We carried out an announced inspection of this service between 4 and 11 January 2019.

Yarrow Housing provides care and support to people living in supported living settings, so that they can live in their own home 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. At the time of our inspection there were 74 people using the service. At our last inspection in March 2016 we rated the service ‘Good’. At this inspection we rated the service ‘Outstanding’.

The service had 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 were empowered by the service. People using the service were supported to develop their independence and be involved in every aspect of running their homes. Person centred planning was well established in the service. People worked with staff to identify their goals and to achieve these, including being able to develop their interests and undertake activities and holidays of their choice. Activities were varied with an emphasis on community involvement and self-expression, including sport, art, video projects and music. People also had individual projects which reflected their own interests and were encouraged to develop these and take ownership.

People and their relatives told us that they were treated with kindness and respect by staff and we saw examples of extremely positive interactions. People had a good rapport with staff and knew them well and were confident in approaching managers for advice or to share news.

People’s goals and achievements were celebrated, and people were encouraged to take their successes a step further. Managers in the service placed a strong and continuing emphasis on co-production, which meant initiatives to improve and develop the service included people and their families throughout. The provider was routinely developing and thinking of new ways to improve and introducing new models for support. People found managers to be visible and approachable.

People were supported to maintain good health. People had chosen to become more active in their chosen way and to eat healthily, and spoke with pride about how their lives had improved as a result. The provider worked with local organisation and people using the service in order to hold events aimed at improving health awareness.

People were safeguarded from abuse and there was a strong culture of speaking up. When people had behaviour which may challenge others, the provider used its in-house expertise to develop plans to address and manage this and promote social inclusion. People were encouraged to look at risks positively to develop their independence and there was a systematic and skilled approach to developing independence and giving people ownership of their daily routines. Medicines were safely managed by staff who had the training and skills to do so, and this was regularly refreshed.

Staffing was available to safely meet people need’s and ensure they could do activities of their choice. Staff members received the training they needed to meet people’s needs and were encouraged to regularly reflect on their training and development needs.

People were able to express their preferences and consent to different aspects of their care, including when they received personal care and the gender of the person providing this. The provider worked in line with the Mental Capacity Act to assess people’s capacity to make specific decisions and to demonstrate how they were acting in people’s best interests.

There was suitable and varied oversi

Yarrow Housing Limited provides care and support to people with a learning disability, in order to enable them to live independently in their own homes. People who use the service reside as tenants in a range of shared houses and flats owned by different local housing associations across five boroughs in West London.

This inspection was announced. We gave the provider 48 hours’ notice of the inspection, to make sure that key staff would be available. At the time of the inspection the service was providing personal care to 72 people in 24 properties. At the previous inspection in February 2014 we found the provider was meeting the regulations inspected.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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 received their personal care and support from staff they trusted and felt safe with. Staff had received training in how to protect people from abuse and knew how to raise any concerns in regards to people’s safety and wellbeing. People’s support plans showed that risks to their safety were identified and plans were put in place to mitigate the risks.

People told us they felt well supported by staff and confirmed that there were sufficient staff to meet their needs. Records showed that there were safe systems in place for the robust recruitment of new staff to ensure they were suitable to work with people who used the service.

Staff had received effective training, supervision and support to meet people’s needs. This included training about the Mental Capacity Act 2005, so that staff understood about supporting people to make their own choices and decisions. People told us they were supported to eat healthily and choose foods that met their dietary and/or cultural need, and to eat out at places of their choice. The provider supported people to meet their healthcare needs through assisting them to attend appointments and follow guidance from healthcare professionals, which was documented in people’s support plans.

People received a caring and compassionate service, which demonstrated some outstanding features. The provider consistently consulted with people and relatives to ensure that their needs and wishes were understood and met. People told us they felt valued as they took part in projects and open days organised by the provider and were supported to make meaningful contributions. The provider keenly sought to celebrate people’s achievements and ensure people understood that their needs were at the core of the organisation. People were treated with dignity and respect and staff protected their confidentiality and privacy.

People received a service that responded to their individual needs and was person centred. People’s needs were properly assessed, and their assessments and support plans were regularly reviewed to ensure they were relevant. The provider responded to people’s aspirations for more independence and their wishes to access community resources, such as regular visits to gyms, cinemas and shopping centres. People were confident about how to make a complaint and relatives said they thought complaints would be dealt with in an open and fair manner.

People received a service that was managed well by the registered manager and other members of the management team. The provider held a clear vision and values that were shaped by people’s contributions to their current strategy plan, and understood by people, relatives and staff. There were systems in place to regularly monitor the quality of the service and identify areas for improvement.

The registered manager told us that staff would obtain consent from people before providing them with care and support.

We spoke with the relatives of two people who used the service as people who used the service were able to verbalise their needs. One person told us "I would not say the care is great but it is good. We get on with the staff and my relative is happy." Another persons relative said "The actual support staff are very good, most have been there for a significant period of time. They do a wonderful job."

We spoke with two members of staff who told us that they worked with social workers, people's family members, psychiatrists and psychologists to meet people's needs

The provider had a recruitment and selection procedure in place which provided clear direction on all aspects of the recruitment process.

Arrangements were in place for responding to complaints. One person said that they had made complaints about the service and these had been dealt with.

People who use the service and relatives made positive comments about the service in the quality questionnaires that the service sent to them. We did not speak directly to them.

Carers and families are involved in daily decision-making about care provided and feel respected. They said staff were generally approachable, listen to their views, act on them and treat them with respect.

Some commented that the management are in regular contact, sometimes visit them, always ask them what they need and they feel they are getting the service they want. They said it was regularly reviewed, updated and delivered on time.

They found staff friendly, competent and prepared to adapt their working methods to provide a good level quality of service.

They are also aware of how to make a complaint and who to.