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Inspection carried out on 23 January 2018

During a routine inspection

The inspection took place on 23 January 2018 and was announced. Inroads Open Care supports people with a learning disability in three settings. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community [and specialist housing]. On the day of our visit there were ten people supported by the service.

The inspection was announced as this service is small we wanted to make sure that someone would be available when we visited.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well-led.

At this inspection, we found that there were sufficient staff to support people and staff morale had improved. The quality assurance system had been developed and information from the audits had been used to improve the service and support provided to people in relation to their assessed needs.

A registered manager was in place and was based at the service central office. They visited people and staff regularly and did provide support themselves on planned occasions. 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 looked at ease with staff and told us that the staff were kind. One person was able to talk with us about their experiences of the service which were positive.

Each person had a support plan and a risk assessment which identified actions which should be taken to minimise the risk. There was a robust recruitment process and staff received an induction, supervision and on-going training. Medicines were safely stored and administered as prescribed.

Staff were knowledgeable about the signs of abuse, and the actions that they would take should they have any concerns.

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 support this practice.

Support plans were in place for each person and written in four interlinking parts. The information provided staff with the information they needed to support people. People’s preferences and choices had been identified in their support plan. People choose the food and drinks they consumed.

There was a complaints policy and procedure in place. Relatives informed us they were confident any complaint would be listened to and investigated. All people were supported by staff to pursue activities and interests of their choice.

The service staff provided a positive culture of support to the people using the service.

Inspection carried out on 7 December 2016

During a routine inspection

The inspection took place between 7 and 20 of December 2016 and was announced. Inroads open care supports people with a learning disability in three supported living settings. On the day of our visit there were ten people using the service. We visited the three supported living projects and spoke to people who lived there and their relatives. The inspection was announced as this domiciliary care agency supported people in supported living settings and we wanted to make sure that someone would be available in the projects when we visited.

A registered manager was in place and was based at the provider’s central offices. 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 the last inspection the service was rated requires improvement and we carried out this inspection to check what changes and improvements had been made.

At this inspection we found that there were issues with staffing in one of the supported living projects. The others were staffed appropriately but in one project people did not always receive the hours for which they had been assessed and the service commissioned. This impacted on people’s wellbeing and access to the community.

People who lived in the service looked at ease with staff and told us that the staff were kind. They were not all able to talk to us about the support they received so we spoke with their relatives who were largely positive about the service and the commitment of staff. They told us that staff kept them updated and communicated with them.

Risks were identified and steps were taken to minimise the impact on individuals. Medicines were safely stored and administered as prescribed.

Staff recruitment records demonstrated that the provider took steps to ensure that they employed people who were suitable to work at the service. However we did identify one anomaly regarding a reference which the manager agreed to address.

Staff were knowledgeable about the signs of abuse, and the actions that they would take should they have a concern. We saw that staff received training on a range of areas including first aid, health and safety and autism. Staff also received training on how to defuse situations to reduce the need for restraint. However staff were inconsistently supported through supervision and team meetings as they were sporadic.

The provider had policies in place with regard to the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) 2005. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. Care staff had a good understanding of the importance of obtaining consent and protecting people’s rights.

The majority of staff knew people well and there were systems in place to ensure that information was handed over to staff coming on duty. Care plans were in place and while there was some omissions in that some were out of date, the majority were detailed and informative. This provided staff with the guidance and direction they needed to ensure person centred care. Efforts were made to identity peoples preferences and ensure that they had choice as part of the care planning process.

There were procedures in place to manage and respond to complaints. We have asked the manager to investigate some concerns which were raised with us as part of the inspection under the complaints procedures.

There was a lack of consistency across the service and staff and relatives told us that the manager was not always visible. We found that the service had expanded over the last year however the manager was onl

Inspection carried out on 20 November 2015

During a routine inspection

The inspection took place on 20 and 23 November 2015 and was announced. Inroads open care supports people with a Learning disability in two supported living settings. On the day of our visit there were seven people using the service. We visited one supported living service where five people lived.

The inspection was announced as this domiciliary care agency supported people in supported living settings and we wanted to make sure that someone would be available when we visited.

A new manager had recently been appointed and had applied to become registered. This application was being assessed. 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 lived in the service appeared very happy and looked at ease with staff. They were not all able to talk to us about the support they received so we spoke with their relatives who were largely positive about the service.

Staff were knowledgeable about the signs of abuse, and the actions that they would take should they have a concern. Medicines were safely stored and administered as prescribed.

Risks were identified and steps were taken to minimise the impact on individuals. However there was a need for greater oversight of risk and more detailed analysis of areas such as restraint.

Staff recruitment records demonstrated that the provider took the necessary steps to ensure that they employed people who were suitable to work at the service. We found that there had been staffing shortfalls and this had impacted on individuals ability to access the community. Considerable recruitment had been undertaken to address this and staff were in the process of being inducted to the role. We saw that training was provided on an ongoing basis and this included how best to support individuals who present with distressed behaviour. We identified that there were gaps in some of the update training and this needs to be managed in a more proactive way. None the less the staff we spoke with were knowledgeable and a number had worked at the service for some time. Supervision was not always taking place regularly but staff told us that managers were approachable and we saw that the provider had a plan to address this.

People received a varied choice of nutritional meals. People health was monitored and they had good access to health care support.

People’s care needs were assessed and care preferences identified. Care plans were informative and staff were aware of people’s needs. Staff recognised the importance of leading a full life and we saw examples where people were supported to fulfil their aspirations. However this was not consistent across the service and further efforts could be made to promote individuals independence and their interests.

Staff were motivated and had good relationships with the people living in the service and their relatives.

Audits had been undertaken and a number of the areas that we identified had already been highlighted by the provider as areas for improvement. There was an action plan in place and work had begun to address the areas that had been identified. However the changes had not yet been imbedded so it was too early for us to assess whether the service had made sustained progress.

Inspection carried out on 13, 20 February 2014

During a routine inspection

We spoke with the manager, one staff member and the parents of five children and young adults who use the service as part of this inspection. We found that people were asked for their consent before care and treatment was offered. All the parents we spoke with were happy with the quality of the service and were very positive in their comments about the staff. One parent told us "They are very professional and show (my child) utter respect. (My child is) very fond of all of them". Another parent said "I am really, really impressed with (the service). I have said to other parents that I would not hesitate to recommend them".

We saw that care plans demonstrated that the service met people's needs and enabled them to set and achieve goals whilst ensuring that they were kept safe.

We found that staff were supported and trained to carry out their roles safely and effectively. Parents told us that staff were reliable. One parent said "I would hate to lose them - they have made my life so much easier" and another told us "They are the best I have ever had - a really nice group of people from the management down".

The service was well led and we found that the management regularly assessed and monitored the quality of the service

Inspection carried out on 12 November 2012

During a routine inspection

We spoke with the relatives of five of the children using the service. This was because the children have complex needs which meant they were unable to tell us their experiences. Relatives told us that they had been consulted about their child�s needs and had been involved in making decisions about their care, treatment and support needs. They told us that their children received care and support from a regular team of staff who always arrived on time, and that they were kept informed if there were changes to the staffing arrangements, due to sickness. One person told us that the support provided by the staff has been 100 per cent. They commented, �The staff have been fantastic at encouraging and supporting my child, which has really made a difference to us, as a family�.

Relatives comments included, �I am absolutely delighted, the service is fantastic and the staff are brilliant�. One person told us, �I am very grateful to Inroads, I am very happy with the service, and would highly recommend them�. One person commented, �The service is very good; I have been very impressed so far at the skill and enthusiasm of the staff�.