This inspection was announced and took place on the on 02, 03 and 04 May 2017. The provider was given 48 hours' notice because the location provides a domiciliary care service to ensure the registered manager would be available for our inspection.

When we last inspected the service on 05, 06 and 09 September 2016 we found the service was not meeting the required standards. At that time we rated the service as inadequate for well-led, with an overall rating requires improvement. At this inspection we found a number of improvements had been made by the provider.

Waterside House consists of two distinct service types: reablement service and supported living service provided by Trafford Metropolitan Borough Council. The delivery of the service was split into four geographical areas: Stretford and Old Trafford (north). Urmston, Flixton and Partington (west). Altrincham, Bowden, Timperley and Hale (south). Sale, Sale Moor and Ashton-on- Mersey (central).

The reablement service is designed to help people recover from a period of serious illness or injury which may have resulted in hospital treatment. The service provides a range of rehabilitation, care and support services for up to six weeks. At the time of our inspection 12 people were receiving the reablement service. The provider was in the process of closing the reablement service and no new admissions were being taken at the time of our inspection.

The supported living service provides supported accommodation to adults with a learning disability who require access to 24 hour support. 17 people received this service in six supported accommodation properties.

At the last inspection there had been no registered manager for approximately twelve months. We found there were no clear arrangements in place to determine who had overall responsibility for ensuring effective systems to assess, monitor and drive improvement in the quality and safety of the service. At this inspection we found vast improvements had been made, a registered manager was now in place and had a clear overview of the reablement and supported living service.

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.

The registered provider was now working within the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards in Domestic Settings (DoLSiDS). Staff sought consent to care from people they supported. Staff were now aware of the principles of the MCA and DoLSiDS. and how to support people effectively.

Staff were supported through induction, regular on-going training, supervision and appraisal. A training plan was in place to support staff learning.

There were appropriate procedures to safeguard people and the staff were aware of these. During discussions with the registered manager they were conducting a full disciplinary investigation, due to an allegation made towards a staff members conduct. We will review this safeguarding outcome once this has been investigated.

Staff were extremely caring and always ensured they treated people with dignity and respect. They had an excellent understanding of the care and support needs of every person receiving the supported living service. People had developed very positive relationships with staff and there was a friendly and relaxed atmosphere.

Staff expressed confidence in the management team and in each other. There were regular staff meetings where staff could contribute their views.

Records showed the service acted upon the written complaints it had received in accordance with their complaints policy.

Information was available to staff about how to support people with their medicines and all staff had been trained in how to admi

This inspection was announced and took place on the on 05, 06 and 09 September 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service to ensure the registered manager would be available for our inspection. The last inspection took place on 04 February 2014 and the provider was compliant with the regulations we checked.

Waterside House consists of three distinct service types: assessment and reablement service, rapid response service and 24 hour supported living service provided by Trafford Metropolitan Borough Council. The delivery of service was split into four geographical areas: Stretford and Old Trafford (north). Urmston, Flixton and Partington (west). Altrincham, Bowden, Timperley and Hale (south). Sale, Sale Moor and Ashton-on-Mersey (central).

The assessment and reablement service is designed to help people recover from a period of serious illness or injury which may have resulted in hospital treatment. The service provides a range of rehabilitation, care and support services for up to six weeks. The rapid response service works alongside the assessment and reablement service and provides short-term intervention (of up to 7 days) to people in a ‘crisis’ situation. The cause of this may be due to carer breakdown, a fall, sudden illness or a change in situation. At the time of our inspection 53 people were receiving the reablement / rapid response service.

The 24 hour supported living service provides supported accommodation to adults with a learning disability who require access to 24 hour support. 18 people received this service in six supported accommodation properties.

At the time of the inspection there was not a registered manager at Waterside House.

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.

During this inspection visit we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to MCA and DoLS, training, complaints and quality assurance and auditing systems. We are considering our options in relation to enforcement for some of these breaches of the regulations and will update the section at the back of this report once any action has been concluded.

Due to there being no registered manager for approximately twelve months, we found there were no clear arrangements in place to determine who had overall responsibility for ensuring effective systems to assess, monitor and drive improvement in the quality and safety of the service.

The registered provider was not working within the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff sought people's consent before providing care but people's capacity to make their own decisions was not assessed when needed. Some people were being deprived of their liberty to keep them safe but applications had not been made to ensure this was formally and legally agreed to be in their best interests.

Staff were supported through induction, regular on-going training, supervision and appraisal. A training plan was in place to support staff learning. There were however, gaps in first aid; MCA and DoLS; fire safety; and infection control.

We saw a record of complaints dated 2009 had been recorded on file, but recent complaints had not been recorded to show how the provider had engaged with the complaint or ensured that it had been resolved to the person’s satisfaction. The registered provider had no system in place to log and analyse complaints and concerns to enable lessons to be learnt.

Information was available to staff about how to support people with their medicines and all staff had been trained in how to administer medication. Checks had bee

We found Waterside House had approximately 150 people currently accessing the reablement service with 129 front line staff 114 working a variety of hours to meet their care needs. The reablement package which is a short term intervention was available for up to six weeks following discharge from other care environments.

We found all people using the service gave written consent and agreed to their reablement package at the outset of their care.

Reablement plans were person focused and were individual to the persons needs and had time scales for achievement of goals within them that were specific to the person.

All staff working within the service had been recruited via a robust recruitment process that ensured all relevant checks were carried out before the person started their role.

Waterside House had a robust quality assurance system in place to monitor the quality of the service delivered to people accessing the service.

We saw evidence of a robust complaints policy being in place managed by a complaints co-ordinator. People who accessed the service were given a copy of the complaints and compliments process when they started with the service.

People who used the service told us; "They are great they encourage me to do things but support me if I can't quite manage yet. They always ask what I am willing to try today and when they ask so nicely how can you not try?". "They are a great support to me I shall be sorry when I no longer need them".

We spoke with two people who use the service. They told us that the staff were helpful and supportive.

People told us they were happy with the care they received and had no concerns. They also told us they were kept involved in the review of care plans.