‘Better Lives’ is a domiciliary care service that provides a wide range of community based support services for adults with learning disabilities who live with their family or alone in their own home. The aim of 'Better Lives' is to empower people to live rewarding lives and to enable them to participate in community activities and develop their independent living skills.

Not everyone using the service received the regulated activity related to domiciliary care; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection, six people were receiving personal care support.

At the last inspection in March 2016, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

We found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going 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.

There was a registered manager at the time of our inspection. A registered manager is a person who has registered with the CQC 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 cared for safely in their own home and when supported to access the community with staff. There were sufficient numbers of staff to support people safely; recruitment practises ensure that staff were suitable to work with people with learning disabilities. Risk management plans were in place to protect and promote people’s safety.

People had personalised care plans that reflected their individual needs and aspirations. Staff had the information and guidance they needed to provide people with the care and support they needed. People's privacy and dignity was respected at all times; they had positive relationships with staff and received care in line with best practice. Staff consistently provided people with respectful and compassionate care.

The provider understood and acted upon their responsibility to comply with the Accessible Information Standard (AIS), which came into force in August 2016. The AIS is a framework that makes it a legal requirement for all providers to ensure people with a disability or sensory loss can access and understand information they were given.

People were encouraged to be involved in decisions about their care and support. Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and they gained people's consent before providing personal care.

People were supported to have sufficient amounts to eat and drink and to maintain a balanced diet whenever this was part of their agreed care plan.

The service had a positive ethos and an open culture. The registered manager was a visible role model in the service. The provider continually monitored the quality of the service provided.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received. Information was available in various formats to meet the communication needs of the individuals. Arrangements were in place for the service to reflect and learn from complaints and incidents to improve the quality of care across the service.

This announced inspection took place on 3, 4, 9, 10 March and 19 April 2016. This domiciliary care service provides support to adults aged between 18-65years with learning disabilities who live with their family or in their own home. At the time of our inspection there were seven people who had personal care needs.

There were 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.

The registered managers owned the business and as a provider they had clear vision and values that were person centred and focussed on people having the opportunity to gain their independence. All staff and managers demonstrated passion and commitment to providing a good service for people.

People had therapeutic relationships with staff. People commented on the positive impact staff had made on their lives and how they had changed for the better. People understood they could rely on staff to always be there for them and to provide guidance when needed during difficult times.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005. People were empowered to make their own decisions and to take responsibility for them. Staff provided people with information to enable them to make an informed decision and encouraged people to make their own choices.

People’s lives had improved as a result of using the service; people were enabled to become more independent by gaining everyday life skills and understanding how to care for their health and well-being.

People received safe care and support. Staff understood their role in safeguarding people and they knew how to report concerns. There were enough staff with the right skills and attitudes to meet people’s needs. The provider included people in the in-depth recruitment and selection of new staff.

Staff had a full understanding of people’s support needs and had the skills and knowledge to meet them. Training records were up to date and staff received regular supervisions and appraisals. Staff were clear about their roles and responsibilities in caring for people and received regular support from the provider.

There was a person centred and flexible approach to each person’s nutritional needs and staff promoted healthy eating. Individuals were supported to realise the knowledge and understanding they needed to attain a healthy weight, plan and prepare meals and keep their food safely stored.

Care records contained risk assessments and risk management plans to protect people from identified risks and helped to keep them safe but also enabled positive risk taking. They gave information for staff on the identified risk and informed staff on the measures required to minimise any risks. Staff were vigilant regarding people’s changing health needs and sought guidance from relevant healthcare professionals

Staff protected people’s privacy and dignity. All interactions between staff and people were caring and respectful; staff were consistently patient, kind and compassionate. Staff demonstrated affection and warmth in their contact with people, which was clearly reciprocated.

Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy. Staff and people were confident that if they had any concerns they would be listened to and any concerns would be addressed.

Systems were in place to monitor the quality and safety of the support people received. People and staff were encouraged to provide feedback about the service and it was used to drive continuous improvement.

‘Better Lives’ is a very small service and when we inspected the staff supported approximately 17 people to participate in community activities and develop their independent living skills. With their prior agreement we met with the family representatives of two people who used the service and we asked them about their experience of using this small agency’s support services. We also spoke with people by telephone and everyone was very happy with the support provided by the staff. One relative commented, “We cannot fault this service. It is really well organised.”

We found the agency to be appropriately managed and we saw that people received reliable, safe and effective support that enabled them to develop their confidence and participate in community activities.