Cheshire and Greater Manchester Supported Living

At the time of the inspection there were 34 people receiving personal care, some of whom may have a learning disability, autism, mental health or physical disability. There were16 separate properties in various community settings, which ranged from supporting one person to a maximum of five people.

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.

People’s experience of using this service:

The service was very responsive to people's needs. People's confidence and independence had increased since they had received support from the service. People were encouraged to live full and active lives and the service supported people to achieve their goals. Activities were meaningful and reflected people's interests and personal preferences. People were encouraged to find work opportunities and learn new skills.

People and their relatives were positive about the support they received. They were well supported to have control and choice over their care and support. An in-house support team was available which included professionals providing expertise in autism and positive behaviour support (PBS). This support meant staff were quickly able to seek help, support and guidance and implement effective strategies to support people. There were many examples of how these strategies had resulted in positive outcomes for people.

People felt safe and were supported by staff who understood how to report concerns and manage risks to keep people safe. The registered manager acted and reported safeguarding concerns when these were identified. Staff were recruited safely, and people were generally supported by a regular team of staff. Medicines were given in a safe way and lessons were learnt when things went wrong.

Processes were in place to protect people from avoidable harm. Risks to people had been assessed and were safely managed, people were supported to take positive risks.

Staff received training that was appropriate to their role and supported them in providing care in the way people wanted. Staff worked with health and social care professionals and followed their guidance and advice about how to support people.

Where people lacked capacity to make their own decisions we saw that best interests’ decisions had been made. We noted that one person's capacity assessment and best interest decision needed review to ensure it remained current.

Staff treated people with dignity and respect and took account of their individual needs when providing care and support. People told us they felt listened to and were able to express their views.

The service had recently expanded, and a few new supported houses had been opened. The provider had identified the need to support the registered manager to oversee the larger service and were recruiting a project manager. The registered manager was aware of areas within the service where they needed to focus, such as staffing, promoting person centred care and was supporting the staff to achieve this.

The management team demonstrated a commitment to provide person-centred, high quality care by engaging with everyone using the service and stakeholders. A full range of detailed quality audits we carried out and we saw that actions were identified and addressed to make continuous improvements.

Rating at last inspection: Outstanding (Report published October 2016). At this inspection the overall rating has been judged as Good.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated outstanding.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The provider was given 48 hours’ notice of this inspection which took place on 5 and 6 July. This was to ensure that the registered manager would be available to assist us with the inspection and appropriate arrangements could be made for us to meet people who received a service.

There was a registered manager in place during this inspection. 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, we found the service provided outstanding care and support to people and was very responsive to their needs, wishes and preferences. All people, relatives and staff spoken with were extremely positive about Cheshire and Midlands Supported Living.

People told us that they felt safe and we found that people were protected from harm and abuse. Staff were trained in safeguarding procedures and understood their responsibilities to report any concerns of this nature. Staff told us that they could raise any concerns and felt that they would be dealt with promptly.

We found that risks to people were well managed and people’s freedom was also supported. Risk assessments were in place to keep people safe whilst they were in their home and the community. Staff described how they kept people safe without restricting them and supported them to have control over their lives.

There were safe arrangements in place to support people with their medication. People were supported where appropriate to self- medicate.

Staff were very skilled and knowledgeable. We found that staff completed an induction prior to starting work in the service and received regular and on-going training.

People received effective care based on current best practice for people with autism. The support provided meant that people experienced meaningful lives and their wellbeing was promoted.

The registered manager and staff were clear about their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and were dedicated in their approach to supporting people to make informed decisions about their care.

There was a strong person centred culture. Staff knew people’s support needs very well and we observed positive interactions between people and staff. We saw staff being kind and thoughtful and treating people with dignity and respect.

The service promoted a philosophy of care, where people who used the service were included, and were enabled to be part of decision making about their support, as well as the service.

We found people received outstanding personalised care and support. They told us they were involved in all decisions about their care and the service had developed creative means of enabling people to lead as full a life as possible. Support plans were extremely personalised and had been written with the people involved and some people had been supported to write their plans in their own words. The focus was on what the individual wanted. We saw that people were also supported to work within the wider community and were employed within various organisations.

People were encouraged to give feedback to the service and people knew how they could complain. Complaints were taken seriously and responded to.

The service was extremely well-led. The registered manager was focused upon improving the quality of the service and there was a strong emphasis on continuous improvement. The service used inclusive ways to enable people to be empowered and voice their opinions about the development of the service.People knew who the registered manager was and felt able to raise any concerns with her. Staff told us that they felt well supported. We saw that regular household and staff meetings were held, as well as supervision meetings to support staff. The registered manager promoted a culture that was open and inclusive. There were comprehensive and robust quality assurance processes in place and people's feedback was sought about the quality of the care.