About the service: Together Trust Domiciliary Service provides support to adults, young people and children who have complex support and personal care needs. The service operates in several local authority areas across the North West, with each project supported by its own management structure. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. At the time of our inspection the service was supporting 16 people in this way.

People’s experience of using this service:

• People who used the service received highly personalised case and support which met their individual needs

• People were encouraged to share their views about what they wanted to achieve and their support was built around these goals to help them achieve them.

• People using the service and staff knew each other well and efforts were made by the service to ensure people were supported by the same staff as much as possible.

• People were treated with respect.

• Staff were imaginative in the ways they developed people’s interests and hobbies to engage them in the wider community, for example through work placements.

• The service had a culture of continually looking to be self-critical in order to improve the quality of care provided. Complaints and other incidents were used as opportunities for learning.

• Risks to people were managed to allow them to do the things they wanted in as safe a way as possible.

• The service met the characteristics for "good" in all of the key questions we inspected. Therefore, our overall rating for the service after this inspection is "good".

• More information is in the full report.

Rating at last inspection: At the last inspection the service was rated Good (30 December 2016)

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Follow up: We will continue to monitor the service through information we receive and future inspections.

This inspection took place on 28 September and 10 and 11 October 2016. The inspection was announced. We last inspected the service on 24 October 2013 when we found the service to be meeting the standards in relation to all regulations inspected. At this inspection we identified one breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which was in relation to governance.

The service was registered to provide personal care to people living in their own homes. This included supported living schemes that were based across Greater Manchester and ‘outreach’ services provided across the Greater Manchester and Cheshire areas. The outreach services were provided to children and young people, and primarily consisted of support for them to access leisure activities outside of school hours. However, a small number of people using the outreach service also received regular support with personal care at home. At the time of our inspection, 10 people were being supported who lived in the supported living schemes. The outreach services were providing support to 84 people, although not all of these people were receiving support with the regulated activity of personal care.

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 using the service, relatives and carers we spoke with all told us they were very satisfied with the service provided by Together Trust. Relatives told us the service was responsive and listened to them.

People using the service were supported by consistent staff teams, which helped staff get to know people well. Some people supported by the outreach service had one regular support worker who worked with them, and people in the supported living services had small teams of regular staff. The provider ensured there was sufficient time for people to get to know new members of staff if they needed to introduce a new staff member to the teams.

The service had access to in-house professionals including a psychologist and speech and language therapist. Relatives told us input from such professionals had helped their family members progress and build confidence. Staff worked alongside these professionals to provide effective support to people that reduced the need for reactive strategies to behaviours that could challenge the service.

Staff worked in ways to help ensure people were provided with the care and support they needed in the least restrictive ways possible. Staff were positive about supporting people to develop their independence and to build their skills. This including using special support approaches that staff had received training in to help people engage in tasks such as preparing drinks or meals.

Staff told us they were well supported and received good quality training that supported them in carrying out their role effectively. We saw staff had been trained in a variety of topics, including training in autistic spectrum disorders, safeguarding, medicines and positive behavioural support. Staff received regular supervision that helped ensure their competence.

Staff were motivated and committed. They spoke positively about the people they provided support to and were proud of the progress they had supported people to make. Staff were consistently positive about Together Trust, who they told us were supportive and interested in providing effective person centred support.

Peoples’ support plans were person centred and identified their needs, preferences, strengths, goals and interests. We saw staff had regularly reviewed and updated support plans to ensure they reflected peoples’ current needs. However, we found one care plan

During our inspection we visited the main offices of The Together Trust and met with The Principal manager, Registered Manager, Team leader and four support workers. We also spoke with one person who used the service and four relatives of young people, two of whom had recently transferred from children to adult service. This process is referred to as 'transition'.

The relatives we spoke with made positive comments about the staff and services provided. Comments included :"We enjoy effective communication with all the staff and know they respect and value the people they support"; "Transition from children to adult services has been great. Staff have worked together to enable YP1 and YP2 to feel at ease and not be afraid of the change" and " Staff have worked with us to ensure we understood the transition and agreed with the way it was happening."

We looked at two care records. We saw people’s personal preferences, likes and dislikes had been clearly recorded throughout.

Young peoples needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who use the service were protected from the risk of abuse, because the provider had ensured staff received appropriate training and had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People who use the service, their representatives and staff were asked for their views about the way the service was run.

During our visit we spoke with two managers, a team leader and three support staff. We spoke with a relative and two senior support staff on the telephone.

From records seen and conversations held we found evidence that this service was provided in a person centred way. People using the service were involved and received care and support that respected their right to make decisions.

Appropriate steps had been taken to assess people's needs and develop care plans that described how their needs would be met safely.

Suitable arrangements had been made to ensure that staff received training in how to recognise abusive situations and the action they must take if they suspected people using the service to be at risk of abuse. Staff had also received training in order to support people appropriately. This was confirmed by a relative who described staff as well trained.

During our visit we found that support staff had alleged that insufficient staff had been provided to one person using the service on three occasions during September 2012. This raised concerns in relation to the registered manager's effectiveness in responding to concerns raised by support staff and the failure to effectively analyse potential risk to the health and safety of the person concerned and staff supporting them.