The inspection took place on 9, 10 and 11 October 2017 and was announced to ensure people and staff we needed to speak with would be available. The service is registered to provide personal care to people living with a learning disability, physical disability or sensory impairment. They do this through teams of staff that are managed from a central office location. For some people, living at one of 22 supported living locations; this means they receive dedicated staff support for up to 24 hours a day, seven days a week. Whilst other people receive staff support for a few hours a day, through one of the provider’s two outreach services. At the time of our inspection, 120 people were provided with the regulated activity of personal care. People who received care were living across the local authorities of: Berkshire, Oxfordshire, Surrey and the unitary authority of Portsmouth.

The service had three operations managers’ to manage the service, two of whom were also registered managers for 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 felt safe from the risk of abuse and relevant processes, procedures and staff training were in place to protect people. The provider was transparent in their safeguarding reporting and ensured all potential safeguarding incidents were reported to ensure people’s safety.

People’s support plans and risk assessments identified potential risks to them and how these would be managed to reduce the likelihood of harm to them. Incidents were documented and relevant action taken to reduce the likelihood of repetition for people.

Some relatives reported there had been too high a use of agency staff at some locations. Although agency usage was high at some locations, people still received the care they needed safely. The provider was taking a proactive approach to recruit staff and in the interim had taken measures to ensure there were sufficient staff to deliver people’s care safely and that staffing was as consistent as possible for people. Safe recruitment processes were in place for all staff recruited since 2014. Further pre-employment information is required for some TUPE staff that transferred to the provider pre 2014 and the provider has requested this to ensure it is available.

People received their medicines from trained staff. Some aspects of people’s medicines management required improvement and the provider took action during the inspection to ensure people’s safety.

Overall, feedback about the effectiveness of the service was good. People were supported by staff who underwent a thorough induction and who had received on-going training. The provider was aware through their own monitoring that not all staff were receiving one to one supervisions at the frequency the provider required and actions were already in place to address this.

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 had clear records of their dietary needs, preferences and any associated risks, which staff had read and understood. Where staff were responsible for preparing people’s meals, records indicated they had been provided with a suitable, varied and balanced diet.

Staff supported people where required to see a range of health and social care professionals in order to ensure they maintained good health.

Overall people and relatives reported staff were caring and kind. We saw people were relaxed in the company of staff and familiar with them. People’s records documented their needs in relation to communication and staff understood how people communicated. Th