This inspection took place on 9 and 16 August 2017. This was an announced inspection as Creative Support Reading is a Domiciliary Care Agency (DCA) and supported living service and we needed to be sure someone would be at the office. A DCA is a provision that offers specific hours of care and support to a person in their own home. The service was broken into two main areas of support – learning disabilities and older adults. The latter was a recent acquisition whereby four locations were added to the original registration that catered solely for people with learning disabilities, who shared one home. These additional locations consisted of four complexes of privately rented flats, for older people. Across Cedar Court and Oak Tree, 54 people were supported by Creative Support Reading. Whereas Chimney Court and Corner Stones, had a total of 49 people supported by the service. These additional four complexes would eventually be registered independently to Creative Support Reading, however were at the time of the inspection under this registration.

At the time of the inspection a registered manager had been in post since July 2016. 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.

Staff knew how to keep people safe by reporting concerns promptly through the safeguarding procedure that was taught as part of the induction process. This was further followed through as a topic of discussion within team meetings and in individual supervision meetings. Systems and processes were in place to recruit staff who were suitable to work in the service and to protect people against the risk of abuse. There were sufficient numbers of suitably trained and experienced staff to ensure people’s needs were met. Staff were matched to meet people’s needs as per experience, knowledge, age and general personality, where possible. This was particularly noticeable within the service catering to support people with a primary diagnosis of a learning disability.

People using the service said they were very happy with the support and care provided. People and where appropriate their representatives confirmed they were fully involved in the planning and review of their care. Care plans focussed on the individual and recorded their personal preferences well. They reflected people’s needs, and detailed risks that were specific to the person, with guidance on how to manage them effectively. The care plans within the older adults services were going through a process of being updated to similarly provide information as that seen within the learning disabilities service. This included information on why people liked to have support in a particular way and how this made them feel.

People told us communication with the service was good and they felt listened to. Communication methods were employed by the service that ensured people were able to be kept up to date with their support plans and with general information on the service. Where necessary these methods of communication were used to inform decisions made by the service, including recruitment of staff.

People we spoke with said they were treated with respect and staff preserved their dignity at all times. We did receive a concern about one member of staff that was passed on to the registered manager. We were kept abreast of the action taken against the member of staff that included disciplinary action and informing the local safeguarding team.

People were supported with their medicines by suitably trained, qualified and experienced staff. Medicines were managed safely and securely. People who could not make specific decisions for themselves had their legal rights protected. People’s care plans showed that when decisions h

The service provides support to people in their own homes, including seven supported living environments, where people have their own accommodation within a shared building. We spoke with six people who use the service, and three relatives of other people who use the service. One relative told us “Generally I’m very pleased with the service. If I’m not I know they will respond to me and deal with the situation.”

We saw people’s care and support needs were documented and reviewed regularly to ensure people were supported safely. People told us they were involved in their care planning. Comments from people who use the service included “Staff don’t rush me, they look after me”, “I like my keyworker” and “They look after you nice and listen to you.” Risks were assessed and managed to promote safety.

Staff understood the provider’s safeguarding procedures and were confident with the reporting procedure. People who use the service told us they liked the staff and felt safe with them. We saw safeguarding concerns were dealt with appropriately.

The manager matched staff hours and skills to the support needs of people who use the service. Staff told us the training provided ensured they were suitably skilled to support people safely.

The provider, manager and senior staff conducted quality monitoring assessments to ensure the service supported people safely and in accordance with the provider’s policies and procedures. An annual questionnaire was sent to people who use the service and their relatives to ask for feedback about care provision. One support worker told us “The service is led by the clients, and involves them”.

We did not speak to people who use the service as their feedback was not required for this inspection.

People were protected from the risk of infection because the appropriate guidance had been followed. Staff undertook initial infection prevention and control training when they started employment, as well as regular updates on infection prevention and control.

We saw the provider had introduced a new policy which clearly defined procedures on how documents should be stored, retained and destroyed when it was appropriate to do so. The provider was in the process of archiving documents in line with the new policy.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People we spoke with told us staff always asked for consent. Staff were able to describe how they would appropriately seek consent from people who use the service.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Relatives we spoke with told us they were involved in people’s care planning and that plans were regularly reviewed. One person told us they were “very happy with the care and support” their relative received. Staff were knowledgeable about each individual’s need, as well as how to meet those needs.

Relatives we spoke with told us people’s homes were clean. Staff were knowledgeable about infection prevention and control. However, the provider did not have appropriate procedures in place to ensure staff had ongoing training in infection prevention and control.

Relatives we spoke with said staff were well trained. One relative told us “they do a fantastic job”. Staff told us they felt well supported by managers and they had enough training to enable them to meet the needs of the people they support.

People’s personal records, as well as staff and other records were accurate and fit for purpose. However, the provider did not have a policy or procedure in place which stated how records should be stored, retained and destroyed.

We were told that the staff listened to people and helped them to do things that they wanted to do.

People said that the staff helped them and looked after them well.

One relative told us that the support they had was, ‘wonderful’ and said about the staff ‘nothing was too much trouble.’

People said they liked the staff.

A relative told us the staff were caring, professional and were ‘on the ball’ with training. They also said ‘nothing fazed the carers and they were really good.’

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. At our last inspection on 14 January 2014, there were no concerns. This was an announced inspection.

Creative Support-West Berkshire Service is a supported living service. It provides people with a learning disability support with personal care. People live in different types of accommodation varying from flats to shared houses. The service provides support to people across a wide geographical area in Berkshire. At the time of our inspection, 34 people were being supported with personal care.

A registered manager was employed by this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People and those important to them told us they were safe. Staff knew how to keep people safe from abuse and knew what do if they thought a person was a risk. Staff had a good working knowledge of the Mental Capacity Act 2005 (MCA) and knew what to do to make sure they had considered people’s capacity and to act in their best interests.

Risk to people’s safety were assessed and managed well. People were supported to be as independent as possible while remaining safe. Although there were enough staff to keep people safe, some people told us there were occasional difficulties communicating with agency staff who did not always know people well. The provider was currently undertaking a recruitment drive to ensure more permanent staff were employed. Recruitment practices were safe and robust and people who use the service were involved in the recruitment process.

Care workers were well supported by managers and had regular training and supervision to enable them to meet the needs of people who use the service. People were helped to have enough to eat and drink and staff supported people to maintain a healthy diet, as well as with shopping and cooking. People were supported to remain healthy, and appropriate referrals were made to health care professionals when needed.

People told us staff were caring. They gave us positive feedback about the care provided by staff. Staff spoke to people who use the service in caring and respectful way. People were involved in making decisions about their care and care plans were person centred.

People were involved in regular reviews of their care needs. Staff knew how to identify changes to people’s care needs and the appropriate action they should take. The provider regularly sought feedback from people who use the service, relatives, staff and others, and acted on it. They had a robust complaints procedure in place, which people were aware of and knew how to use.

The service was well led. People and their relatives said managers were friendly and approachable. Staff were well motivated and gave positive feedback about working for the provider. The registered manager and provider had a strong emphasis on improving the quality of service. There was a robust incident and accident monitoring system in place. The registered manager led by example and promoted an open culture among staff.