Caritas Care is a domiciliary care agency, which provides personal care and treatment of disease, disorder or injury to people in the local community. At the time of our inspection, the service supported 43 people in their own homes. Additionally, they supported 17 people across eight supported living houses. The service is available to people of all ages whose needs range from mild, moderate or complex learning disabilities and associated medical conditions. The agency is situated in the Ashton area of Preston.

At our last inspection in March 2016, we rated the service as good overall. Under safe and effective we rated the service as requires improvement because we found breaches of legal requirements. This was because the provider had not fully ensured staff were aware of procedures to report safeguarding concerns. The contact details of the appropriate agencies were not up-to-date and we could not determine if restrictive practice procedures had been followed lawfully. Additionally, there was limited evidence to show why people did or did not consent with their full understanding. After the comprehensive inspection in March 2016, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. The provider also demonstrated they had implemented and embedded good practice and were meeting the requirements of the regulations. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

During this inspection, we found the provider had updated safeguarding and other relevant policies and the contact details of responsible authorities. Staff had relevant training and we found the management team reviewed any lessons learnt to maintain everyone’s safety and welfare.

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. We found the management team had obtained each person’s consent to care, or their representatives where this was applicable. A relative of a person who lived at one of the supported living houses told us, “It’s a democratic house where the staff help people to make decisions. They act as their advocates, which is very important to me.”

People who received support in their own homes or a supported living house told us they felt safe using Caritas Care. A relative said, “My [relative] is very safe.” The registered manager reinforced this by guiding staff to support each person safely when they used the service. We also saw good systems to manage, review and mitigate accidents and incidents within the service.

The management team had implemented and completed audits to improve the quality and safety of their medicines procedures. We observed staff administered medication with a safe and patient approach. People told us they received their medicines on time and as required.

The registered manager followed safe recruitment procedures to reduce the risk of employing unsuitable personnel. Staff told us teams they worked in were sufficient to meet people’s needs with a timely approach. A relative commented, “There is excellent continuity of care. Having the same carers and being able to build up that trust in familiarity is a huge thing.” The registered manager had a training programme staff were required to complete and refresh themselves with.

Where applicable, we saw care plans evidenced staff worked with people to develop a healthy lifestyle. They were supported with their cooking skills by helping to make meals of their choice.

We observed staff and the management team had a kind and caring approach to people they supported. A relative

We inspected this service on the 5, 9, 10 and 11 March 2016. The provider was given notice of the inspection to ensure someone was available in the office to support us.

The service was last inspected In July 2013 where it was found complaint with the regulations inspected. This is the first inspection under the new methodology, where the service has been provided with a rating under the Health and social Care Act 2008 (Regulated Activities) Regulations 2014.

This report is for the inspection of the supported living service. The service supports 35 people living with learning disabilities in the community. Some people live in their own homes and some live with their families. The service supports people living in Lancashire.

The provider operates a number of other services including services accessible to people supported by the supported living team. These include day centres, self- advocacy services, befriending services and social and educational projects.

The provider has a manager who is registered with the commission. 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.

We found risk assessments were completed as required on both the properties where people lived and for specific risks to people using the service. We saw the provider had a good set of policies and procedures to protect people and staff as the service was delivered.

However we found the safeguarding policy needed updating to include key contact information and staff needed further information on who to inform in the event of a suspected act of abuse including notification to the Care Quality Commission. We found the service in breach of the regulation associated with ensuring that people were safeguarded against potential acts of abuse.

The service had recently reviewed a number of policies including those associated with medicines and infection control. We discussed these with the provider and registered manager who acknowledged work was ongoing to ensure their full implementation.

Recruitment was undertaken equitably and safely with potential staff. People using the service were involved in the selection of future staff where appropriate. Suitable checks were undertaken to ensure people were suitable for the role they were applying for.

We were told by staff that the induction to the role was good and ongoing training was provided. A new suite of training had recently been commissioned which staff were looking forward to attending. Staff undertaking clinical tasks were to complete competency tests shortly after the inspection to ensure they were competent in supporting those people with more complex needs.

We found some concerns around how the service acquired consent from people. Consents had been acquired before people had been assessed to determine if they could safely give their consent. We discussed this at length with the provider and registered manager who were to implement the guidelines with the Mental Capacity Act 2005 as a matter of urgency. We found the provider in breach of this regulation but were given assurances work had begun to address these concerns.

We spoke with four people who used the service in their homes and saw four others whilst participating in planned activities. We saw relationships between staff and people using the service were well developed. Staff were knowledgeable about people’s likes and dislikes and understood triggers that could result in changes in behaviour or health care needs. We saw staff reacting appropriately in all the situations we observed and people being supported were very happy.

People we spoke with spoke about their support workers in a high regard and staff spoke about the people they supported with

During our inspection we looked at care and staff recruitment records. We did this to confirm people were being well supported and staff members had been recruited properly. We also spoke with family members of people being supported by the agency and interviewed some staff members. The people we spoke with said their relatives were receiving safe and appropriate care which was meeting their needs. They told us the staff visiting them were polite, reliable and very professional when undertaking their work.

“I have been fully involved in my daughters care from day one. I am consulted about her care needs on a daily basis and agree with the staff what support they should be providing. The agency is very professional in everything they do”.

“I have been with several other agencies and very disappointed with the service provided. I have been very impressed with this agency”.

“My daughter has really complex care needs. They understand her moods so well and are always relaxed and professional when delivering her care. They make my daughter very happy and that makes me happy”.

Information received from Lancashire councils contracts monitoring team confirmed they currently had no concerns with the service being provided by the agency.

We spoke to the manager, senior management, support workers, nurses, people who use the service and family carers. Comments we received were all positive and included, "Yes wonderful." Another said, "They look after two of us me and H..... they are very good to me." A family carer spoke to said, "This is the best agency we have had. My daughter and I have used plenty of other agencies none as good as this."

Staff members we spoke to told us they thought it was a good agency to work for.

Comments included, "I have been here for years and love it." A person recently employed said to us, "I have worked a long time in the care industry and must say, this is the best."

Other professional agencies we spoke to, such as Lancashire social services said they

have no issues with the agency. They told us they have not been involved in any

safeguarding incidents.

Some people require a lot of care because of their complex needs. Staff we spoke to about these people had a good awareness of individual care needs, also the importance of treating people with respect and dignity. One senior staff member said, "Because of the high needs of some clients we have to have a good working knowledge of what support and care each person requires."

We visited Caritas Care on 5th July 2013 as part of our schedule of routine inspections. We spoke to a professional involved in the care of a person on 5th July 2013 and a family member on 8th July 2013.

We looked at outcomes 4, 8, 13, 16 and 21 and found compliance with all these outcomes.

People that used the agency, a relative and professional involved in the care of a person told us that people’s health care needs were very well managed. Words such as professional and responsive were used to describe the agency.

People told us that they received support to keep themselves healthy and well by having guidance and support about good personal hygiene and food preparation available to them. They told us that the agency supplied them with soap and towels in their kitchen, bathroom and toilet so they could wash their hands when needed.

People told us they had support from the same staff team and that the support they had was flexible to meet their needs and support them to pursue social and leisure interests.

People told us that they were asked about the service they received and that they could contribute toward the agency’s development or ask for their care to be changed to their liking. One person said, “When …. moved jobs and not my team leader I asked what would happen as she knows me. The lady replacing her wasn’t starting straight away so they agreed until she did and the new lady got to know me that …. would still be my team leader. That’s great”.