The inspection took place on 18 August and 6 September 2016 and was announced.

At our previous inspection in April 2014 we found the provider was meeting the regulations in relation to the outcomes we inspected.

Warrington Community Living (WCL) was established in 1991 is a local charity that seeks to support people with learning disabilities, physical disabilities, older people, people with dementia and people experiencing mental health issues to lead their lives in a purposeful, healthy and enjoyable way as full and equal members of their local community. They do this through the provision of residential homes and supported living schemes, provision of short breaks for children and young people as well as other forms of support for individuals in the community.

The head office is in the centre of Warrington located on an upper floor of the Gateway building and is accessible to people via a stairway or a passenger lift.

This inspection focussed on the domiciliary care and supported living network provided by Warrington Community Living. The service provided services to people with severe learning disabilities or autistic spectrum disorder in their own homes. At the time of the inspection the service offered support to 29 people, however only four people received care and support which involved an activity the provider was registered for with the Care Quality Commission.

The service has a registered manager. 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 who used the service and their relatives spoke of the outstanding care delivery. They told us the provider and staff of the service went above and beyond to ensure they received a person centred service. Staff maintained people’s privacy and dignity ensuring any care or discussions about people’s care were carried out in private. We saw interactions both verbal and non-verbal between staff and people who used the service were caring and respectful with staff showing patience, kindness and compassion. We observed staff knew and understood the people they cared for and ensured people were provided with choices in all aspects of daily life by way of discussion. Innovative assistive technology had been introduced to enable people who used the service to keep up to date with news and events and to be personally involved with recording their daily diaries.

Staff were recruited through a rigorous procedure. As part of the recruitment process the provider used value based recruitment techniques, a clearly defined culture statement and staff competency assessments. Staffing provision was responsive to people’s changing needs and preferences which enabled people to lead fulfilled lives. People who used the service and their relatives were encouraged to participate in the interviewing process for potential employees. This demonstrated the service’s commitment to the culture of inclusion and participation within the service.

People who used the service, family members and external agencies were most complimentary about the standard of support provided. The registered manager involved families and other agencies to ensure people received the support they needed to express their views and make decisions that were in their best interests. Relatives and professionals were very positive about the service people received. The service specialised in supporting adults and children with behavioural problems some who had lived in large institutions for a long period of their life or had experienced several failed placements prior being supported by Warrington Community Living.

Positive risk taking was driven throughout the organisation, balancing the potential benefits and risks of taking part

We undertook an inspection of Warrington Community Living Domiciliary / Supported Living Network on 8th April 2014. At the time of our inspection the agency provided a service to five people. During the inspection we visited the agency's office. We spoke with the acting manager, two staff and four relatives. Likewise, we also spoke with two people who received support from the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Policies and procedures had been developed by the registered provider (Warrington Community Living) to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

We were informed that none of the people using the service had been referred for a mental capacity assessment and no applications had therefore been submitted to deprive a person of their liberty.

Training records highlighted that the majority of staff had completed Mental Capacity Act training but only one staff had completed Deprivation of Liberty Safeguards training. This has been brought to the attention of the provider so that action can be taken to increase staff knowledge and understanding.

The provider had developed guidance on recruitment and selection to provide information to staff on the procedures for recruiting new employees. We looked at a sample of recruitment records for three staff which had been stored electronically. Examination of records and / or discussion with staff confirmed staff had undergone a comprehensive recruitment process prior to commencing work with the provider.

Some records could not be located for one employee. We have received assurances from the provider that action was being taken to recover the missing records and to audit all personnel files to identify any other gaps.

Policies and procedures had been developed for the administration of medication. Staff had completed in house medication training and / or medication and healthcare procedures training prior to administering medication.

We noted that staff had signed one person’s Medication Administration Chart (MAR) using a pencil. Furthermore, some medication details had been hand written which had not been signed or countersigned by another suitably qualified member of staff to confirm the details were correct. We have brought this issue to the attention of the provider so that action can be taken to improve records.

Is the service effective?

We spoke with two people using the service by telephone who were both complimentary of the service provided. Comments received included: “”I’m very happy and I’m not moving”; “The staff help me” and “The support I receive is great. I’ve never been so happy.”

Records highlighted that there had been no complaints in the last twelve months and no complaints or allegations were received from people using the service or their representatives during our inspection.

Is the service caring?

We also spoke with the relatives of four people who were supported by the service. All feedback received was positive and confirmed the service was responsive and caring to the needs of the people using the service.

We received comments such as: “The standard of care provided is exceptional and the service is reliable”; “They provide a very personalised service in every aspect including the care plans; “The manager and staff are all lovely people. They genuinely care and have the right ethos” and “The care provided is outstanding and they understand the needs of my relative.”

Is the service responsive?

Records viewed highlighted that the provider was committed to the inclusion of people in the development and operation of the service. For example, we noted that the provider was exploring options to engage people using the service in staff recruitment.

Furthermore, files viewed contained a range of personalised records that had been developed using signs, symbols and pictures to enable people using the service to participate in the development of person centred planning and to understand the information more easily.

Summary information on each individual’s progress with independent living skills, involvement in activities / interests and learning observations had been recorded by support workers. This helps the people using the service to develop and monitor progress and to develop new skills and life experiences.

We could not locate an assessment of need for one person using the service during our visit. We have brought this to the attention of the provider and received an assurance from the acting manager that an assessment tool will be developed to ensure the needs of people using the service are assessed prior to the service commencing (if a care management assessment is not available).

Is the service well led?

The provider has worked well with the Care Quality Commission and is aware of the need to keep us updated on any significant events via statutory notifications.

An acting manager had been appointed who was in the process of applying to register with the Care Quality Commission. We noted that there had been a significant delay in the acting manager progressing his application.

Since completing our inspection we have received a detailed report together with supporting evidence of events contributing to the delay and action taken. This included an action plan to cancel the registration of the previous manager and to ensure the acting manager applies for registration as a matter of urgency.

The service continued to utilise a comprehensive internal quality assurance system and has developed systems to obtain feedback from people using the service and / or their representatives.

At the time of our visit the agency was providing personal care and support to only one person.

The service user spoken with confirmed they were given appropriate information and support regarding their care or treatment. We noted that the service was using electronic tools together with pictures, signs and symbols to assist the person to plan an individualised service and to assist in communication.

The person reported: “I am very happy living here”; “I like the staff” and “I don’t want to move”.

Systems had been established to ensure an appropriate response to abuse and ensure the quality of service provided was kept under review.

No concerns, complaints or allegations were received during our visit.

During this review we spoke with the acting manager, an assistant manager and three staff. We also visited three properties and spoke with three people who use the supported living service.

We used a number of different methods to help us understand the experiences of other people using the service because some of the people using the service had non-verbal communication needs which meant they were not able to tell us their experiences. We therefore made observations on the standard of care provided and also spoke with a relative and support staff to check people were given appropriate information and support regarding their care.

People spoken with confirmed they were given appropriate information and support regarding their care and confirmed care and support was planned and delivered in a way that ensured people’s safety and welfare. One person informed us that: “I have been given a service user guide and I have a care plan.”

Comments received from three people using the service included: “I like it here”; “The staff are not bad” and “I can’t grumble. I’m much happier since moving to this house.” Likewise, a relative spoken with informed us that they were happy with the care provided and that their family member had become more independent since using the service.

People spoken with also confirmed that they felt safe using the service but the provider was unable to provide evidence that it had sought the views of the people using the service or persons acting on their behalf.

No concerns, complaints or allegations were received during our visit.

Due to the complex support needs of the people we met, no direct feedback was received, as the service users were unable to communicate verbally. We noted that the people using the service looked well cared for and content and feedback received from their representatives was generally positive.