This inspection took place on 25 January, 2018. The inspection was announced.

Solutions in Service Ltd is registered to provide domiciliary care to younger and older people who have complex support needs. The registered provider supports 54 people across five separate shared houses. Each person within each shared house has their own separate tenancy agreements and are supported by staff 24 hours a day, seven days a week.

At the time of the inspection there were two registered managers in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered managers had a number of different systems in place to assess and monitor the quality of the homes, ensuring that people were receiving safe, compassionate and effective care. Such systems included weekly, monthly, annual audits and the relevant health and safety and infection control checks.

We reviewed medication management processes which were in place. Medication was administered safely by staff who had received the appropriate medication training. Medication audits were being completed on a weekly basis. However, we did discuss with the registered managers at the time of the inspection that the medication audit could be further developed in order to capture all aspects of the medication processes and procedures.

We recommend that the medication audit process is further reviewed.

People we spoke with during the inspection expressed that they felt safe. People explained that they felt staff were approachable, responsive and would listen to their views and opinions. Staff were knowledgeable around the area of safeguarding procedures and knew how to report concerns and who they would report their concerns to. Staff had completed the necessary safeguarding training and there was an up to date safeguarding policy in place.

Care files contained individual care plans and risk assessments were in place for people who were being supported by the registered provider. Care records we reviewed contained important information about the person and staff were familiar with people’s care needs, risks and support measures which needed to be implemented.

Recruitment was safely managed. Staff personnel files which were reviewed during the inspection demonstrated that safe recruitment practices were in place. This meant that all staff who were working for the registered provider had sufficient references and Disclosure and Barring System checks (DBS) in place.

There was an up to date ‘Accidents and incidents’ reporting policy and procedure. Accidents/incidents including safeguarding incidents were being routinely recorded by all staff and trends were being monitored and analysed. People’s care records were being updated accordingly and actions were being taken by the registered provider when trends had been established.

The registered provider operated within the principles of the Mental Capacity Act 2005 (MCA) People were supported to remain independent, to have ‘choices’ and to be fully involved in the decisions about the care which needed to be provided. People who were being supported by the registered provider had all consented to the care being provided. Staff were also aware that any decisions made on behalf of people, due to fluctuating/lack capacity must be made in their ‘best interests’.

Staff expressed how they were fully supported in their roles. Staff had received all the necessary training needed to perform to the best of their abilities and regular supervision and appraisals were taking place.

Staff supported people to make their own decisions around their own nutrition and hydration. People’s choices, preferences, likes and dislikes were taking in to account and people t