This inspection took place on 1, 2 and 7 August 2018. The inspection was announced and the service was given 48 hours’ notice to ensure a member of staff would be present.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger adults who have learning disabilities, autism and/or physical disabilities.

People using this service live in single houses of multi-occupation across Trowbridge and Salisbury. Houses of multiple occupation are properties where at least three people in more than one household share a toilet, bathroom, or kitchen facilities. Staff support people with personal care, medicines, cooking, shopping, activities and other day to day tasks.

At the previous comprehensive inspection, on 12 and 18 July 2017, the agency was rated as requires improvement. We found the service had not complied with Regulations 9 and 11 of the Health and Social Care Act Regulations 2014. We found care plans were not always person centred and did not give staff guidance on how to meet people’s changing needs. We also found the staff were not following the principles of the Mental Capacity Act (MCA). The provider wrote to us, explaining the actions they would take to meet the requirements of the legislation. At this inspection we found some improvements had been made. We made a recommendation about staff attending training in the principles of the MCA.

This is the second consecutive time the service has been rated Requires Improvement.

The care service has been developed and designed in line with the values that underpin the 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. Registering the Right Support CQC policy.

The current manager was undergoing the process to be registered with CQC. 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.

Medicine systems were not always well managed. Staff that administered medicines had attended appropriate training. We saw records of administration were mostly signed to show medicines administered. For one service, the records of administration were not consistent with the directions noted on the medicines in stock. Also, staff were not always signing records when topical prescriptions, such as creams and lotions were applied. The manager took prompt action to ensure people were having their medicines as prescribed.

The staff were not given clear guidance on when to administer medicines prescribed to be taken. as “when required” (PRN). Where protocols were in place we observed that staff did not follow the guidance or updated the protocols to reflect current practice.

Care plans and risk assessments were combined. Where risks were identified action plans on how to minimise the risk were devised. Care plans had aspects of person centred approach.

Guidance from healthcare professionals to support people’s behaviours, was not always followed. We found that at one service, people did not receive support in accordance with what was recorded in their care plan.

There was an online system of reporting incidents and accidents. However, copies of the incidents were not always completed and a review of the care plan was not triggered for re-occurrences of the same incident. This meant people's needs were not reviewed to develop action plans that prevent or reduce the potential of the same incident from reoccurring.

Staff knew the day to day decisions people were able to make. One person told us the

This was the first inspection since the service made changes to their registration. Voyage DCA Wiltshire offers a supported living service to people within shared houses. People who use the service have learning disabilities, autism and/or physical disabilities. They are supported with personal care, medicines, cooking, shopping, activities and other day to day tasks. At the time of this inspection, 29 people were using the service.

This inspection took place on 12 and 18 July 2017.

A registered manager was 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’s capacity to make decisions such as medicine administration, finance and personal care was assessed. We saw for people with Court of Protection orders in place the appointed deputies had not been consulted for specific decision. We saw for one person, their relative was managing the finances where there was no Court Appointed deputy in place. The registered manager had not made the Court of Protection aware that they were caring for a person who were deprived of their liberty. Members of staff knew how to support people to make day to day decisions

Copies of records were not kept at the service office which included copies of Healthcare action plans and hospital passports were not kept at the service. Copies of medicine administration records (MAR) and when required (PRN) protocols were not kept at the service. This meant office staff did not have access to people’s information and were not able to give staff guidance over the phone. In addition office staff were not able to monitor records and the effectiveness of the delivery of care and treatment.

Care plans and risk assessments were combined. A traffic light system was used to identify the level of risk. Members of staff knew the actions needed to minimise risks. For example, aggressive and physically challenging behaviour. While some information about people’s preferences was included, the care plans were not always person centred. They lacked detail on how staff were to encourage people to meet their needs. Where healthcare professionals had made recommendations on how to support people these guidelines were not always used to develop care plans. Care plans were not monitored and there was no evidence to show that the care plans were effective.

Some people at times used verbal and physical aggression to show they were distressed or frustrated. A record of these incidents were in place but there was no evidence that all the recommended were followed to prevent the challenging incidents from escalating. Reports of challenging incidents were analysed to see if staff had followed guidance in people’s care plans, or to determine whether care plans needed to be updated.

People told us they received kind and compassionate care from staff. The staff told us how they developed relationships with people and they knew why this was important. The staff comments indicated staff knew people well and knew their preferences.

People told us they felt safe with staff. The staff told us they had attended safeguarding of vulnerable adults training. These staff were aware of the types of abuse and the expectations placed on them to report allegations of abuse.

Recruitment procedures were safe. Where staff had convictions, risk assessments were completed. However, action plans needed to be in place on how these staff were to be supported going forward.

Staff said the training was good and they had attended all mandatory training required by the provider. A combination of face to face and online training was provided. The staff we spoke with said they had regular one to one supervision with their line manager to discuss issues, th