This inspection took place on 10 October 2016 and was announced. At our previous inspection in February 2016, we found the service was in breach of the regulation relating to consent to care. We found that proper consideration had not been given to whether restrictions on people living at Maldon Road could have amounted to a deprivation of their liberties. At the time of that inspection the provider had not applied for authorisations to deprive people of their liberty lawfully. During this inspection we checked that the necessary improvements had been made to address the breach.

Maldon Road is a four bedded supported living service for adults with a learning disability, including autism and poor mobility. At the time of our inspection there were four people using the service. One of the four people was in the process of moving on from the accommodation on the day of this inspection. People had their own tenancies with the housing association which owns the property. They received support with their personal care from Walsingham.

The service had a manager who was on duty at the inspection. They took up this post in April 2016 and we saw evidence they were in the process of registering with the Care Quality Commission. The previous registered manager moved to another post within the Walsingham organisation. 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.

At this inspection the manager and staff demonstrated their understanding of the Mental Capacity Act 2005 and Deprivation of Liberty legislation. We saw documented evidence that discussions about depriving people of their liberty took place with the local authority for the people living at Maldon Road. In addition to this the registered manager and the staff were aware of the importance of gaining consent for the support they offered people.

Social care professionals told us they thought people were safe living at the service and they received safe care and support from staff. Staff told us the signs of potential abuse and understood the relevant reporting procedures. Assessments were completed to assess any risks to people and to the staff who supported them. At this inspection we found needs and risk assessments were reviewed and up to date. There was appropriate guidance in place for staff to follow that helped to keep people safe. We saw there were other systems in place to protect people from the risk of possible harm. There were risk assessments in place to do with the environment and equipment to provide guidance to staff on how risks could be managed and minimised where possible.

People’s needs had been assessed and we saw care plans included detailed information relating to their individual needs. Care plans were personalised and demonstrated people’s preferences, and choices. People’s care and support packages were amended as necessary to meet their changing needs.

There were sufficient numbers of staff available to meet people’s individual support and care needs. There were safe staff recruitment practices in place and appropriate recruitment checks were conducted before staff started work to help ensure people were supported by staff who were suitable for their role.

Medicines were managed, stored and administered safely and people were appropriately supported to take their medicines.

There were processes in place to ensure new staff were inducted into the service appropriately and we saw staff received regular training. Staff told us they felt well supported through their supervision, team meetings and annual appraisals.

People were supported to maintain good health and had access to a range of health and social care professionals when required.

Staff were caring

This inspection took place on 24 February 2016 and was unannounced. At our previous inspection in April 2015, we found the provider was meeting the regulations in relation to the outcomes we inspected.

Maldon Road is a four bedded supported living service for adults with a learning disability, including autism and poor mobility. At the time of our inspection there were three people using the service. They all had their own tenancies with the housing association which owns the property and received personal care from Walsingham.

The service had a registered manager who was not available at the inspection. A senior member of staff was acting manager for this service at the time of this inspection. After the inspection we spoke with the registered manager who said he was in the process of de-registering with the Care Quality Commission (CQC) and recruitment of a new manager was in process. This new manager would then 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.

Staff were aware of the importance of gaining consent for the support they offered people. The manager and staff had some understanding of the Mental Capacity Act 2005 and Deprivation of Liberty legislation. We also found that proper consideration had not been given to whether restrictions on people could have amounted to a deprivation of liberty and if so whether the provider had applied for authorisations to deprive people of their liberty lawfully. The acting manager took action to address these matters when we pointed this out. We have made a recommendation in relation to following national guidance on this issue.

Relatives told us they thought their family members were safe living at the service and that they received safe care and support from staff. Staff were able to describe to us the signs of potential abuse and understood the relevant reporting procedures. Assessments were completed to assess any risks to people and to the staff who supported them, although we found these were now due for review. Appropriate guidance was in place for staff to follow to help keep people safe. There were other systems in place to protect people from the risk of possible harm. There were risk assessments in place to do with the environment and equipment to provide guidance to staff on how risks could be managed and minimised where possible.

People’s needs had been assessed and care plans included detailed information relating to their individual needs. Care plans were personalised and demonstrated people’s preferences, and choices. People’s care and support packages were amended as necessary to meet their changing needs.

There were sufficient numbers of staff available to meet people’s individual support and care needs. There were safe staff recruitment practices in place and appropriate recruitment checks were conducted before staff started work ensuring people were supported by staff that were suitable for their role.

Medicines were managed, stored and administered safely and people were appropriately supported to take their medicines.

There were processes in place to ensure new staff were inducted into the service appropriately and we saw staff received regular training. Staff told us they felt well supported through their supervision, team meetings and annual appraisals.

People were supported to maintain good health and had access to a range of health and social care professionals when required. People’s nutritional needs and preferences were met.

Staff were caring and compassionate in the way they met the needs of the people they supported and could describe peoples’ preferences as to how they liked to be supported. We observed staff speaking to and treat

This unannounced inspection took place on 28 April 2015. Although this service has been in existence for many years it has been re-registered on 13 August 2014 to the current provider, Walsingham Supported Living and Community and Home Support Service. This is the first inspection under the new registration.

Walsingham- Supported Living and Community and Home Support Services provide personal care, support and assistance to people with a physical and learning disability living in their own flats and homes. 34 Maldon Road is a supported living scheme where people have tenancy agreements for their accommodation. There were three people living at Maldon Road, which is divided into four self-contained flats, based on two floors, with lift and stair access. There is a shared garden and office space at the house. In addition, the service also provides care and support to two people living in their own homes within the community.

The service had a registered manager at the time of the inspection. 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.

People at the supported living accommodation were not always able to verbally communicate their needs. Staff used assistive technology such as telecare and fall mats to alert them when a person may have fallen or had a seizure. All these measures helped to ensure that people were kept safe. Healthcare professionals we spoke with were happy with the systems that had been put in place at Maldon Road to keep people safe.

Staff had received training to ensure the safety of the people they supported. Staff were able to describe what abuse and keeping people safe meant to them and the people they worked with. The registered manager told us that concerns or safeguarding incidents were reported and we saw documented evidence to confirm this.

People had individual risk assessments and risk management plans in their care files. Action plans were in place to help minimise the risks faced by people. These measures helped to ensure that people were kept safe while giving them the freedom to do what they liked doing.

The provider had arrangements for health and safety checks on the flats people lived in. These checks ensured people using the service were living in a safe and maintained environment. The provider had systems in place for the investigation and monitoring of incidents and accidents. Staff would monitor any actions implemented to reduce the risk of the incident or accident reoccurring.

We saw that safe recruitment processes had been carried out before staff started to work with people. There were enough staff employed to meet people’s needs. People’s medicines and medicines administration records (MAR) were kept securely and monthly monitoring checks helped to ensure the safe administration of medicines to people in their homes.

People were cared for by staff who had appropriate support and training to do their job. The provider had identified a range of mandatory training courses for staff including safeguarding adults, awareness of the Mental Capacity Act 2005 (MCA), the safe administration of medicines, health and safety and food hygiene. Staff had supervision sessions with the registered manager every six to eight weeks and felt supported by the registered manager.

Although many of the people using the service were unable to verbalise their consent, it was clear from speaking with staff that people were actively involved in making decisions about their care and support needs whenever they could. Staff had a good understanding of how and why consent must be sought and what to do if they felt people were not able to make decisions. The provider had policies and procedures which provided staff with clear guidance about their duties in relation to the MCA and consent.

We saw the dietary requirements for each person using the service were detailed and staff responded to people's individual dietary needs. Staff had developed menus which were based on people’s favourite meals. People were encouraged to help with the preparation of meals and tidying up afterwards.

People had access to healthcare professionals when they required this. Records showed that people could visit their GP at any time, and that other healthcare professionals were available when required. People had annual health checks and staff understood the importance for people to maintain good health and supported people with this.

Not all people were able to tell us if they were happy with the care they were receiving but we could see from our observations that they appeared happy and were comfortable with staff. We saw staff treated people with kindness and compassion and were enthusiastic in delivering the support people needed.

We saw that people's support plans were comprehensive and focussed on who the person was, this helped staff to have a better understanding of the people they were caring for. People using the service had regular reviews of their care and support plan. Whenever possible people were encouraged to make decisions. If a person needed additional support to make decisions they had access to advocacy services and social workers who could help them.

We saw that people privacy and dignity was maintained by staff.

The provider carried out an initial assessment of peoples support needs to check the person’s care and support needs could be provided by the service. People lived in individual self-contained flats. Staff said this could make people isolated and could have an effect on their behaviour. The registered manager in response to people’s changing needs has appointed an activities co-ordinator to find out what activities were available in the community, so that if people wanted to they could be supported to join in with events.

Support plans and risk assessments were reviewed annually or sooner if needed. Additional information from other people involved in people’s care was also included. There was a day to day breakdown of how a person liked to spend their time and how staff could help the person achieve this. This helped to ensure that people’s needs were met and changes made when necessary.

The provider had a complaints policy and procedure. The forms used by people wishing to make a complaint were in an easy to read format to help people understand the process.

The service was well-managed. The service had a registered manager in place who was aware of all aspects of the service including the support needs of all the people using the service. The registered manager encouraged a positive and open culture by being supportive to staff and by making themselves approachable.

Systems were in place to monitor and improve the quality of the service, such as annual satisfaction surveys. The manager attended local and national forums to ensure they kept up to date with any changes that may affect the support they offered to people.