The inspection took place on 25 August 2016. We gave notice of our intention to visit Appletree Support Limited to make sure people we needed to speak to were available.

Appletree Support Limited provides personal care services in their own homes to children and young people who were living with a learning disability, a physical disability or sensory deprivation. Some of the children and young people had very complex needs. At the time of our inspection there were nine children and young people receiving personal care and support from the service. The service also provided support services to people and their families that were outside the remit of our regulatory activities because they did not involve personal care.

At the time of our inspection visit there was no registered manager 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. The family services manager had applied to register with us, and their application was successful on 24 October 2016. They were not available on the day we inspected, but we spoke at length with the registered provider who was closely involved with the management of the service.

The provider made sure staff knew about the risks of abuse and avoidable harm and had suitable processes in place if staff needed to report concerns. The provider had procedures in place to identify, assess, manage and reduce other risks to people’s health and wellbeing. There were enough staff to support people safely according to their needs. Recruitment procedures were in place to make sure staff were suitable to work in a care setting. Procedures and processes were in place to make sure medicines were handled and administered safely.

Staff received specialised support to obtain and maintain the skills and knowledge they required to support people according to their needs. This was through regular and targeted training, supervision and appraisal. Training took into account the complexity of people’s needs and was tailored to supporting individual people. Training included specialist arrangements for people who took in their food and liquids through a tube or intravenously. Arrangements were in place to record consent to people’s care and support, taking account of people’s age. Where people were of an age at which the Mental Capacity Act 2005 applied, staff were guided by the Act’s principles and code of practice.

People’s relations were complimentary about the stable, and very caring relationships people could develop with their support workers and described their support workers as members of the family. Support workers showed imagination and creativity in finding ways to involve people in their care and support. People had support when they needed it, and were supported to be independent where appropriate. People and their relations were able to influence the care and support they received. Staff put people’s needs and preferences at the centre of the service and demonstrated examples where they went beyond the agreed and contracted level of support.

Staff provided care and support that was individual to the person, reflected their preferences and met their needs. Care and support were based on detailed plans which were reviewed regularly. The provider could show that their support had led to positive outcomes for people.

There was an open and empowering culture. The provider had appropriate management systems in place. The management team were available to both people’s relations and support workers, and communications were described as good. The provider worked in partnership with other agencies. Systems were in place to monitor and improve the quality of service provided.