This inspection took place on 16 and 17 October 2017 and was announced. The provider was given 24 hours' notice because the location provides a personal care service to supported living services and we needed to be sure someone would be in. One inspector carried out this inspection.

Adelaide Care provides supported living and personal care to adults with autism and learning disabilities living in their own homes. At the time of this inspection there were 36 people using the service.

At the last inspection on 23 and 24 July 2015 the service was given a Good rating overall and we found one breach of the regulations. This was because the provider had not arranged for applications to the Court of Protection as required by the Mental Capacity Act (2005) when people were having their liberty restricted. At this inspection we found significant improvements had been made. The provider had liaised with the different local authorities and appropriate applications had been made to the Court of Protection where people’s care and support may amount to their liberty being deprived.

There was a registered manager at the service. 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.

The provider had systems in place to ensure there were enough suitably experienced and qualified staff available to meet people’s needs. Staff were knowledgeable about reporting safeguarding concerns and understood the whistleblowing procedure. The provider reported accidents and incidents appropriately and used these as an opportunity for learning. People had risk assessments and management plans which included behaviour management and protection of finances. Medicines were managed safely by suitably trained and competent staff. People were protected from the risk of the spread of infection.

People and relatives thought staff provided an effective service. Staff had regular opportunities for learning and development. Staff confirmed they had regular support through supervisions and they found this useful. People were supported to prepare a choice of nutritional food that met their dietary requirements. Care plans included important health information and people had access to healthcare professionals as needed.

Staff were knowledgeable about people’s care needs and preferences. People and relatives thought staff were caring. Staff were aware of equality and diversity issues and providing an inclusive service. People were supported in a dignified manner and their privacy was respected. Staff were knowledgeable about maintaining people’s independence.

Care records were personalised and contained people’s preferences. Staff were knowledgeable about providing a personalised care service. People were able to access activities of their choice. Complaints were dealt with appropriately and people and relatives knew how to raise concerns. The provider used complaints and compliments to make improvements to the service.

People, relatives and staff spoke positively about the leadership in the service. The provider had a system of obtaining feedback from people through a survey in order to make improvements to the service. People also had regular meetings so they could contribute to the development of the service. Staff had regular meetings so they could be updated on changes within the service and policies and to encourage good working practices. The provider had quality assurance systems in place to identify areas for improvement.

We considered our inspection findings to answer questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Is the service safe?

Care and support was planned and delivered in a way that ensured people's safety and welfare. People who used the service had up to date risk assessments on their files which showed they were not put at unnecessary risk but had access to choices. Staff told us what they would do in an emergency and a member of the management team was available on call in case of emergencies.

Staff personnel files showed that staff had regular supervision and annual appraisals. Training records showed that staff received a detailed induction program which included shadowing experienced staff when they started working for the provider. Regular refresher courses were given to staff and all training was up to date. For example staff had received training in health and safety, first aid and fire safety. One member of staff told us that Adelaide Care is "a company that gives people the opportunity to grow."

The provider had policies for safeguarding and whistleblowing in place and signed copies of these were on staff files to show they had read them. Staff received regular training in safeguarding and whistleblowing. Staff were able to tell us the procedure they needed to follow if they witnessed abuse.

Is the service effective?

People we spoke with expressed satisfaction with the care and support given and that their needs were met. One person told us "staff are extremely helpful, my life is easy." It was clear from speaking with staff that they had a good understanding of people's care and support needs.

People's needs were assessed and care was planned and delivered in line with their care plan. The provider involved relatives in the assessment and care planning process. Support plans and health action plans were pictorial, individualised and updated regularly.

Is the service caring?

Staff received training to provide a caring service and were able to tell us how they did this. When speaking with staff it was clear that they knew how to meet the needs for the people they supported in a caring way. One member of staff gave an example of how they ensured the safety of a person who chose to prepare their own food in the kitchen independently. Another staff gave an example of encouraging a person to wear warmer clothing by offering a similar clothing item that would be warmer. Feedback from people was positive, for example, one person who used the service said "I'm really enjoying living here...the best thing is decent staff." A relative we spoke to said "people are kind." A representative from another authority told us they had several people placed with this provider and they would use them again.

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

Is the service responsive?

People's needs had been assessed before they started to use the service. We saw evidence that plans were put into place before people moved into their new home. Staff told us there was a system in place where people who used the service had monthly meetings with a named member of staff to review their support plan. People were able to take part in activities that were of interest to them and were able to access education or work opportunities if they wished. A representative of another authority told us the "manager is very good and very responsive."

Is the service well-led?

The provider had a quality monitoring system in place which showed that opportunities to improve the service were identified and followed up promptly. The provider told us that they were in the process of transferring paper records to a computer system so that they would be able to monitor quality more closely. Staff told us that they had opportunities to give suggestions or opinions through the staff newsletter, staff forum or discussions with their managers.

We spoke to relatives and staff and they told us that they were satisfied with the care and treatment provided by Adelaide Care Limited. People who used the service had varying verbal abilities and were unable to tell us over the phone their views of the care provided. However, one person told us they" liked to play games and that X was their favourite staff."

Care was assessed before people started to use the service. A transition period was facilitated so that people got used to staff and their new home before they started to use the service. "My plans" and support plans were pictorial, individualised and updated regularly.

We looked at ten staff files and found that appropriate recruitment checks were completed before staff began work. These included a medical fitness to work test, disclosure and barring and right to work checks. Staff offered choice and made sure that people gave consent before care was delivered. Staff demonstrated an awareness of the Mental Capacity Act (2005).

Staff had up to date training on medicine administration and were able to tell us how to store administer and dispose of medications. We saw medicine risk assessments in care folders that were detailed and individualised with picture portraits.

Complaints were dealt with in a timely manner. Staff were aware of the complaints policy and it was available in a format that people could understand. Staff told us they would support people to make a complaint if the need arose.

Adelaide Care provides supported living for adults with autism and learning disabilities in various properties in Kent, Croydon and Hackney. At the time of this inspection there were 43 people using the service in 12 different properties.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered manager had not made applications to the Court of Protection as required by the Mental Capacity Act (2005) when people were prevented from leaving their home freely due to a keypad lock being in place or due to them needing staff support to access the community safely. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe with staff in their service. Staff were knowledgeable about the different types of abuse, how to report concerns and how to whistleblow. People had risk management plans to enable them to be as independent as possible whilst reducing the risks. Safe recruitment checks were carried out for new staff and there were adequate numbers of staff to meet people’s needs. People had an assessment of their needs and risk assessments were carried out to ensure safe care was provided. We found people consistently received their medicines safely and as prescribed.

Staff received regular training and opportunities for skill development and received regular supervisions to enable them to improve their delivery of care. People were assisted to plan, cook and shop for nutritious meals to ensure they maintained good physical health. Staff described how they obtained people’s consent before supporting them with any care task. People were assisted to access and attend various healthcare appointments.

People and their representatives thought staff were kind and caring and staff were observed to take their time when they spoke with people. We saw staff treat people with respect and to promote people’s privacy and dignity whilst enabling them to maintain their independence.

Staff assisted people to access a wide range of activities and people were able to choose an alternative if they wished. People’s care plans were personalised and written in an accessible way using pictures. Staff were knowledgeable about delivering personalised care. People and their representatives knew how to raise concerns or make a complaint but most preferred to follow a more informal route.

There was a registered manager at the service. 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 had monthly meetings with their allocated staff member to review and plan their care plans. They were able to give feedback through an annual quality of care survey. Staff received updates on the service and were able to voice their opinions through a staff forum, team meetings and through the annual staff survey. Managers carried out regular audits of the services to ensure the quality of care provided was of a good standard.