We inspected Creative Support on 28 and 29 March 2017. Both visits were announced. Our last inspection took place on 26 January 2016 where the service was meeting all the requirements of the Health and Social Care Act 2008.

Creative Support provides personal care and support to people living in their own homes in a supported living environment.

At the time of our inspection there was a registered manager in the home. 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 they felt safe receiving this service. There were effective systems in place to ensure people’s safety who used the service, whilst also encouraging and promoting their independence. Staff could describe the procedures in place to safeguard people from abuse and unnecessary harm. Recruitment practices were robust and thorough.

Staff received supervisions in the service; however these supervisions differed in standard and content throughout. This was dependent on the coordinator who had completed these. We spoke to the registered manager who told us this would be looked into and addressed at the next staff meeting.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. Staff were trained in supporting people’s medicines management. We spoke to the registered manager on the importance of ensuring when people were away from their home that the records indicated this.

People were cared for by sufficient numbers of suitably trained staff. We saw staff received the training and support required to meet people’s needs well. Staff spoke positively of their training and said this prepared them well for their role. The registered manager told us they were recruiting staff at the time of inspection to ensure consistency for people.

People’s needs were assessed, and care and support was planned and delivered in line with their individual care needs and preferences. People had detailed, individualised support plans in place which described all aspects of their support needs and aspirations.

Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions.

Health, care and support needs were assessed and met by regular contact with health professionals. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity.

People participated in a range of activities both in their home and in the community and received the support they needed to help them stay in contact with family and friends. People were able to choose where they spent their time and what they did.

Staff had good relationships with the people living who used this service. Staff were aware of how to support people to raise concerns and complaints and we saw the provider learnt from complaints and suggestions and made improvements to the service.

There were effective systems in place to monitor and improve the quality of the service provided.

This was an announced inspection carried out on the 26 January 2016. At the last inspection in June 2015 we found the provider had breached one regulation associated with the Health and Social Care Act 2008.

We found there were not always effective systems in place to respond appropriately to complaints and comments made by people who used the service or people acting on their behalf. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations. During our inspection, we found improvements had been made in the required area.

Creative Support provides personal care and support to people living in their own homes in a supported living environment.

At the time of our inspection there was a registered manager in the service. ‘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.’

During our visit we saw people looked well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated hey knew people’s individual characteristics, likes and dislikes.

Systems were in place to monitor the quality and safety of service provision; however, the provider did not have structured processes in place to enable people who used the service to give regular feedback on the service received. There were enough staff to meet people’s needs. However relatives of people who used the service told us they felt at times there were not staff on shift to support the service. This was mainly on weekends when agency staff were used.

We found staff had received training during their induction and also saw evidence of annual refresher training in areas such as dementia care, Mental Capacity Act 2005, safeguarding, health and safety, fire safety, challenging behaviour, first aid and infection control. This meant people living in their home could be assured staff caring for them had up to date skills they required for their role. We spoke with staff who told us about the action they would take if they suspected someone was at risk of abuse. We found that this was consistent with the guidance within the provider’s safeguarding policy and procedure.

People participated in a range of activities within the home and also in the community. People were able to choose where they spent their time.

The service responded to complaints and comments made by people who used the service or people acting on their behalf. Relatives of the people felt the new manager listened to them and felt confident any complaints would be dealt with effectively.

Medicines were administered to people by trained staff. People did receive their prescribed medication when they needed it. However, appropriate arrangements were not always in place to check medication on a daily basis.

We looked at four staff files and saw the recruitment process in place ensured staff were suitable and safe to work in the agency. Staff we spoke with told us they received supervision four times a year and had annual appraisals carried out by the registered manager. We saw minutes from staff meetings which showed they had taken place on a regular basis and were well attended by staff.

We saw the provider had a system in place for the purpose of assessing and monitoring the quality of the service. We saw evidence of weekly and monthly audits which demonstrated these systems were effective.

Health, care and support needs were assessed and met by regular contact with health professionals. People were supported by staff who were respectful of their privacy and dignity.

The home cares for and supports people with a wide range of complex needs. People who used the service had limited communication. We were unable to find out their views and experiences through discussion. We looked at surveys, information received from people or their representatives who used the service. We spoke with the manager and three staff. We contacted the Local Authority for information about the service and the Adult Social Care Contracts Officers were currently of the opinion that Creative Support was delivering a good quality service at Hall Lane.

The provider and staff were aware of their responsibilities regarding protecting people from abuse. Staff told us they knew how to raise concerns.

We found that robust monitoring arrangements were not in place to ensure that staff received appropriate training.

There were effective quality auditing procedures and appropriate systems were in place for gathering, recording and evaluating information about the quality of the service provided.

We were not able to speak with people at this visit as most were not available on the day.

We found that medicines were not always managed in a safe way.

All the people who used the service that we spoke with said that they were happy with the care and support they received. This was because people were treated with respect and supported in meeting their care needs, whilst maintaining their independence.

The provider and staff were aware of their responsibilities regarding protecting people from abuse. Staff told us they knew how to raise concerns.There were enough qualified, skilled and experienced staff to meet people’s needs.

The provider had quality assurance systems in place to check that the quality of the service being delivered was meeting people's needs.

This was an announced inspection carried out on the 25 March 2015. At the last inspection in June 2014 we found the provider had breached four regulations associated with the Health and Social Care Act 2008.

We found that care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. We found care records needed to be better organised and improvements were needed to make sure people accessed the activities they wished to. People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. We also found there were not always enough qualified, skilled and experienced staff to meet people's needs. Not all the staff were trained in the principles of the Mental Capacity Act 2005 and fully understood its implications. We also saw that the provider did not have an effective system to regularly assess and monitor the quality of service that people received.

We told the provider they needed to take action and we received a report on the 27 July 2014 setting out the action they would take to meet the regulations. At this inspection we found improvements had been made with regard to these breaches. However, we found other areas where improvements were needed.

Creative Support provides personal care and support to people living in their own homes in a supported living environment.

At the time of our inspection there was no 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 and associated Regulations about how the service is run.

Systems were in place to monitor the quality and safety of service provision; however, we did not see there were structured processes in place to enable people who used the service to give regular feedback on the service received. People told us they had found recent management changes unsettling and were looking forward to having a stable, consistent management team in place.

There were not always effective systems in place to respond appropriately to complaints and comments made by people who used the service or people acting on their behalf. Relatives of people who used the service were not confident that their comments and complaints were always listened to and dealt with effectively.

There were good systems in place to ensure people’s safety and manage risks to people who used the service. Staff could describe the procedures to safeguard people from abuse and unnecessary harm. Recruitment practices were robust and thorough. Appropriate arrangements were in place to manage the medicines of people who used the service. There were enough staff to meet people’s needs. However, relatives of people who used the service raised concerns that there were times when staff were not always skilled and experienced enough.

Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions to enhance their capacity and where people did not have the capacity decisions had to be made in their best interests.

Health, care and support needs were assessed and met by regular contact with health professionals. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity.

People participated in a range of activities both in their home and in the community, this also included supported employment. People were able to choose where and how they spent their time.

We found the service was in breach of one of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to 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.