This unannounced inspection took place on 04 and 09 May 2017.

Creative Support Morecambe Service (Learning Disability) supports people who have a learning disability or mental health needs in their own home. Support is provided through domiciliary care home visits and also through the provision of supported living services. At the time of the inspection visit the service was providing support to 57 people.

There was 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 2008 and associated Regulations about how the service is run.

The service was last inspected on 13 January 2016. At this inspection the service was rated as Requires Improvement and we made a number of recommendations to ensure the fundamental standards were consistently met.

At this comprehensive inspection visit carried out on 04 and 09 May 2017, we found recommendations had been considered and improvements had been implemented. We found improvements had been made to the management and administration of medicines. Also, quality assurance checks had taken place within the outreach service.

People and relatives told us they were happy with the service provided by Creative Support. Staff were described as kind, caring and committed. Observations of interactions between staff and people who used the service demonstrated people were happy and content.

At the supported living services we visited we observed staff responded in a timely manner and people did not have to wait to have their needs met. We observed staff demonstrating patience with people and taking time to sit with them to offer companionship and comfort. People were given time to carry out tasks as a means to promote independence and were not rushed.

Staffing arrangements were personalised to fit around the needs of the people who used the service. People told us support from staff was flexible and varied to meet their needs. This enabled people to have active lives in their community. We saw evidence of people being supported to take part in work and activities of their choosing.

When people required support to communicate choices and decisions we saw evidence they were supported with easy read guidance, photographs and symbols. This promoted autonomy for people who used the service.

Detailed person centred care plans were in place for people. Care plans covered support needs and personal wishes. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required. Consent was gained wherever appropriate.

There was a focus on partnership working with families. Families told us they were involved where appropriate in managing people’s care and support.

People’s healthcare needs were monitored and referrals were made to health professionals in a timely manner when health needs changed. We saw evidence good health was promoted throughout the service. Documentation regarding health needs of each person was comprehensive and concise.

We saw evidence of multidisciplinary working to ensure people’s dietary needs were addressed and managed in a safe way.

People told us they felt safe whilst being supported by the service. Arrangements were in place to protect people from the risk of abuse. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns.

Suitable recruitment procedures were in place. Staff told us they were unable to commence work without suitable checks taking place.

We saw evidence staff had been provided with relevant training to enable them to carry out their role. Staff told us they received supervisions and appraisals as a means for self-development.

Staff had received training in The Mental Capaci

The inspection visit at Creative Support - Morecambe Service (Learning Disability) was undertaken on 13 January 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care and supported living service to people living in the community. We needed to be sure people in the office and people the service supported would be available to speak to us.

Creative Support - Morecambe Service (Learning Disability) provides personal care and support to people living in their own homes. The service supports people who have a learning disability or mental health needs in their own home. Support can be provided at specific times, to full time care throughout the day and night. The office is located close to Morecambe town centre. At the time of our inspection there were 62 people receiving a service from Creative Support - Morecambe Service (Learning Disability).

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 2008 and associated Regulations about how the service is run.

At the last inspection on 17 October 2013, we found the provider was meeting the requirements of the regulations that were inspected.

Staff had received abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure. One staff member told us, “The training refreshes you, it makes you more aware, more vigilant.”

The provider had put in place procedures around recruitment and selection to minimise the risk of unsuitable employees working with vulnerable people. Required checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff. Recruitment checks made by head office were not explored at interview.

We found staffing levels within the supported living service were adequate with an appropriate skill mix to meet the needs of people who used the service. We were told that people being supported in the domiciliary service did not always get their allocated hours at the agreed times. Staffing levels were determined by the number of people being supported and their individual needs.

Staff responsible for assisting people with their medicines had received training to ensure they were competent and had the skills required. Documentation looked at made it unclear whether all people were supported to meet their care planned requirements in relation to medicines.

We have made a recommendation about the management of some medicines.

Staff members received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. One staff member told us, “The training is great, you couldn’t ask for more.” The provider ensured staff had the skills to fulfil all care tasks required by people being supported. For example, the registered manager had sought specialised training to ensure staff delivered effective support to people who display complex behaviours.

People and their representatives told us they were involved in their care and had discussed and consented to their care packages. We found staff had an understanding of the Mental Capacity Act 2005 (MCA).

People told us they were mostly supported by the same group of staff. This ensured staff understood the support needs of people they visited and how individuals wanted their care to be delivered. Comments we received demonstrated people were satisfied with the service they received.

The registered manager and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people in their care. Compatibility visits took place prior to anyone moving into a supported living service. This allowed personalised care plans and support strategies to be in place beforehand.

Systems were in place for monthly house audits to be completed by the provider. The monthly audits had not all been completed by the team leaders. This meant that the information held by the registered manager was not up to date.

A complaints procedure was available and people we spoke with said they knew how to complain. We saw examples where a complaint had been received, responded to, investigated and the outcome documented. Staff spoken with felt the management team were accessible supportive and approachable and would listen and act on concerns raised.

We have made a recommendation about how quality assurance is assessed within the domiciliary service.

We spoke with a range of people about the care and support provided. They included the unit business manager, team leader, care staff, people who used the service and relatives.

We visited two of the houses where people were supported. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff treated people with respect and dignity.

Staff we spoke with had a good knowledge and understanding of their role to support people to make decisions that reflected their likes, health care needs and preferences.

Staffing levels had recently been reduced in one of the homes. There had been a recent safeguarding incident because there had only been one member of staff available to take out three people. The local authority were re assessing people`s needs in a second home and were proposing to reduce the hours of support. Staff and relatives had concerns regarding the proposed reduction of staff support. The provider may like to note that to ensure the service continues to run effectively, the deployment of staff based on the needs and desires of people who use the service should be monitored, and any issues be raised with the Commissioning bodies.

There were a range of audits and systems in place to monitor the quality of the service being provided.

We visited three of the homes and met several people who received support from the service. Some people had been supported by the service for a long time, whilst others who were younger, had left home for the first time. It was their first experience of living independently away from their family. Because some people were unable to tell us about their care we also talked with members of the staff team and observed care and support being delivered. We could see that people were being cared for by staff who were motivated and enthusiastic about their work. The staff showed us they were responsive to people’s changing needs and showed skill and empathy with the people they were caring for. We received positive comments about the service. We were told,” I get on very well with the staff, they help me and we do all sorts. We have built a pond”.

“I like football, I am a Liverpool supporter. We went on the train to watch the match last week.”

“I watch TV downstairs. I have my own room which overlooks the garden. I get on well with everyone”.

We met several people who used the service during the inspection. Some were not able to tell us about their service due to their severe learning disability but we saw that they looked content and comfortable.

One person told us ”I like living in this house. The staff show me how to cook. (Name of staff) takes me and (another person) to the pub to watch Liverpool play football: They take me to visit my granddad. Yesterday, (name removed) and I went to the Liverpool football museum with staff.

People spoke highly of staff describing them as kind, nice, caring. One person told us that her support workers were ‘dead funny’ and made her laugh. She said ‘’We do nice things, they help me look after my dog and take her for a walk and they show me how to cook.’’

We also spoke to a number of relatives of people who use the service. All the comments we received were very complimentary and everyone we spoke with expressed satisfaction with the service provided.

One mother told us, ‘’My son has lived here since it opened in 1996. The staff here can’t do enough for him. They have parties to celebrate their birthdays and everyone is always invited.”

Another parent commented ‘’I could not think of a better place for my son to be looked after. It’s so reassuring to know that he is well cared for.’’