Centre 404 provides personal care services to adults with a learning disability living in their own homes in the London Borough of Islington. There were 48 people using the service at the time of this inspection on 30 October and 2 and 6 November 2017.

This inspection was short notice, which meant the provider and staff did not know we were coming until shortly before we visited the service. At the last inspection on 4 and 18 August 2015 the provider met all of the legal requirements we looked at and was rated Good.

At this inspection we found the service remained Good.

The service had a registered manager in place. 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 and associated Regulations about how the service is run.

Staff respected people’s privacy and dignity and worked in ways that demonstrated there was diligence at ensuring this. People’s preferences were known about and were recorded and staff worked well to ensure these preferences were respected. The provider and staff teams worked hard to ensure that the service offered an outstandingly caring environment. The service was bespoke and built around the people that used it and was not operated for anyone’s convenience other than the people that used the service. Compassion and respect were at the heart of the values that staff displayed and people’s abilities, or impairment to their abilities, did not dictate how they were supported to live their lives.

People using the service, relatives and other stakeholders were highly satisfied with the way the service worked with people and the steps that were taken to keep people safe from potential avoidable harm.

The service was diligent with ensuring that the requirements of the Mental Capacity Act (2005) were complied with. Where Deprivation of Liberty issues were applicable, this too was managed well and proper consultation took place to help protect people’s human rights.

People who used the service had a variety of support needs, in some cases highly complex needs, and support plans clearly described people’s care and support needs and provided clear guidance for staff about how to meet these needs. Any risks associated with people’s care were assessed, and the action needed to minimise risks was recorded. Risk assessments were updated regularly and did not place restrictive limitations on the reasonable risks that people were allowed to take.

Staff training described mandatory training required for all staff as well as specific training required where staff worked with people that had specific care needs that required staff to undergo specialised training. Staff participated in regular supervision which was designed as a supportive process for staff as well as to address their development and work with the service. Staff appraisals took place yearly and development and training objectives were set arising from the appraisal system.

People were informed about how to complain and were supported to raise concerns if they were unable to do it independently by using advocacy services if a family member or friend could not assist with this on their behalf. If concerns were raised these were listened to and the provider was open about action taken and changes made as a result.

People who used the service, relatives and stakeholders had a range of opportunities to provide their views about the quality of the service. The provider worked hard to ensure that people were included in decisions about their care and their views about how the service was run were respected and taken seriously.

At this inspection we found that the service met all of the key lines of enquiry that we looked at and was not in breach of any of the regulations.

Further information is in the detailed findings b

The inspection took place on the 4 and 18 August 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. At our previous inspection on 20 and 21 February 2014 the provider met all of the legal requirements we looked at.

Centre 404 provides personal care services to adults with a learning disability living in their own homes in the London Borough of Islington. There were a 85 people using the service, approximately half used the low level outreach support with the rest using the service that provided more intensive shared living support in a total of six shared houses

The service had a registered manager in place. 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 and associated Regulations about how the service is run.

From the discussions we had with people using the service, relatives and other stakeholders we found that people were highly satisfied with the way the service worked with people. Relatives and stakeholders told us they were confident about contacting all staff at the service to discuss anything they wished to. They believed that staff were highly knowledgeable and skilled. People felt that there was honesty and transparency in the way the service communicated with them.

The service took a proactive approach to end of life care. We saw an example of how the service had supported a person who was at the end of their life. This service worked hard to gather the person’s views and wishes and involve people important to them whether they were family, friends or others they valued. The service had won an award for their work in this area.

The service finds innovative and creative ways to enable people to be empowered and voice their opinions. The provider regularly consulted people who used the service, their families and others about the development of policies, involvement in staff recruitment and about their views of the service. People were able to speak freely about their experience of the service and share their views openly. People’s feedback showed a very high degree of satisfaction about how well the service operated and how open and transparent people believed the service to be.

The service was diligent with ensuring that the requirements of the Mental Capacity Act (2005) were complied with. Where Deprivation of Liberty issues were applicable we found that this too was managed well and proper consideration and consultation took place to help protect people’s human rights.

People who used the service had a variety of support needs, in some cases highly complex needs, and from the four care plans we looked at we found that the information and guidance provided to staff about people’s care and support needs was clear. Any risks associated with people’s care needs were assessed, and the action needed to mitigate against risks was recorded. We found that risk assessments were updated regularly and did not place restrictive limitations on the reasonable risks that people were allowed to take.

During our review of care plans we found that these were tailored to people’s unique and individual needs. Communication, methods of providing care and support with the appropriate guidance for each person’s needs were in place and were regularly reviewed.

We looked at the training records of staff at two shared living projects. We saw that in all cases training considered mandatory by the provider had been undertaken and the type of specialised training they required was tailored to the needs of the people they were supporting. We found that staff supervision was regular and geared to support staff and to address their development and work with the service. Staff appraisals were taking place yearly and staff had development and training objectives set arising from the appraisal system.

Staff respected people’s privacy and dignity and worked in ways that demonstrated there was diligence at ensuring this. From the conversations we had with people, our observations and records we looked at, we found that people’s preferences had been recorded and that staff worked well to ensure these preferences were respected. It was evident during our inspection that people were placed at the heart of how the services operated and staff built the care and support provided around each person as a unique individual. This was the driver of the service and people’s support was not restricted by procedures or systems but care was individually designed and the resources required were governed by their needs.

As an example of just how much staff paid attention to detail, a stakeholder told us they saw that a specially adapted kettle had been fitted into someone’s kitchen. They could make their own cup of tea or coffee by just pressing a button and getting the exact amount of water they needed. Staff had found this for them and it helped them to keep some independence and be safe. They thought it showed such thoughtfulness from staff. They told us the staff paid attention to people as individuals, not clients.

Records showed that people were able to complain and felt confident to approach staff and management of the service if they needed to. People told us they confident that any concerns they had would be listened to and the service was open about action taken and changes made as a result.

As an example of the flexible way that they service worked we saw that additional resources were made available whenever people’s daily lives required additional support to achieve their goals. In one instance we were told by someone about the way in which staff supported them to have a part time job, which they thought was of real help to them.

People who used the service, relatives and stakeholders had a range of opportunities to provide their views about the quality of the service. We found that the provider worked hard to ensure that people were included in decisions about their care and their views of how the service was run were respected and were taken seriously. People who had contact with us, whether the used the service, were relatives or other professionals all believed the service had a highly positive and inclusive culture. In our communications with staff we also found that staff demonstrated a positive and inclusive approach and this was also shown in the flexible way in which the service operated.