This was our first inspection of Waters End. The visit was announced and was carried out on 20 August 2018. This service provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. The provider was given notice because we needed to be sure that someone would be in the office.

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.

At the time of our visit the manager, who was also the provider, was in the process of registering to be the registered manager. They had been the manager since April 2018. 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.

Systems were in place to monitor the quality of the service being provided though these had not always been effective.

Risks associated with people’s care and support had not always been identified or assessed.

Pre- employment checks had not always been carried out in a timely manner.

The manager was in the process of identifying and providing the training the staff team needed in order to maintain the knowledge and skills required to meet people’s needs.

Relatives of the people using the service felt they were safe with the support workers who provided their care and support. The staff team were aware of their responsibilities for keeping people safe from avoidable harm and knew the actions to take should they be concerned for anyone.

There were suitable numbers of staff available to meet people’s care and support needs.

People were supported with their medicines in a safe way and as prescribed by their GP. Protocols were in place for medicines prescribed as and when required and a homely remedies protocol was being developed.

Protective personal equipment was available and used and the staff team ensured peoples home environment was clean and tidy.

There were arrangements in place to make sure action was taken and lessons learned when things went wrong to improve the service provided.

People’s care and support needs had been identified and plans of care had been developed for each person using the service. The staff team knew the needs of the people they were supporting well.

The staff team supported people to make decisions about their day to day care and support. They were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) ensuring people's human rights were protected.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People's food and drink requirements had been identified and a balanced diet was being provided. People received on-going healthcare support and had access to the relevant healthcare services.

People told us the staff team were kind and they treated people in a caring and respectful manner.

An end of life policy was in place. This showed the staff team how to provide the personal and emotional care people deserved as they approached the end of their life.

People knew who to talk to if they had a concern of any kind and were confident any concerns they had would be taken seriously and acted upon by the manager and the staff team.

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