This unannounced inspection took place on 23 and 24 October 2018. At our last inspection in May 2016 we rated the service good. At this inspection we found the service had deteriorated to requires improvement This was because we found a breach of our regulations in the well-led domain.

FitzRoy Supported Living - Cambridgeshire provides care and support to people living in two supported living settings, so that they can live as independently as possible. It provides a service to people with a learning disability and autism. 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.

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.

FitzRoy Supported Living - Cambridgeshire provides a service to people with a learning disability, people with a physical disability, older people, people living with dementia, younger adults and people with sensory impairments.

At the time of our inspection there were eight people using the service who received the regulated activity of personal care.

A registered manager was in post. The registered manager was on leave at the time of the inspection and an interim manager who knew the service well was available throughout the inspection. 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 not always well-led. The registered manager and provider had not always ensured we were notified about events that by law we must be notified about. The provider did not always follow their policies.

People, relatives and health professionals had a say in how the service was run. Staff upheld the provider’s and values to make a positive difference to people’s lives. Staff worked as a team to help people and each other. Quality assurance, audits and spot checks undertaken and these helped find improvements which were acted on. An open and honest staff team culture was in place. Staff were given support in a positive way. The interim manager and staff worked in partnership with others including health care professionals.

The service was safe. People were safeguarded from harm by staff who knew how to report and act on any concerns. The provider’s representatives identified risks to people and managed each risk safely. Sufficient staff were in post and the recruitment process for new staff helped ensure that only suitable staff were employed. Lessons were learned when things had not gone well and prompt action was taken to keep people safe. People had their medicines as prescribed and only competent staff undertook this task. Medicines were managed safely. Staff helped people to maintain a safe and clean home.

The service was effective. People’s needs were met by staff with relevant training and skills to do this effectively. People were supported to have enough to eat and drink and have a healthy balanced diet. Staff supported people to access health care services to maintain their health. People were given choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. The manager worked with other organisations involved in people’s care to help ensure that when people used the service they received consistent care.

The service was caring. People were cared for with kindness, compassion and sensiti

Fitzroy Supported Living – Cambridgeshire and is registered to provide personal care to people living in their own home. At the time of our inspection there were eight people on the Autistic spectrum using the service.

This unannounced inspection took place on 17 May 2016.

The service had a registered manager. 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’s training and knowledge in protecting people from harm meant that appropriate reporting and actions were taken to help ensure people’s safety.

The provider’s recruitment process and pre-employment checks ensured that staff were safely recruited and deemed suitable to work with people using the service. There was a sufficient number of suitably qualified and experienced staff to support people and meet their needs.

A process was in place that ensured staff were trained and assessed as being competent before they were authorised to safely administer people’s prescribed medicines. People’s medicines were administered and managed safely.

Risk assessments were in place to help manage each person’s assessed health risks. Staff used recognised national standards of de-escalation to support people with behaviours which could challenge others.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service’s registered manager and staff were knowledgeable about when an assessment of people’s mental capacity was required. Staff were aware of the circumstances and conditions when an application to lawfully deprive any person of their liberty was required. Appropriate applications had been made and acknowledged to lawfully deprive some people of their liberty.

Staff were supported with regular supervision to develop their skills, increase their knowledge and obtain additional care related and management qualifications.

People’s care was provided with consideration of people’s needs and this was done compassionately by staff who people well. People were supported to improve their independent living skills and staff respected their choices.

People used their preferred means of communication to inform staff of their preferences and needs. Relatives, care staff, health care professionals and social workers contributed to people’s to the assessment of people’s care needs. People’s care plans were in a format that enabled people to be part of the planning of their care.

People were supported to access a range of health care professionals including dieticians, occupational therapist and GP services. Staff adhered to the advice and guidance provided by health care professionals.

People were encouraged to eat sufficient quantities of a healthy and balanced diet which was appropriate for their needs.

Easy read/pictorial format of care plans enabled people’s involvement in planning their care. The registered manager was proactive in taking preventative action to prevent the potential for any recurrences. Staff knew when people were happy with their care.

The provider, registered and deputy manager had effective audits and quality assurance in place. These audits were used as a means to drive improvements.

We considered our inspections findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service caring?

We observed how members of staff cared for and treated people. We saw that this was done well and in a respectful way. We saw that staff provided effective reassurance when people became anxious until the person became calm once again.

Is the service responsive? We saw that people's care was assessed, reviewed and changed to ensure that people were provided with individual and person centred care and support. This ensured that people's needs were assessed and met. People were able to choose what they wanted to do, the support they wanted and the way they liked to spend their day.

Is the service safe?

People's safety was considered by the provider to be paramount. People were supported to take risks to improve their independence where this was safe to do so. Risk assessments regarding people's individual activities had been completed to ensure that measures were in place to minimise these risks. Action had been taken following accidents and incidents to ensure that the potential for any recurrence was eliminated or significantly reduced.

Is the service effective?

During our observations we found that members of staff clearly knew how to effectively support people with their individual needs. We saw that staff ensured that people had a good experience of using the service. We saw that people's independence had grown and that they were supported with their social activities and education. One relative told us, "Once the staff get to know my son, they are really good in meeting his needs."

Is the service well led?

Staff said that they felt supported and trained to safely do their job. Improvements had been made since our last inspection to ensure that people who used the service received support and care from staff that were supported, trained and competent to safely do their job. Quality assurance systems were in place and people were listened to and were safe from the risk of unsafe and inappropriate support and care.

Fitzroy Supported Living Cambridgeshire provides supported living for five adults with autistic spectrum disorder and domiciliary care support for one other adult.

Relatives we spoke with said that they were happy with the care and support their family member received. One relative told us the service is:“Excellent. They [the staff] have made a proper home for [their relative]”. It’s the young men’s place.”

Support plans were person centred and provided staff with information about how to meet people’s care and support needs. However, it was not clear from some records when a person’s care had been reviewed and if any changes had been made as a result. This meant that there was a risk that they had not received the care and support they needed.

During our inspection we found the provider’s recruitment procedure had not always been followed to ensure that only people suitable to work with vulnerable people were employed. We have asked the provider to take action to improve this.

Staff we spoke with felt well supported by their manager and told us they had received the training they needed to meet people’s care and support needs. Staff talked knowledgeably about the steps they took to protect vulnerable adults from abuse.

The provider had a system in place to assess and monitor the quality of the service provided to people who used the service.

All of the relatives that were spoken with said that they were happy with the provider. We were told that the provider had. "Made a really lovely home". This was because people were treated with respect and support and their care needs were met.

People were supported to maintain their health and well being. This was because of the available range of social activities. A stakeholder told us that the Deputy Manager had set up an activity pilot scheme with them to help people gain access to the local community within safe boundaries and this had now run successfully for over two years.

People were also supported to access health care services and a professional told us that there was a. "Really positive focus on service users when facilitating hospital visits". Staff also supported people with their personal care needs in an appropriate and safe way.

Effective staff recruitment were in place to make sure that people who used the service received support and care from suitable, skilled and knowledgeable staff.

We also observed quality assurance systems in place meant that people could be assured that their support and care was reviewed and monitored as an ongoing quality assurance measure.

You can see our judgements on the front page of this report.