Mrs Lavinia Dawn Bellis & Mr Andrew William Bellis - 1 Arkwright Suite

This inspection took place on 20 and 21 November 2018. We gave the provider 2 days' notice of the inspection as we needed to make sure the registered manager would be available.

At our last inspection on 7 March 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection

The service had a registered manager in post. 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.

Recruitment checks took place before staff started work but we have made a recommendation in the 'Safe' section of the report around the need for more robust pre-recruitment checks. The service had safeguarding and whistle-blowing procedures in place and staff had a clear understanding of these procedures. There was enough staff available to meet people’s care and support needs. Risks to people had been assessed and reviewed regularly to ensure their needs were safely met. Medicines were managed appropriately, and people were receiving their medicines as prescribed by health care professionals.

Staff completed an induction when they started work and they received training relevant to people’s needs. They had received training in infection control and food hygiene and they were aware of the steps to take to reduce the risk of the spread of infections. Assessments of people’s care and support needs were carried out before they started using the service. People’s care files included assessments relating to their dietary support needs. 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.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people's preferences of care. Staff always worked hard to promote people's independence through encouraging and supporting people to make informed choices.

People and their relatives had been consulted about their care and support needs. Most people could communicate their needs effectively and could understand information in the current written format provided. Most of this was provided in an easy to read or pictorial format. People and their relatives said they were confident their complaints would be listened to and acted on. Staff said they would support people according to their diverse needs.

The registered manager and management staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. People had access to health care professionals when they needed them.

The provider recognised the importance of monitoring the quality of the service provided to people. They took people’s views into account through telephone monitoring calls, spot checks and satisfaction surveys. Staff said they enjoyed working at the service and they received good support from the registered manager. There was an out of hours on call system in operation that ensured management support and advice was always available for staff when they needed it.

Further information is in the detailed findings below.

The last inspection of the service took place on 24 September 2014, when it was found to be compliant with all outcome areas assessed at that time.

A visit to the agency office was conducted on 07 March 2016 by two Adult Social Care inspectors from the Care Quality Commission. The registered manager was given short notice of our planned inspection. This was so that someone would be available to provide the information we needed to see.

One of the owners of the agency is also the registered manager, who was on duty when we visited the office premises. 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 and associated regulations about how the service is run.

Records showed the staff team were well trained and those we spoke with provided us with some good examples of modules they had completed. Regular supervision records and annual appraisals were retained on staff personnel files.

Staff were confident in reporting any concerns about a person’s safety and were aware of safeguarding procedures. Recruitment practices were robust, which helped to ensure only suitable people were appointed to work with this vulnerable client group.

The planning of people’s care was based on an assessment of their needs, with information being gathered from a variety of sources. Evidence was available to show people, who used the service, or their relatives, when relevant had been involved in making decisions about the way care and support was being delivered.

Structured reviews of people’s needs were conducted, with any changes in circumstances being recorded. However, reviews were completed as often as circumstances dictated. Areas of risk had been identified within the care planning process and assessments had been conducted within a risk management framework, which outlined strategies implemented to help to protect people from harm.

People were supported to maintain their independence and their dignity was consistently respected. People said staff were kind and caring towards them and their privacy was always promoted.

In general, staff spoken with told us they felt well supported by the management of the agency and were confident to approach any member of the management team with any concerns, should the need arise.

Medications were, in general being well managed. Policies and procedures were in place, which were to be updated. Medication Administration Records were being completed appropriately and people told us they received their medicines on time and in a safe manner.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with those who used the service, some relatives, support staff and the manager. We also examined a wide range of records and documents. We visited four people, who lived in the community and who received support from the agency. They all gave us positive responses to the questions we asked.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People we spoke with told us they felt safe when care and support was being provided. They told us they were able to choose which activities they joined in and were happy with their support staff. Systems were in place to help managers and the staff team to learn from untoward incidents. This helped the service to continually improve.

The home had proper policies and procedures in place in relation to the management of records and infection control. People (or their relatives) were involved in making decisions about the care and support provided.

At the time of our inspection we visited three properties within the community, where those who used the service lived. These were found to be safe, clean and hygienic. The houses were all tastefully decorated and well maintained, with good quality furnishings. Therefore, people were not put at unnecessary risk.

Is the service effective?

The health and personal care needs of those who used the service had been thoroughly assessed, with a range of people involved in their care and support. Specialist dietary needs had been identified, where required.

Systems were in place to ensure the service was effectively assessed, so the quality of service provided could be consistently monitored. A broad range of training modules were provided for staff. This helped to ensure the staff team delivered effective care and support for those who used the service.

Is the service caring?

We asked those who used the service about their support workers. Feedback from them was very positive. They said staff were kind and caring towards them and helped them to meet their needs. When speaking with staff it was clear they genuinely cared for those they supported and were observed speaking with people in a respectful and friendly manner.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a wide range of leisure activities regularly, including holidays abroad and trips to places of interest. Some people attended college courses and others were involved in voluntary work. This helped them to maintain links with their local community.

Staff responded to people well by anticipating their needs appropriately. The service worked well with other agencies to make sure people received care and support in a consistent way. Evidence was available to show systems were in place for the agency to respond to any suggestions for improvement and appropriate action would be taken to rectify any shortfalls identified.

Is the service well-led?

The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result, the quality of service provided was continuously monitored.

Staff spoken with had a good understanding of their roles. They appeared confident and said they felt well supported by the managers of the service. Feedback was regularly sought from those who used the service and their relatives, through regular face to face contact, telephone conversations and annual satisfaction surveys. Systems were in place for any shortfalls or concerns to be dealt with appropriately.

Care plans placed an emphasis on people's right to be self determining in how they lived their lives as valued citizens within the wider community.

Peoples' capacity to make their wishes known either verbally or non-verbally was also recorded and appropriate communication methods used.

The right of people to take informed risks had been acknowledged and risk assessments ensured a balance of safety and effectiveness.

People were protected against the risks associated with medicines and they were supported to be self medicating.

An easy read version interview form supported people to be involved in selecting new staff. People were involved in staff appraisals. Written comments include, 'She respects me for who I am so in turn I respect her for who she is'. 'I love the way A'. supports me in the best way possible. I know I'm not the easiest person to live with but I'm grateful for the friendship we have'.

People said they were visited by the provider and were consulted all the time about the service they received.

People had access to an effective complaints system provided in a format that met with their needs.