on them was done in their best interest using appropriate safeguards.

Relatives of people were complimentary about the care their family member received from staff at the service. All had positive comments about the service and care their family member received.

People had care and health action plans that ensured their assessed needs would be met. Relatives of people confirmed that they had been involved with the care plans. There were risk assessments in place to enable people to take part in activities with minimum risks to themselves or others.

People had care plans to ensure staff undertook people’s individual assessed needs. People received the care and support as and when required. People were supported to do their food shopping and to plan and cook the meals they had chosen. We saw people were offered support in their homes with the preparation and cooking of meals. People were complimentary about the staff. They told us that staff treated them with respect and dignity and their privacy was respected by staff.

People told us they knew how to make a complaint and they would talk to the manager if they ever had the need to make a complaint. One person told us they had made a complaint and the registered manager resolved this for them. They stated they were very happy with how it was dealt with and the outcome.

The provider had a clear set of values that included the aims and objectives, principles, values of care and the expected outcomes for people who used the service. The service had quality assurance systems in place. These ensured people continued to receive the care, treatment and support they needed. Staff, relatives and other external health and social care professionals told us that they believed the service was well led by the registered manager.

The people who use the service had learning disabilities but were able to tell us about their experience of the care and support they received. People told us that staff were kind and caring and encouraged them to be as independent as possible. One representative of a person who uses the service told us that the provider understood the needs of their relative well and that staff were kind and respectful.

We spent time talking with staff and also observing interactions between them and people using the service to determine if people were being cared for in a way that respected their individual needs. We observed staff talking calmly and sensitively to people and offering choice about care, treatment and activities people using the service wanted to participate in.

We saw from people’s care records that they were person centred meaning that they contained personal and up to date information about the person, their needs and choices about their care. People’s support plans and risk assessments were up to date and had been reviewed in line with the provider’s policy.

During the inspection we spoke to the staff on duty. We found the staff to be supportive and respectful to the people using the service. We observed the staff and their interaction with people and saw that they understood the individual needs of people using the service well and were able to tailor their interaction with each person depending on how they liked to be engaged.

Staff had knowledge of adult safeguarding procedures and how to report concerns. This meant that they were able to recognise suspected harm or abuse and what action to take to reduce the risk of harm and how to deal with it if it happened. On our visit staff told us that their safeguarding training was undertaken annually and that the training equipped them to understand their safeguarding responsibilities. One person who uses the service told us that they knew about safeguarding and that it had been discussed at each of their assessments and reviews.

We saw that there was a variety of activities planned to meet the individual needs of people using the service and that the people were able to choose whether or not they wanted to take part in the activities. From the records we looked at we saw that the provider encouraged people to be as independent as possible and many of the people who use the service had opportunities to engage in local community activities which people told us they enjoyed undertaking. A representative of a person who uses the service said “we are always consulted and know what activities are planned” another representative said “we are always involved in assessments and reviews and are consulted on all decisions”

The provider had an audit framework and audits were carried out monthly as to ensure that the quality of the service was maintained to a high standard and that actions to rectify concerns were taken within reasonable timescales. The provider also sought the views of professionals, representatives and people who use the service to determine whether people were satisfied with the service. We saw that changes to the service had been made based on comments people who completed the survey had made. In a recent audit one professional said “communication is good and service users appear happy and content”. Another commented that the service was caring, personal and adapted and tailored to meet the needs of individuals.

The services staff provided personal care to six people who lived in a supported living environment at the same address. We spoke to four people who used the service and four staff including the manager. We looked at three peoples files, which included for example, their need assessments and their plans of support. We also looked at three staff files.

Everyone one spoken with was very pleased with the service they received. We had a large number of very positive comments and they included; “the staff are alright and help me with things like looking after my money”, “the staff treat me well, they let me make my own choices” and “staff are there to help me, and they are always very kind.”

People told us that staff were good and kept them informed of what was happening each day and they knew who would be supporting them.

We found the staff had been recruited in a way that made sure that vulnerable adults would be protected. New staff also undertook induction training to make sure they had the skills and knowledge to provide care to people with differing needs. The agency also had systems in place to monitor the quality and safety of the care and support they provided.

A person using the service said they had been involved in decisions relating to their support needs. These covered lifestyle choices, personal care, community involvement and opportunities to develop their skills. They told us that staff treated them well, that they were enabled to develop independence skills and were encouraged to try new experiences.

People said they were supported with their healthcare needs and to attend various healthcare appointments to maintain good health. Staff helped them budget and manage their finances and plan and cook healthy appetising meals of their choice. They were encouraged and assisted to keep their home clean and tidy. Staff were stated to always respect their dignity and privacy. They said they were frequently asked if they were happy with services.