This inspection took place on 20 February 2018 and was announced.

This service provides care and support to fifteen people living in four ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are 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 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. Each supported living setting had a project manager in place.

At the last inspection in December 2015, the service was rated Good. At this inspection we found the service remained Good.

Risk assessments were in place with full information on steps that should be taken to reduce the risks.

Staff had received training in safeguarding adults and the registered manager understood their responsibilities to identify and report any concerns. Safe recruitment processes were followed to ensure only suitable people were employed. The services did have a shortage of staff and the provider was in the process of trying to employ more staff. Agency staff were being used in the meantime. Staff raised concerns about the shortage of staff and having to work long hours to cover this. This was looked into by the service director.

Medicines were managed safely and people received their medicines as prescribed. We have made a recommendation about the management of when required medicines.

People accessed health and social care professionals. People benefited from strong, caring relationships with staff that treated them with dignity and respect.

People received effective care from staff that had the skills and knowledge to support them. We have made a recommendation about training.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems in the service support this practice. Consent to care and treatment was clearly documented and appropriate authorisations were in place when people lacked capacity to make decisions.

Activities were developed around people’s interests. People were supported to maintain relationships and access the local community.

Effective management systems were in place to monitor the quality of care provided and to promote people's safety and welfare. Staff did not feel supported by the management team and stated morale was low.

We carried out this inspection on 3 December 2015. The provider was given 48 hours’ notice because the location provides a domiciliary care services and we needed to be sure that the manager would be in.

Creative Support Limited Durham has its registered office at Innovation Court, Stockton-on-Tees. However, the service actually delivers support and/or personal care in three supported living type services in the Durham area. Each of the supported living services provides support to people who live in their own houses or flats, with their own tenancy agreements. The people using the service received individual or shared support hours depending on their assessed needs. Some of the services provide support on a twenty-four hour basis.

The service had a registered manager who had been registered with the Care Quality Commission since November 2015. 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.

Due to people’s communication needs we were unable to gain some of their views about the service and therefore we observed staff interactions and spoke with relatives.

The registered provider had policies and procedures in place which were there to protect people from abuse. Staff we spoke with understood the types of abuse and what the procedure was to report any such incidents. Records showed staff had received training in how to safeguard adults. A whistleblowing policy (where staff could raise concerns about the service, staff practices or provider) was also in place. Staff we spoke with again demonstrated what process to follow when raising concerns.

We found medicines were being managed safely. Only staff who were trained to dispense medicines did so. We recommend that the service consider the current guidance on managing medicines that need to be administered ‘when required’’ and take action to update their practice accordingly.

Staff supported people to attend healthcare appointments and liaised with other healthcare professionals as required if they had concerns about a person’s health.

Risk assessments for people who used the service and for the day to day running of the service had been carried out . Clear and very detailed written plans were in place to manage these risks..

Staff were trained and competent to provide the support individuals required. Staff were supported through a system of induction and training.. Although staff demonstrated an understanding of Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards, they had not received training in this. Staff were covering shifts whilst waiting for newly recruited staff to start. Staff did not received regular supervision and appraisals. The registered manager was aware of this and had put a system in place to improve this.

Where people did not have the capacity to make certain decisions, the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People had been included in planning their own care. Feedback from people who used the service had been listened to and acted on. Some people were actively involved in meal preparation.

From discussions with relatives and documents we looked at, we saw people who used the service or their families were included in planning and agreeing to the care provided at the service.

Staff demonstrated they knew; the people they were supporting, the choices they had made about their support and how they wished to live their lives. All this information was fully documented in each individual care plan.

People knew how to complain and we saw people had regular feedback opportunities to discuss how they felt about the service. Each person had a key-worker who checked regularly if people were happy or wanted to raise any concerns.

We saw evidence that comprehensive quality assurance processes were regularly undertaken to ensure the service was aware of people’s views of the service and could monitor auditing processes at the service. This helped to ensure an open service culture that was open to challenge and learning from issues as they affected the quality of the service.

The service provides support to a group of people across the Durham area and this involves assisting people who live in four communal houses as well as others who live in their own flats. A number of the people require Creative Support staff to support them with psycho-social aspects of their lives and do not need assistance with personal care. The people who received a personal care service either lived in their own flats; in a communal house; or in their own house. The services where people required personal care services were spread across four locations. Most of the people who used these Creative Support services lacked capacity and their tenancies had been agreed via the Mental Capacity Act use of Court of Protection procedures. We visited people in two of these four services and met seven people during the inspection. As this was a routine visit we were looking at what the care was like; and what people thought about the staff.

All the people we met had limited verbal communication skills and were not able to tell us in detail what they thought of the service. However, they indicated that they were happy in their homes and with the staff. From our observation of staff interactions with people we found the staff clearly understood what people wanted. Staff constantly sought people’s views and permission around all aspects of the service they were delivering. Staff understood exactly how much support each individual needed and we saw that they worked in ways which empowered people to take control of their care and lead ordinary lives.

A single inspector carried out this inspection. The focus of the inspection was to look at the chosen regulations and use what we found to answer five key questions; is the service safe, effective, caring, responsive and well-led?

During this inspection we visited the services registered office. We also visited two of the supported living schemes where personal care was being provided. We spent time meeting and speaking with six people who used the service. We also spoke with nine staff and we looked at records. Some of the people who used the service had complex communication needs, making it difficult for us to speak with them about their care and support. To help us better understand people’s experiences we spent time in the supported living services, so that we could observe how people were supported by staff. We also spoke with one person’s relative.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Creative support had in place arrangements to assess and plan people’s care and support needs. This included risk assessments and arrangement to manage behaviour that challenges in a safe and consistent way. For example, staff who worked in services where people experienced behaviour that challenges had received appropriate training and people had detailed personal behaviour support plans in place. This helped to ensure that staff responded in safe, consistent ways, which were safe and effective for the individuals involved. The service had in place systems for the safe management and administration of medication.

Staff told us that they received training, with access to regular training refreshers and updates. The training records we were provided with showed that staff had completed a variety of training relevant to their roles. However, the training records did not demonstrate that staff had completed all of the training listed on the services ‘Mandatory Training Matrix’ or the training update frequencies suggested by the services training calendar.

We found that the services quality assurance systems included checks and audits related to health and safety. For example, regular checks of the arrangements for fire safety and maintenance in the supported living services.

Is the service effective?

People who used the service and their relatives told us that they were happy with their care and support. During our visits we saw that people looked well cared for and appeared comfortable and at ease with the staff in their homes. Records showed that people’s care and support needs had been assessed, planned and reviewed. Staff knew people well and felt that they provided people with good quality support.

Is the service caring?

We observed staff treating people kindly and with respect. People who used the service appeared comfortable with their staff, conversing and interacting with them in a friendly and relaxed way. People we spoke with told us that they liked their staff and were happy with their service. The staff we spoke with knew the people they supported well and could explain their individual preferences and how they liked to be supported.

Is the service responsive?

People’s needs had been assessed and planned. Reviews took place regularly and included people who used the service, relatives and other professionals. Records showed that people’s suggestions and wishes were listened too. For example, one person had wanted to make some improvements to their garden and staff had supported them to do this.

Is the service well-led?

The person who was registered with us as manager of the Creative Support Limited – Durham service did not currently have management oversight of any of the services covered by this registered location. However, Creative Support had recently recruited a new regional service director and was in the process of reviewing the management structure, which included looking at the arrangements for registered managers.

Quality assurance systems were in place, including arrangements for staff supervision and support, local maintenance checks and audits at both local and corporate level. However, we highlighted some inconsistencies in quality assurance systems across different Creative Support registered services. We saw that good practice in one area had not been recognised and implemented in others and found some variations in quality across the different services. For example, the implementation of medication checks and staff supervision and support systems varied. We discussed this with the service director who was already aware of these inconsistencies and was looking at how QA processes could be improved and strengthened across the organisation.

What people told us about the service:

The people we spoke with told us that they were “happy” with their support, that everything was “alright” and that there was nothing they wanted to change. We also spoke with a relative of a person who used the service. They told us that their relative appeared well cared for and that staff seemed to be good with them. They commented “I just wanted a peaceful, happy life for (relative) and I think, by and large, that is what they have achieved.”