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Inspection carried out on 15 January 2019

During a routine inspection

The inspection took place on 15 January 2019 and was announced. The inspection continued on 16 January 2019 and was again announced.

This service provides care and support to people living in six ‘supported living’ settings, so that they can live 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.

The service is registered to provide personal care. At the time of inspection the service was supporting nine people with learning disabilities and autistic spectrum disorder.

The care service had been developed and designed in line with the values that underpinned the Registering the Right Support and other best practice guidance. These values included choice, promotion of independence and inclusion. People with learning disabilities and autism using the service could live as ordinary a life as any citizen.

The service had two registered managers 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.

At our last inspection 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.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of seizures, or behaviours which may challenge the service, staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained staff.

Where possible people had been involved in assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People’s eating and drinking preferences were understood and their dietary needs were met. Opportunities to work in partnership with other organisations such as community learning disability teams took place to ensure positive outcomes for people using the service. 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.

People and their families described the staff as caring, kind and friendly and the interactions observed between people and staff were relaxed, encouraging and engaging. People were supported to express their views about their care using their preferred method of communication and were actively supported to have control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. Equality, Diversity and Human Rights (EDHR) were promoted and understood by staff. People were set realistic goals which proved to have had positive outcomes in the health and wellbeing. A complaints process was in place. People and families felt listened to and actions were tak

Inspection carried out on 23 May 2016

During a routine inspection

The inspection took place on 24 May and was announced. The inspection continued on 25 May 2016.

Advanced Housing and Support deliver domiciliary personal care to people with learning disabilities and autism. Personal care was provided to 5 people at three separate locations. These locations were shared supported living set ups which had communal kitchens, living and dining areas. There was a central office base which had a shared toilet and a small kitchenette facility.

The service had a registered manager in place. 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.

Advance Housing and Support worked with the Local Authority in assessing people's capacity but the service did not complete their own capacity assessments or record best interest decisions. This potentially put people at risk of decisions being made which may not be in the person’s best interest. The registered and service manager acknowledged this and told us that they would complete capacity assessments and record any best interest decisions as and when appropriate. We found that no one had come to any harm as a result of this.

Staff records did not hold up to date staff induction records. The registered and service manager started to collate these for the central files during the inspection. We saw that these were completed which ensured staff had the skills to and understanding to do their job.

People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding adults.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they chose to live their lives. Each person had a care file which also included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored in people’s homes, correctly recorded and only administered by staff that were trained to give medicines.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, autism, epilepsy and learning disability.

Staff told us they received regular supervisions which were carried out senior management. We reviewed records which confirmed this. A staff member told us, “I receive regular supervisions”.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this.

People were supported with cooking and preparation of meals in their home. People were supported to choose meals through weekly menu planning meetings. The training record showed that staff had attended food hygiene training.

People were supported to access healthcare appointments as and when required and staff followed GP and District Nurses advice when supporting people with ongoing care needs.

People told us that staff were caring. During home visits we observed positive interactions between staff and people. This showed us that people felt comfortable with staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. Information was available in various easy read and pictorial formats. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before using the service and care packages reflected needs identified in these. We saw that these were regularly reviewed by the service with people, families and health professionals when availabl