We carried out this inspection on 30 November and 1 December 2016. As Brandon trust provides a domiciliary care service we gave 24 hours’ notice that we would be visiting. We did this to ensure we would be able to meet with people in their own homes.

There were twelve registered managers in post as they cover the whole of the county of Cornwall, Plymouth and Devon. 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.

Brandon trust is a domiciliary care service that provides care and support to people in their own homes. This includes people with general health needs, mental health needs, and learning disabilities. The care ranges from a minimum of six hours support , up to 24 hour care for people in supported living. A supported living service is one where people live in their own home and receive care and support in order to promote their independence. People have tenancy agreements with a landlord and receive their care and support from the domiciliary care agency. As the housing and care arrangements are separate, people can choose to change their care provider without losing their home.

We visited by agreement, people living in their homes where supported living support was being provided by this service. Some people lived in their own homes and others lived in a shared house where people had their own bedrooms and collectively used the other parts of the house with staff supporting them throughout the 24 hour period.

People told us the care staff that supported them were “good” and felt they were safe. Relatives echoed this view. Staff were confident about the action to take if they had any safeguarding concerns and were confident the registered managers would follow up any worries they might have.

The service strived to develop their knowledge and expertise in the area of learning disability. They were awarded the Autism Accreditation by the National Autistic Society due to the work they had undertaken at some of the supportive living services.. The team leader of one of the supportive living homes provided a presentation at the ‘National Autistic Society Positive Outcome Events’ to explain their work. The team leader had now gained the ‘Autism experienced practitioner’ qualification of which there were only two in Cornwall. This had led to the team leader being asked to publish articles for the national Autistic Society on the work they have undertaken in how they support people. This demonstrated the service was committed to ensuring staff had the specific knowledge and skills to support people who required specialist support.

Team leaders also had specific roles in training as ‘champions’. This meant that they had a specific area of expertise such as, positive response training (PRT), autism, epilepsy, dementia, communication and assistive technology.

The training department had sourced bespoke specialist courses including end of life care and ‘young people self- harm’ when the need for this was identified. This demonstrated the level of commitment from the service to ensure that staff had access to relevant training courses so that it could provide bespoke care to the people they supported. It also demonstrated the commitment staff had to broaden their expertise and knowledge in care.

People were supported by stable and consistent staff teams who knew people well and had received training specific to their needs. People and their advocates, were involved in recruiting and choosing the staff who supported them. Efforts were made to match staff with people by identifying any shared interests and hobbies.

Staff told us they enjoyed their work and were well supported through supervision, appraisals and training. The area man

We talked to people who use the service and staff teams at ten different homes of people who receive a service. The homes that we visited had between one and five people living there, although we were not able to speak to all of the people as some were out during our visit. Some were not able to communicate with us.

We also spoke with relatives and representatives of people who use the service and they told us that they were confident with the staff and satisfied with the care that their relative received.

We were told that some people who use the service have experienced changes in the care that they receive because of staff shortages. Three people who use the service and live together, told us that they enjoy going out together when possible but that they also go out on their own with a member of staff. We talked to the staff about this and were told that the duty rota reflects the activities that people wish to attend and undertake, in that additional staff are on duty to support people when needed. We saw the duty rota for this service and identified that the staffing levels increase on certain days and times.

One person told us that they talk to their care staff about anything that worries them. They told us that the staff are kind and help them.

People told us that they make choices of how to spend their time. People gave us examples of how they make choices and how the staff listen to them and support them with activities and decisions within the home.

We met and spoke with six people who used the service in their own homes. We visited services in the Newlyn, Longrock and Camborne areas of Cornwall..

The majority of people who used the service, who we met with, had very limited verbal communication skills. The people we were able to speak with were very happy with the support they received from Brandon Trust. Everyone we met looked well cared for. We observed the support people received and saw this to be professional and caring.

We spoke with seven Brandon Trust support staff, and all were very positive and passionate about the service, and about their experience of working for Brandon Trust.

During our visit to the Brandon Trust office in Bodmin we met and spoke with the area manager, three registered managers, and personnel responsible for training, finance and quality assurance.

Documentation regarding the service provided was to a good standard. For example care plans provided clear information regarding care and what support staff needed to assist people with.

Staffing levels were satisfactory, and there was evidence that staff had received suitable recruitment checks. Staff training was to a good standard. The service had a satisfactory quality assurance system in place which should ensure the service was maintained to a good standard and improvements were made as necessary.