The inspection took place on the 25 and 26 September 2018, the first day was unannounced.

This service provides care and support to 44 people living in 13 ‘supported living’ settings or flats, 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.

People lived on their own or in small groups, each person having their own bedroom and sharing lounges and bathroom. Where required staff either slept in the house to be available in the event of an emergency, or stayed awake throughout the night.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

DSAS South had a new registered manager, who had been in post since November 2017. 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 in September 2017 we found three breaches in regulations because person centred plans and risk assessments had not yet been completed in some properties, support plans had not been reviewed and the governance of the service was not robust as the issues with care plans and risk assessments had not been addressed. Staff job consultations (supervisions) had not been regularly completed.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good.

At this inspection we found there were continued breaches in the same three areas. Staff and regular contracted agency staff (called R1s) told us they now received regular supervisions with their care co-ordinator although the written record of these meetings was not always stored in the staff files.

There was a variation across the properties we visited, with some risk assessments, care plans, positive behaviour support (PBS) plans, epilepsy care plans and eating and drinking care plans having been reviewed and updated to reflect people’s current needs.

However in other properties these had not been reviewed and updated. One person did not have a person centred plan in place. A plan had been partly completed but the care co-ordinator had moved to a sister service within Manchester and the person centred plan had not been finished. Other people’s risk assessments and health action plans had not been reviewed. Therefore staff may not have the information they needed about people's needs to support them effectively.

Not all care co-ordinators were confident to review the care plans that had been written by other agencies, for example the PBS plans. At our last inspection in September 2017 the community learning disability team (CLDT) nurse said the service had been informed that they needed to review all the PBS plans and refer people back to the CLDT if there had been any changes in people’s needs and behaviours. This was not consistently applied at DSAS South.

The care co-ordinator team had not been fully staffed, due to sickness, vacancies and co-ordinators moving roles, until May 2018. This had impacted on the service’s ability to review and update all of people’s care and support plans. The provider had not ensured there was sufficient continuity across the care co-ordinator team to complete the review of all care files which had been identified in our previous inspec

This was an unannounced inspection which took place on the 5 and 6 September 2017. This was the first inspection of DSAS South since it had been re-registered with the Care Quality Commission in August 2016. The re-registration had taken place to formally integrate the learning disability supported living service and the physical disability service under one registration. The service, under its previous registration as South Network, was inspected in June 2016. References throughout this report to ‘the last inspection’ concern that inspection.

South Network provides support for 62 people living in their own homes. Thirty-seven people live in shared supported accommodation with staff support 24 hours per day. Twenty-five people with physical disabilities live at Alsager Close, 16 of whom live in their own flat with a range of different support hours each day and nine who live in two shared bungalows with staff support 24 hours per day. Each house or set of flats had a designated staff team. The staff teams were managed by a care co-ordinator. There were seven care co-ordinators in total.

Manchester City Council has two other similar services covering the North and Central areas of the city. An improvement plan had been established in 2016 covering all three services. Regular meetings were held to monitor the implementation of the improvement plan.

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 we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found some improvements had been made; however progress was not always consistent across the properties.

We found a new risk screening tool and person centred risk assessment and safety management plan was being introduced. This clearly identified any relevant risks and referred to the guidance in place for staff to follow to mitigate the risks. However the person centred risk assessment and safety management plan had not been completed in all properties. Where applicable positive behaviour support plans were in place to guide staff how to manage people’s behaviour.

New person centred plans were being written. These gave good details of people’s life history, likes and dislikes, the support they needed and what they were able to complete for themselves. Most of the plans were in the process of being reviewed by the staff teams and relatives at the time of our inspection. Again we found not all properties had the draft person centred plans in place.

This meant staff in some properties did not have up to date information about the support people required and how to mitigate the identified risks.

People and their relatives told us they felt safe when supported by DSAS South staff. Staff had completed training in safeguarding vulnerable adults and were able to explain the action they would take if they suspected any abuse had taken place.

We saw sufficient staff were on duty to meet people’s needs. Regular contracted agency staff were used to cover vacancies, which meant they got to know the needs of the people they were supporting. We were told other agency staff were sometimes used to cover annual leave and staff sickness. We were told that shifts at weekends were more difficult to cover, especially if staff due to work were unable to at short notice. Relatives we spoke with said that the staff teams were more stable at the moment.

An exercise had been completed to record the exact support each person required. This was because people’s needs had not always been re-assessed by the relevant social services department. The service increased people’s suppor