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Inspection carried out on 6 April 2018

During a routine inspection

This inspection took place on 6 April 2018. It was an announced visit to the service.

We previously inspected the service on the 30 July 2015. The service was rated Good at the time. However the provider was failing to report events it was legally required to do so. We found a breach of the Regulations of the Health and Social Care Act 2008. We asked the provider to complete an action plan to show what they would do and by when to improve the key question, Well Led to at least good. At this inspection we found improvements had been made.

Living Horizon provides care and support to people living in three supported living settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of the inspection three people were supported with personal care needs by staff. People supported either had a learning disability or mental health condition.

We received positive feedback from people who were supported by the service. This was supported by health and social care professionals we received feedback from. Comments from people included “This is the best support I could ask for…They [Staff] care for me and worry about me.” Another person told us “I get good support, whatever you need help with. I would recommend it.”

People were encouraged to be independent and staff supported them to manage risks posed to them. This was supported by what a social care professional told us “They [Staff] work flexibly with her, giving her independence and managing risks.”

People were treated with dignity and respect and staff were able to adapt their communication style to suit the situation.

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.

Systems were in place to ensure important information about people was shared with staff. Daily notes on what support people had received were updated in a timely manner. Staff shared learning with each other to achieve the best outcome for people.

The provider monitored the service and regularly involved staff in the development of the service. Staff felt valued and listened to. There was a clear culture in the service to provide a high quality service.

We found gaps in some of the required records. For instance there was not a full record of member of staff employment history. We also found gaps in records relating to the support given to staff. We have made a recommendation about records in the report.

Inspection carried out on 30 July 2015

During a routine inspection

Living Horizon provide personal care and support to people who live in two supported living schemes in Aylesbury, Buckinghamshire.

When we last inspected this service in February 2014 the service met the requirements for the areas of its operation we assessed.

This inspection took place on the 30 July 2015. The provider was given 48 hours notice of our visit. This was because the service provides personal care support for up to seven adults who are often out during the day and we needed to be sure that someone would be in. At the time of our visit there were six people who received care and support within the two schemes.

There were joint registered managers in place. 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.

Although the service was, in general, well-led, we found the provider had not always informed the CQC of important events which they were required to notify us about by law. This was a breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

We found people were safe and well cared for. They received appropriate care and support which enabled them to access the community and to retain their independent living skills. The staff team maintained a calm, relaxed and homely atmosphere within the service. People appeared to be at ease and indicated they were happy with the care provided.

There were sufficient appropriately trained staff who had the knowledge and support they required to provide effective care. Where people had specific communication requirements, staff were able to meet these and both understand and make themselves understood effectively.

Staff knew the people they supported and did so in a way that took account of their individual preferences and choice. Staff respected people’s dignity, privacy and rights and ensured their healthcare needs were met.

People appeared relaxed and there was positive interaction observed between the providers, staff and people who received care and support.

Inspection carried out on 26 February 2014

During a routine inspection

Although first registered with the Care Quality Commission in October 2012, Living Horizon did not provide personal care to anyone until December 2013. There was one person who received care at the time of our visit. We spoke with them and they told us they discussed their care and support on a daily basis with the providers and registered managers.

We spoke with two health or social care professionals involved with the person who received a service and also to the local authority commissioning team. They told us they had received good co-operation from the providers since the service became active. The health and social care professionals we spoke with had been involved in discussions about the welfare of the person concerned and had found the provider responsive. They did not raise any concerns with us about the standard of care and support provided.

As there was currently only one person resident within the supported living scheme, all activities and arrangements were focussed entirely upon them. We observed interaction between staff and the person who received support. It was relaxed, informal and respectful. We found questions were open and the person was not directed by staff. They were able to make decisions and express their opinion, in their own time. This confirmed people expressed their views and were involved in making decisions about their care and support.

We looked at support plan documentation and other records and spoke with support staff. All relevant documentation was provided in a format which made it accessible for the person who received support. The support plan included comprehensive information about the person concerned, their family and medical history and established their care and support needs. There were detailed records of how the person's assessed needs were to be met. There was evidence these assessments had been reviewed and that the review process included the involvement of the person concerned.

We found there were robust systems and procedures in place which would ensure any staff recruited were subject to the necessary checks to protect people who received care and support. The systems, policies and procedures the provider had put in place for the operation of the service meant they would be able to provide effective management of the service as it expanded.