This inspection took place on 20 September 2017. Wellbeing Support Services is a supported living service. People live in a small complex of 10 self-contained flats. Wellbeing Support Services provides support to people in their own flat. At the time of our inspection they were supporting nine people.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

On the day of our inspection the manager was not registered with the Care Quality Commission (CQC). They had applied to register and were going through the registration process. A registered manager is a person who has registered with the 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 told us they felt safe and relatives agreed. Support staff knew how to recognise and report abuse. Risks to people had been assessed and action was in place to manage any identified risks. Medicines were managed and administered safely. Staffing at the service was adequate and recruitment procedures were robust.

Support staff told us, and records confirmed, support workers received the induction, training and on-going support they needed to provide people with effective care. 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 were supported to make healthy food choices. Where appropriate staff supported people to develop their cooking skills. The service sought advice from other healthcare professionals when necessary.

People and support staff had developed positive relationships. Support staff were aware of professional boundaries when supporting people with social activities. People’s views about their care and support were sought on a formal and informal level.

Support plans were detailed and written with the involvement of the person and their family where appropriate. The service was pro-active in ensuring people did not become socially isolated and worked to develop a supportive relationship between people living in the flats. People were also supported to access the wider community by taking on employment or social activities.

The service had an effective management team. A range of audits were used to monitor the safety and quality of the service, of which the provider had oversight. The provider was committed to improving the quality of the service. They had re-organised the management structure of the service and had invested in a new smart phone based support planning system.

This inspection took place on 29 September 2015 and was unannounced.

At the inspection on 2 April 2015, we asked the provider to take action to make improvements in the quality of care plans and risk assessments, staff training and the governance of the service. They provided us with an action plan of how these matters would be addressed. At this inspection we found that the action plans had been completed.

The service provides personal care and support to adult with a learning disability who live in flats rented independently from the provider. On the day of our inspection five people were receiving support from the service.

The manger had applied to the Care Quality Commission to be registered. 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 were safe because staff understood their roles and responsibilities in managing risk and identifying abuse. People’s care needs were identified in care plans which clearly described their needs and assessed risks which they may encounter.

There were sufficient staff who had been recruited safely and who had the skills and knowledge to provide care and support to people in ways they needed and preferred.

People were supported by staff to manage their health needs. Staff supported people to have sufficient food and drink that met their individual needs.

People were treated with kindness and respect by staff who knew them well. They knew and understood people as individuals.

People were supported to engage and socialise with other people living locally. This included pursuing their hobbies and engaging in voluntary activity.

There was an open culture and the management team demonstrated good leadership skills. Staff morale was good, they were enthusiastic about their roles and they felt valued.

The management team had systems in place to check and audit the quality of the service. The service was seeking the views of people as to the quality of the service provided.

We carried out an unannounced comprehensive inspection of this service on 2 April 2015. After that inspection we received concerns in relation to the safety of people living in the service. As a result we undertook a focused inspection on 21 July 2015 to look into those concerns. Our inspection of 2 April 2015 had found breaches of legal requirements after which the provider wrote to us to say what they would do to meet legal requirements in relation these breaches. This inspection also checked that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Wellbeing Care Support Services on our website at www.cqc.org.uk.

The service provides personal care and support to adults with a learning disability who live in flats owned by the provider. On the day of our inspection there were seven people receiving support from the service.

The service did not have a registered manager in place. 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 our focused inspection of 21 July 2015 we found that the provider had followed their action plan and improvement had been made. Legal requirements relating to breaches relating to the key question ‘safe’ had been met. This was because medicines were now managed safely and there were sufficient adequately trained staff to meet people’s care needs. There were also sufficient adequately trained staff to provide the support people required.

However, on this inspection we identified that risk assessments put in place following our 2 April 2015 inspection did not always do everything practicable to mitigate risks to people. This meant that people were exposed to unnecessary risk when receiving care and support.

You can see what action we told the provider to take at the back of the report.

This inspection took place on 2 April 2015 and was unannounced.

Our previous inspection of 6 March 2015 had found breaches of a number of regulations. These were how the service looked after the care and welfare of people, assessed and monitored the quality of the service provided, safeguarded people from abuse, managed medicines, obtained people’s consent, managed complaints, recruited and supported staff. After the inspection of 6 March 2015 we served the provider with a notice preventing them taking on any new clients.

At this inspection we found these breaches of regulation had not been fully addressed.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

The service provides personal care and support to adults with a learning disability who live in flats owned by the provider. On the day of our inspection there were seven people receiving support from the service.

On the day of this inspection there was not a registered manager in place. The provider had recently appointed a manager who told us it was their intention to register. 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.

This inspection found that the new manager had begun to put in place processes and procedures to deal with the breaches of regulations identified above. However, due to the timescale since our previous inspection these had been fully implemented and as yet were not effective.

Some new care plans had been written but these did not address the support people using this type of service required. The manager was in the process of devising care plans which would fully meet the complex needs of people.

Medication training had been undertaken. However an audit carried out by the inspector found discrepancies in the administration and recording of medication.

The Mental Capacity Act was not being applied. The manager told us they had arranged for the way people were cared for to be reviewed in conjunction with their social worker and other appropriate people and appropriate applications made to the Court of Protection. The reviews had not taken place on the day of our inspection.

Plans to monitor the quality of the service and carry out risk assessments relating to the provision of care were being formulated but were not in place on the day of this inspection.

This inspection took place on 5 March 2015 and was unannounced.

Our previous inspection of 20 May and 17 June 2014 had identified concerns with the training of staff, how risks to the service were managed and how the service assessed and monitored the quality of the service provided. At this inspection we found these concerns had not been addressed.

The service provides personal care and support to adults with a learning disability who live in a small block of flats owned by the provider. On the day of our inspection there were seven people receiving support from the service.

There was no registered manager in place. 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 safety was compromised in a number of areas. This included being exposed to avoidable harm and the management of people’s medicines. Staff did not demonstrate that they had the required knowledge to be able to safeguard people and report any safeguarding concerns to the relevant safeguarding authority.

Staffing levels were insufficient to meet the needs of people who used the service. The provider did not have a system in place to ensure continuous assessment of staffing levels and make changes when people’s needs changed.

The provider did not operate a safe and effective recruitment system. People were put at risk because when Disclosure and Barring (DBS), criminal records checks revealed staff had relevant records no actions were in place to assess or mitigate any risk.

We were not assured that people’s choices and rights were being respected. Staff had not received training in the Mental Capacity Act 2005 (MCA). No applications has been made to the Court of Protection when people my require restraint to be used. They were not fully meeting the requirements of the Mental Capacity Act 2005.

People had not always been supported to access, when needed, the support of health care professionals. People had not been supported to attend follow-up appointments, for example to a dentist.

The service was not run in the best interests of people using it because their views and experiences were not sought. Improvements were needed in the way that the service obtained people’s views and used these to improve the service.

There was insufficient planning to support people’s wishes and preferences regarding how they wanted to be cared for. There was also insufficient planning to promote and support people’s individual leisure interests and hobbies. We were therefore not assured that the planning and delivery of care supported people’s individual needs, wishes and preferences.

We found there to be a number of continued breaches. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we spoke with three people who used the service. They told us that they were happy with the care and support they received. One person said, "I am really well looked after." They told us about some of the things that they liked to do and how staff supported them in this.

We looked at the care records of the five people who used the service. These were not all up to date and did not show evidence of regular review. However we were assured by the new management team that this was being rectified and shown the new care plans and risk assessments that were being introduced.

We looked at the training records of four of the staff team. These did not show that staff had received sufficient training to ensure that they had the necessary skills to support and meet the needs of people who used the service.

At the time of our inspection, there were seven people using the service. During our visit, all seven people were on a day out at the beach. During our inspection, the manager was unable to provide us with evidence of staff training. The provider told us that staff had received the training, but that they needed additional time to request the certificates from the training centre. We agreed to give the provider extra time to provide this evidence, and this evidence was considered as part of the inspection on 17 June 2014. In addition, we asked the manager of the service to supply the contact details of people’s advocates and family members. However, this information was not provided to us in a timely manner, so we were unable to consider it as evidence during this inspection. We spoke to the provider about this, who told us they never received the request.

We looked at the care records for six of the seven people who were using the service at the time of our inspection. In addition, we reviewed audit records, complaints records, incident records and staff records. We considered our inspection findings to answer five key questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? and is the service well led?

Below is a summary of what we found during our inspection;

Is the service safe?

We found that each person had detailed care plans setting out information about them, and instructions for staff on how to meet their needs. This meant we could be assured there were systems in place which were being used to protect people from unsafe or inappropriate care.

We found that the service was following the principles of the Mental Capacity Act (MCA) 2005, where a person lacked the capacity to make decisions, for five of the six people whose records we reviewed. However, the provider may find it useful to note that there was no mental capacity assessment for one person where this would have been appropriate. There were systems in place to ensure that people were protected from the risk of unlawful decisions being made on their behalf.

During a previous inspection of the service, we identified that staff did not have the appropriate training in key principles relating to care. The service provided us with an action plan, telling us how they would rectify this issue. However, we found that during this inspection, the manager of the service could not provide us with evidence of staff having had essential training. We gave the provider additional time after our inspection visit to provide evidence of staff training. The provider was able to provide us with this information, to evidence that staff had received the appropriate training. This meant that the provider had ensured that staff were suitably trained to support people using the service.

Is the service effective?

The service did not have audits in place to identify issues so they could action these in a timely manner. For example, there was no process or procedure in place to identify when staff needed to renew their training.

We saw evidence to support that people were given the opportunity to speak about their care and support at monthly care plan approach meetings. This meant we were assured that people had the opportunity to voice their opinions.

Is the service caring?

We found that records contained information about people such as their past history and their goals for the future. Records demonstrated that staff supported people to be independent and achieve their goals. One person had been supported to learn how to make themselves drinks, and this had been one of their goals.

Is the service responsive?

Records showed that people who used the service were supported to receive input from health professionals in a timely manner.

We found that the provider had processes and procedures in place to protect people from the risk of abuse. Staff were aware of these policies and procedures, and were aware of how to raise concerns. This meant we were assured that people were protected from the risks of abuse.

Is the service well-led?

During our inspection, we observed that records we requested were not readily available and it took the manager and other staff some time to find the records we had requested. These included policies and audits linked to quality assurance. This meant that at the time of our inspection, we could not be assured that the service was well led in a way that assured us there was effective and clear managerial oversight in place. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.