This inspection took place on 5 October 2016 and was announced. When we last visited the service on 25 September 2014, we found the service was meeting all the regulations we looked at.

Access for Living provides care and support to people with learning disabilities, mental ill health, physical and sensory impairment in their own homes and supported living schemes in the London Borough of Lewisham. At the time of our inspection, 39 people were accommodated in supported living schemes and 27 people were being supported in their own home.

The service had a registered manager. 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 were safe. Medicines were managed safely. Risk assessments identified the risks to people and how these could be prevented. Staff were available to meet people's needs.

People were involved in decisions about their care and how their needs would be met. Managers and staff had received training on the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

Staff had access to ongoing training. They were knowledgeable about their roles and responsibilities. They had the skills and knowledge to meet people's support needs.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people's needs.

People received individualised support that met their needs. Staff knew how to respond to people's needs in a way that promoted their individual preferences and choices regarding their care.

People were treated with dignity and respect. Staff understood people's preferences, likes and dislikes regarding their care and support needs. Care was planned and delivered in a way that enhanced people's safety and welfare according to their needs and preferences.

People, relatives and staff said the manager was approachable and supportive. Systems were in place to monitor the quality of the service. People felt confident to express any concerns and that these would be addressed.

A single inspector carried out this inspection. We spoke with three people who used the service, two relatives and two members of staff. We reviewed the care records in place and looked at how the service was managed in relation to the standards we inspected.

The focus of the inspection was to gather evidence to answer the five key questions : is the service safe, effective, caring, responsive and well-led?

Is the service safe?

The service was safe because risks were identified and managed effectively. Staff had received safeguarding training. The organisation undertook the proper checks before staff were allowed to work with people receiving support. These checks included whether a potential staff member had any previous criminal convictions.

People's medicines were handled safely and staff had been trained in the safe administration of medicines.

Is the service effective?

The service was effective because we received very positive feedback from people who used the service, their relatives and staff. The service worked well with professionals who visited people in their homes and offered guidance and advice.

The service was effective because it had provided relevant training to staff which enabled them to support people well.

Is the service caring?

The service was caring because we observed very positive interactions between the manager who accompanied us on our visit and the people who we visited. There was a clear desire to meet people's needs as comprehensively as possible.

People receiving support described staff as being very caring and this was corroborated by relatives in relation to support provided to their family member.

Is the service responsive?

People's needs had been assessed initially before support was provided. There were regular meetings in place between people supported and staff. People undertook activities they enjoyed and chose for themselves.

People were encouraged to maintain friendships and relationships as well as have their family visit them regularly.

Is the service well-led?

There were effective quality monitoring processes in place. Surveys had been carried out to seek the views of people who used the service, relatives and staff. We saw actions arising from these were undertaken.

Decisions were taken at an appropriate level within the organisation, for example the Chief Executive reviewing all complaints and working with managers to seek to address all of the issues raised. .

People and their relatives were mostly positive about their experience of the service provided. One person’s relative said, “I can’t praise the staff enough. They are really knowledgeable about my son and meet his needs and more.” Another said, “We have a good, open relationship with managers and carers. You can speak freely with them and they always listen to you and deal with things quickly.”

Up to date, individual care plans were in place for people who used the service which addressed their care and support needs and protected them from risks. We saw evidence of regular reviews of support provided and assessed risks in people’s care records and people and their relatives we spoke with confirmed this.

The service worked in partnership with other providers to ensure people's health, safety and welfare needs were met.

People who used the service and their relatives said they felt safe and secure in the presence of the staff who supported them. People in supported living told us that they could call staff at any time if they needed support and could also speak to the manager if they needed to. Relatives of people being supported in their own home, told us the managers and staff at the office were readily accessible if they needed to raise any issues.

New staff received an induction, training and support for their role. Staff received regular refresher training to update key skills and knowledge and were supported to undertake further professional development. There were appropriate systems for supervising and appraising staff.

There were systems in place to monitor the quality of the service provided. People who used the service gave regular informal feedback and there was an annual satisfaction survey to enable them to comment formally on service quality and delivery. The service had systems to manage and review incidents and complaints.

People told us they were satisfied with the care and support they received, and that the staff members who looked after them were ‘good’.

People were made aware of the complaints system. However most people we spoke with did not have any complaints.

Care records were in place for people using the service and these were kept up to date.

There were suitable arrangements in place to ensure consent was sought from people in relation to the care and support they received.

Staff responsibilities in relation to the management of medicines were clearly recorded, and both staff and people using the service understood these responsibilities.

People with relevant qualifications, knowledge, skills and experience were employed to care for people at Access for Living. Recruitment and background checks were completed before new staff joined the service. However the provider may find it useful to note that Disclosure and Barring service checks (formally Criminal Record Bureau checks) had not been repeated for staff who had been employed in the service for many years.

Policies and procedures were maintained in relation to all aspects of the operation of the service. However, the provider may find it useful to note that review dates were not set on policies and procedures, and many of them had not been reviewed for more than three years.

People felt supported by the service. One person said that they were “very satisfied” with the service. Another said that they were “treated well” and “everything was fine” with the service they received.

People said that staff respected their privacy and dignity. They said that they were involved in their care planning and were helped to be independent. They said that staff helped them with their daily lives and activities that in which they were interested.

They said that staff always turned up and stayed for the allotted time. They said that the service kept them informed about their care and who would be providing it.

They also said that if they were concerned about something, they felt able to speak with their support worker or someone in the office.