We inspected this service on 12 and 17 August 2016. The inspection was unannounced.

Catherine Tam Agency is situated in the grounds of Landermeads Care Home in the Nottingham suburb of Chilwell. The service is provided from two bungalows which have been adapted to meet people’s needs and allow them to live as independently as possible. The agency provides a supported living service to three adults who experience a learning disability or who have acquired brain injury.

At the time of our inspection, the service did not have a registered manager in place although an application had been submitted and was in progress. 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 told us the service provided made them feel safe and they did not have any concerns about the care they received. Staff showed a high level of understanding of how to keep people safe and protect them from harm. Safeguarding referrals were made to the appropriate authority when concerns were raised.

Risks to people’s safety were identified and managed and assessments carried out to minimise the risk of harm. People were kept safe with as few restrictions as possible. People were supported to take positive risks which enhanced their experience and enjoyment of life.

People received care and support in a timely way and there were sufficient numbers of suitably qualified and experienced staff employed. Appropriate pre-employment checks were carried out before staff began work at Catherine Tam Agency.

People received their prescribed medicines when required and these were stored and administered safely.

People received effective care from staff who received thorough induction, training and support to ensure they could meet people’s needs and ensure they had a good quality of life. Ongoing training and assessment for care staff was scheduled to help maintain and further develop their knowledge.

The provider kept up to date with latest research guidance and developments and had links with organisations that promote and guide best practice. Staff had access to guidance and training which helped drive improvement of the service and enhance people’s quality of life.

People provided consent to any care and treatment provided. Where they did not have capacity to offer informed consent their best interests and rights were protected under the Mental Capacity Act (2005). People’s wishes regarding their care and treatment were respected by staff.

Staff supported people to help them maintain healthy nutrition and hydration.

Excellent links were established with healthcare professionals and people had access to these when required. Staff worked in partnership with healthcare professionals and followed their guidance to ensure people maintained good health.

People told us they were treated with compassion dignity and respect and staff ensured their privacy was protected. We observed very positive, caring relationships between staff, people using the service and their relatives. Staff always ensured that people and their relatives were involved in making decisions about their care and their wishes were respected. .

Staff had an excellent understanding of people’s support needs and used skill and innovative methods to ensure they received personalised, responsive care. Staff ensured that people had the opportunity to take part in enjoyable, constructive activities that reflected their interests and life history. There was an open and transparent culture at the service. People were encouraged to raise any issues or complaints and could be assured these would be listened to and acted on by the provider.

Effective quality monitoring systems were in place and were reviewed continuo

We spoke with all three people receiving a service in their home with the manager of the agency. We also spoke with three staff and the manager of the service to help us assess compliance.

People received the care and support they needed to meet their individual needs. All of the people were happy with the care they received, one person told us, “I like my home, the staff support me and help me when I need it.”

Staff followed good hygiene practices to make sure people were protected against the risk of infections. One person told us, "It's nice and clean. I clean my bedroom; staff help me if I need it."

We found that people had the equipment they needed to keep them safe and to make them comfortable. One person showed us the assisted bathing facilities. They told us, “I love having a bath; I know how to work it and I can have a soak.” They showed us how this equipment worked showing they could use it independently.

Staff files did not have all of the information the provider would need to check that staff were suitable to work with vulnerable adults. They said they would take urgent steps to sort this out.

Two people told us they would talk to the staff if they had any concerns about the service. One person said, “If I was worried I would talk to the staff. I think they would help me and it would be ok.”

We spoke to three people who receive a service and to a relative of one of these individuals.

People we spoke to told us that they valued the service and the staff who provide the service.

People we spoke to told us about a wide range of staff supported activities they enjoy including shopping, meals out, attending football matches, bowling and involvement with a drama project. People told us about and showed us photographs from holidays they had enjoyed, supported by staff, family and friends. One person told us that with support from staff “things are going well” One person who experiences mobility and dexterity problems, and who enjoys hot drinks told us that, sometimes “staff get the coffee for me”

People we spoke to told us that they feel safe with service providers. People told us the names of key staff and service managers. One person told us that “I go to staff” when they have problems and “I speak to the manager” if they have problems with staff.

The relative we spoke to told us of their satisfaction with the service provided stating that “I cannot fault it” and “staff are excellent.”