This inspection was announced and took place on the 4 and 5 January 2017. At the last inspection on 27 and 28 July 2015 we found the provider had breached one regulation associated with the Health and Safety Act 2008 (Regulated Activities) Regulations 2014 (HSCA 2014). This breach related to Regulation 13 (Safeguarding service users from abuse and improper treatment). The provider had not always taken appropriate action to prevent people from the risk of financial abuse.

We told the provider they needed to take action and we received a report setting out the action they would take to meet the regulation. At this inspection we reviewed whether or not these actions had been taken and found the provider was now meeting the requirements of the HSCA 2014. We found improvements had been made regarding the management of risk relating to peoples finances and documentation was in place to support this work.

East Hill Place is a supported living service situated within a number of residential flats located on the outskirts of Liss Village Centre. The service provides care and support for up to seven younger adults with learning disabilities. People using the service also live with a number of complex emotional and behavioural needs including autism as well as other health needs such as epilepsy. East Hill Place is comprised of seven self-contained individual one or two bedroomed flats within the grounds of a residential home owned by the same provider.

A supported living service is where people are provided with personalised care and support in their own home which is situated within a purpose built residential area. At the time of the inspection the service was providing personal care and support to six people.

East Hill Place has a registered manager 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.

People using the service told us they felt safe. Staff understood and followed guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm in their own flats had been identified and guidance provided to staff on how to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

Recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. New staff induction training was followed by a period of time working with experienced colleagues. This ensured staff had the skills and confidence required to support people safely. There were sufficient staff employed to ensure that people’s individual needs were met.

Contingency plans were in place to ensure the safe delivery of care and support in the event of adverse situations such as large scale staff sickness or fire and floods. The registered manager was also able to deliver care if staff were ill and unable to work.

People were protected from unsafe administration of their medicines because staff were trained effectively. Staff had completed mandatory training to ensure they could prompt people to take their medicines where required. Where staff administered people’s medicines this was carried out safely. Staff followed guidance to ensure people safely stored and disposed of medicines which were kept in their own flats or in the staff office when required. Staff skills in medicines administration were reviewed on a regular basis by an experienced and suitably trained member of staff to ensure they remained competent to continue.

People were supported by staff to make their own decisions. Staff were knowledgeable about the actions to take to

The inspection took place on 27 and 28 July 2015 and was announced. Consensus Community Support Limited- East Hill Place Liss is registered to provide a domiciliary care service to younger people with a mild to moderate learning disability who may experience an autistic spectrum disorder.

At the time of the inspection the service was supporting 12 people who live on three sites at Liss, Croydon and Redhill. Four people share a house at Croydon, two people are supported in their own flats at Redhill and six people are supported in their own flats at Liss. Following our inspection we have asked the provider to review whether they should submit an application to vary their type of service provision from domiciliary care to supported living, as this would more accurately reflect the type of service provided to people by this service.

The service had a registered manager. 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 manager was based at the Liss service and there was a second manager based at the Croydon service who managed this location and the Redhill location.

People had not been fully protected from the potential risk of financial abuse. Staff had received training on how to safeguard people and understood their role and responsibilities in relation to safeguarding. The registered manager had not ensured the provider’s written guidance in relation to the management of people’s monies had been followed fully, to protect them from the risk of financial abuse. During the inspection it was identified that a person may have experienced financial abuse. The registered manager was informed and they took the appropriate actions to report this incident to the relevant authorities. They made immediate changes to how people’s finances were monitored to protect people from this risk.

Risks to people had been assessed and staff had access to guidance about how to manage risks. If people experienced health conditions they had relevant care plans in place to provide staff with guidance about how to manage any associated risks. Environmental risks to people had been identified and safely managed. Staff had access to management support out of hours to ensure they could seek advice about people’s care if required.

People were supported by sufficient staff to meet their individual needs. Staff had undergone recruitment checks at the time of their recruitment. The registered manager had recently completed an audit of staff recruitment records and identified that references for two long-term staff had been lost. They had taken appropriate action to request copies of these references, to ensure there was evidence to support staff recruitment checks.

People kept their own medicines in their accommodation and trained staff supported them to take them. There were processes in place for the ordering and return of people’s unused medicines. People were supported to take their medicines safely.

Staff had received an induction to their role when they commenced work and were supervised in their work with people. Staff had completed the provider’s mandatory training and were undertaking additional relevant training to ensure people’s care was provided effectively. Staff had undertaken relevant professional development. People were supported by staff that were adequately supported in their role.

One person required continuous support and supervision from staff to ensure their safely. This person was potentially deprived of their liberty and this needed to be authorised by the Court of Protection (CoP). The provider was legally unable to make this application to the CoP and had liaised with the commissioners of this person’s service, who were authorised to submit the required application. The provider had not ensured the commissioners had completed this application in a timely way.

We have made a recommendation about ensuring people’s human and legal rights are respected.

Staff had received training in the Mental Capacity Act (MCA) 2005 and understood their role and responsibilities. Staff informed us people had the capacity to make day to day decisions about their care. Therefore, they had not yet needed to complete any MCA assessments for people as they had been able to consent to decisions about their daily care.

People felt involved by staff in making decisions about their care. People’s wishes about who they wanted to be consulted by about their care had been documented and were respected. People’s care records provided staff with guidance about how to involve people in decisions about their care.

People had nutritional care plans in place which documented the support they required with cooking and how to encourage them to eat healthily. People were supported to plan their meals on a weekly basis with staff and their weight was monitored with their agreement. People received appropriate support from staff to encourage them to maintain a healthy diet.

Staff supported people to ensure their health care needs were identified and met. People were enabled to see a variety of professionals in response to their identified health care needs.

At two of the locations people were supported on either a one to one basis or a two to one basis by staff, which required very close working relationships between people and staff. People’s records provided staff with information about people’s backgrounds and preferences about their care. People’s choices about who they wished to work with were respected where possible. People were observed to enjoy positive relationships with staff.

Staff treated people with dignity and respect when they provided their care. Staff knocked on people’s doors before they entered and ensured people were ready to receive their care.

People were involved in their care planning. They had detailed care plans which provided staff with written guidance about the assistance they required. Where people required support with communications or behaviours which challenged staff they received this. The registered manager was making arrangements for people to have an annual review of their care. People led individualised lives based on their interests and preferences. Staff respected their right to choose how to spend their time whilst encouraging them to have a structure to their day. People received care that was responsive to their needs and arrangements had been made for their care to be reviewed.

People were provided with information about how to complain and felt able to do so. Where a complaint had been received the provider had listened to the concerns expressed and tried to resolve the complaint. The provider listened to and responded to people’s feedback.

The provider had clear values which staff learnt about and practised in their work with people. Most staff said there was an open culture within which they could speak out about issues. The registered manager was aware there had been a level of dissatisfaction from some staff but they were now moving forward as a team in the provision of people’s care.

There was sufficient management presence at the three locations. The registered manager was based at the Liss location but visited the other two locations regularly and supported the on-site manager at these locations.

The registered manager monitored the quality of the service through a variety of methods, which included audits and observations of staff interactions with people. They took action to improve people’s care when they identified changes were required, such as changing the staff working with people.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.