United Response Spire provides personal care for adults in supported living. This includes people living with a learning difficulty. There were 70 people using the service for personal care at the time of our inspection. Fifty two people were in 'supported living' accommodation. 'Supported living' is where people live in their own homes and can have full time staff support available. Eighteen people were living in their own homes.

This inspection took place on 21 September 2016. The service is run from an office in the Staveley area. The provider was given 48 hours' notice because the location provides a domiciliary care service and we wanted to make sure the registered manager was available. In addition we also carried out visits to people using the service on 6 October 2016.

There were two registered managers at the service. 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 service was following the guidance in people’s risk assessments and care plans and the risk of unsafe care was reduced. People’s records were up to date and indicated that care was being provided as detailed in people’s assessments. The records had been updated to reflect changes in people’s care needs. Medicines were managed safely.

People were safeguarded from abuse because the provider had relevant guidance in place and staff were knowledgeable about the reporting procedure. The provider's arrangements for staff recruitment and deployment helped to make sure there were sufficient staff who were fit to work at the service to provide people’s care.

Staff understood their roles and responsibilities for people's care and safety needs and for reporting any related concerns. The provider's arrangements for staff training and their operational procedures supported this.

The principles and requirements of the Mental Capacity Act (2005) were being met. People were supported by staff who knew them well. Staff were aware how to promote people’s safety and independence. People were provided with information to support them to make day-to-day decisions.

People received appropriate support to plan and manage their meals and nutrition. This was done in a way that met with their needs and choices. People’s health needs were met. Referrals to external health professionals were made in a timely manner.

People and their relatives told us the staff were caring and kind and that their privacy and dignity was maintained when personal care was provided. People and their relatives were involved in the planning of their care and support.

There was a complaints process in place. The leadership of the service was praised by external professionals and relatives and communication systems were effective. Systems to monitor the quality of the service were inclusive and identified issues for improvement.

We read care records for five people who used the service and found information had been recorded on the best way to help people make choices. This included using pictures, repeating information and assessing what the best time of day would be for each person to consider and weigh up information. When we spoke with people supported by the service, one person said, “Staff always listen to me and its ok if I change my mind.” Another person told us, “I like the things staff help me to do.”

One family member we spoke with said, “I have seen my relative’s confidence grow daily. Staff support them to learn new things and they are encouraged to do as much as they can. My relative is always telling me how happy they are.”

On the day of the inspection we found there were effective recruitment and selection processes in place and the appropriate checks were made before staff began work.

Both members of staff we spoke with told us their work had been observed by a supervisor to ensure people using the service received support in line with their care plan. When we looked at the staff files we found evidence that observations on staff’s work had been recorded and feedback given to staff to improve their practice.

We found evidence that staff received training on record keeping. This included why record keeping is important, legal requirements and how records keep people who use the service safe.

We visited two community homes with four people living in each. We spoke to three people in total. Some people were not able to talk to us because of their disability. Two people were not at home as they were attending a local day care service. One person told us they were very happy with the care they received and that they liked to wash the car they used for trips out and about their favourite football team. Another person wanted to know who would be driving them to their parental home for the week-end.

We saw person centered care plans which described people's needs and how they wanted to be treated. We saw staff use Makaton sign language to communicate with one person.

A healthcare professional from the community learning disability team told us that the care people received was person centred and that staff listened to the advice of the professionals in the team. He also told us he had been involved in people's service reviews.

We visited two schemes supported by the agency but because of the degree of learning disability exhibited by the people being supported, we only spoke to one of them directly. We spoke to some of the staff who support them and observed interactions taking place during our visits.

We were told ‘we all get on well together here and there’s always plenty of staff. They help me do the things I want to do; I work at Grass Routes all week which I really enjoy. In the evening I go out to the pub with staff’.

Our discussions with the team managers and staff indicated a commitment to individual working and they told us that ‘the work is all about patience and caring, and building up trust is very important’ and that ‘staffing levels are high enough for us to support a range of activities that they want to do and our work is aimed at meeting individual needs’.

We observed that staff were aware of people's individual needs and knew to best to communicate with and support people make choices for themselves regarding their daily routines. Staff told how they routinely contribute to the care records and documentation and how it is continually being improved to make it more meaningful for the safe completion of support activities. They told us that ‘the care plans are very useful, particularly when you start work‘.

The motivation of everyone we spoke to about the work carried out by the agency was at a high level.