This inspection was carried out on 25 and 26 September and 2 October 2018. This is the second comprehensive inspection of the service and was announced.

Creative Support – Derby Service is a domiciliary care agency. It provides personal care and 24 hours support to people living in their own houses and flats in the community. It provides a service to adults with learning disabilities and autism and associated disabilities.

At our last inspection in February 2016 we rated the service overall as ‘Good’. At this inspection we found evidence to support a continued rating of ‘Good’.

At the time of our inspection visit the service supported 10 people living in four ‘supported living’ houses so that they could live in their own home as independently as possible. People’s care and housing were provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

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.

People continued to feel safe using the service. Risks related to people’s lives and wellbeing had been continuously assessed, monitored and reviewed to support people’s safety. Independence was promoted.

Staff knew how to keep people safe and understood their responsibility to protect people from the risk of abuse.

People continued to be supported with their medicines in a safe way. People could choose the food and drink they wanted and staff supported people with this. People’s nutritional needs were met, and they were supported with their health care needs when required. The service worked with other organisations to ensure that people received co-ordinated care and support.

Staff recruitment systems reduced the risk of employing unsafe staff. There were sufficient numbers of staff available who worked flexibly to support people. Staff continued to be supported in their role and received regular training and supervision to provide effective care.

People continued to be involved and made decisions about all aspects of their care. People were encouraged to take positive risks. They 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.

People continued to receive person centred care. They were involved in the development and review of their care, and advocacy support was provided, when required. The support plans were in formats that people could understand. Support plans reflected the care and support people needed, specific communication needs and their likes, dislikes, and interests. People’s wellbeing and independence was promoted. People pursued their interests and hobbies and maintained contact with family and friends.

Systems were in place for people to express their views and to raise any complaints or concerns. Concerns were acted upon promptly and any lessons learned were shared with the staff team to improve the quality of care provided.

The provider promoted a culture of openness and worked partnership with other agencies. Quality monitoring systems were in place which supported continuous learning and improvement of the service. Regular audits were carried out on all aspects of the service and areas identified for further improvement had appropriate action taken.

We inspected this service on 24 and 25 February 2016 and the inspection was announced This was to make sure that there would be someone in when we visited.

Creative Support – Derby Service provides personal care and support to younger adults. This included people with learning disabilities or mental health. At the time of this inspection there were 10 people using the service, which included 7 people who received personal care.

There was 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 were protected from abuse because the provider had taken steps to minimise the risk of abuse. Staff understood their responsibility in protecting people from the risk of harm. Sufficient staff were available to meet people's needs.

Risk assessments and support plans had been developed with the involvement of people. Staff had the relevant information on how to minimise identified risks to ensure people were supported in a safe way.

People received their medicines as prescribed and safe systems were in place to manage people’s medicines.

Recruitment procedures ensured suitable staff were employed to work with people who used the service. Staff told us they had received training and an induction that had helped them to understand and support people better.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005. Staff knew about people’s individual capacity to make decisions and supported people to make their own decisions.

People’s needs and preferences were met when they were supported with their dietary needs. People were supported to maintain good health and to access health care services as required.

People told us that staff treated them in a caring way and respected their privacy and supported them to maintain their dignity. The delivery of care was tailored to meet people’s individual needs and preferences.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. People knew how to make a complaint.

Suitable arrangements were in place to assess and monitor the quality of the service, so that actions could be put in place to drive improvement.

We spoke with people who use the service. They told us they had never experienced treatment or support given against their wishes. One person told us “they don't make you do things you don't want”. This was confirmed by evidence we saw.

People told us they were happy with the care and support they received and felt safe with Creative Support staff. One person said “Having lovely support workers makes me feel safe”.

At our last inspection we raised concerns that staff were not supported and the provider did not have systems in place to monitor the quality and effectiveness of the service. During this inspection we saw that We saw that staff had access to support and training to enable them to carry out their duties. One staff member told us “things have definitely improved, if we have any problems (the registered manager) is always there for you”. Another person told us “ Things are much happier here now”.

We saw that the provider had implemented systems to monitor the quality and effectiveness of the service and these were used by staff.

We spoke with people who use the service and one person’s relative. People told us they felt staff treated them with respect and dignity and helped them to be as independent as possible.

People told us they were happy with the care they received and felt safe.No one we spoke with had any concerns about staff and felt staff supported them and treated them with dignity and respect. People could not recall taking part in any satisfaction surveys or meetings but were confident they could raise an issue and it would be resolved by staff.

People were involved in making decisions about their day to day activities. One person told us they could choose to do what they wanted, they said “I have my own key (to the front door) and I let myself in and out”. People’s rights, such as consent for people to access their homes were not fully considered.

One person told us they were happy with the care they received. People were able to access their community including local shops and clubs. Many of the people who used the service were out in the community during the time we visited.

One person told us they felt safe when receiving care by staff at the service. But we found that care workers were making decisions about keeping people safe on information that may not be accurate, this was because their risk assessments had not been regularly reviewed.

People were cared for by staff who had received some basic training, but lack of specific training which was based on people’s individual needs had not been received. This meant that staff may not be properly skilled to care for people who use the service.

People were able to have a say in the running of the service.