We carried out an announced inspection of Freedom Care and Support Limited on 30 and 31 May 2018.

This service provides a combination of support as a domiciliary care agency and supported living service. It provides personal care to people living in their own houses in the community. The supported living service provides care and support to people living in 'supported living' settings, 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. At the time of the inspection, a total of 24 people were receiving care and support from the service.

The service was managed by 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.

At the last inspection, in January 2015 the service was rated as overall ‘Good’. At this inspection, the rating had deteriorated to ‘Requires improvement’. We found four breaches of the regulations in respect to safeguarding vulnerable adults, the failure to review risks to people’s health and safety, the implementation of the Mental Capacity Act 2005 and the failure to submit statutory notifications. You can see what action we told the provider to take at the back of the full version of the report.

Whilst there were safeguarding adults’ procedures in place and staff had received appropriate training, we found the provider had failed to report two incidents to the local authority under safeguarding procedures. This meant there was the potential for people to be exposed to further harm. Following the inspection, the registered manager confirmed they had reported all incidents to the local authority, as appropriate.

People received their medicines when they needed them from staff who had been trained and had their competency checked. Risk assessments had been carried out; however, the assessments had not always been reviewed in a timely manner and in line with people’s changing needs. Staff understood best practice for reducing the risk of infection. Appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the home. Sufficient numbers of staff were deployed to provide people's care and support.

People were not always supported to have maximum choice and control of their lives and staff had not always supported them in the least restrictive way possible. Staff received appropriate training to meet people's needs. An induction and training programme was in place for all staff. Whilst the registered manager visited people and their families several times before they received a service and spent time sourcing a property, there were no records maintained during the assessment process. People were supported with their healthcare and nutritional needs as appropriate. However, it was unclear how people’s routine medical appointments were monitored.

Staff treated people with kindness and compassion in their day-to-day support. Staff knew people's needs well and people told us they valued and liked their support staff. People were aware of their individual care plans; however, there was no evidence people had been involved in the review process. Staff understood the importance of promoting people’s independence, however, there were no clear objectives or goals set for people’s future development. This meant it was unclear how people’s level of independence skills were monitored and developed.

People were supported to plan and participate in activities that were personalised and meaningful to them. We noted people participated in a wide range of activities and

During this inspection we were able to speak with a number of people who used the service and in some cases, their relatives. Everyone we spoke with expressed satisfaction with the service they received. People told us that they received a good level of support that met their needs. People said that they were enabled to express their views about their care and support and spoke highly of staff and the provider. Comments included:

''The longer I have Freedom the more brilliant I think it is!''

''I am very happy with the service I get from Freedom. They listen to me.''

''I think it is a very good service.''

''I don't think there's anything I'd change because I'm happy with how things are going with Freedom. It works for me.''

''We can't believe how well it is going. We are very happy with the service.''

During this inspection we assessed standards relating to the care and welfare of people who use services and involvement. We also looked at the processes used by the provider to assess quality and manage complaints. The recruitment and selection of staff was also assessed. We did not find any concerns in any of the areas we inspected.

This was the first inspection of this service since it’s registration with the Care Quality Commission. We were advised that the service had only very recently become operational and that there were no people who had been using the service for a significant amount of time.

We spoke with people who had care packages about to start with the service and asked them their opinions about how the manager had assessed and planned their support.

We received very positive feedback and everyone we spoke with told us that they felt the manager had taken a great deal of time to understand their needs and plan their support as they wanted it. Comments included;

‘’Mark (the manager) is really easy to talk to and he listens.’’

‘’I am really happy with the way it’s gone so far. I am looking forward to having the service.’’

‘’I know its all going to work out really good because he has listened and made it all right for me.’’

Freedom Care and Support develops and provides personalised care packages for people who have a disability and receive support in their own homes. Following assessment, care plans are developed in line with the individual needs and wishes of the person who uses the service. The care provided can range from a small package of just a few hours each week to personal care throughout the day and night. At the time of this inspection there were 14 people who used the service.

The last inspection of this service took place on 1st October 2013. During this inspection the service was judged to be meeting all the standards we assessed.

The inspection took place on 29th January 2015 and was carried out by a lead Adult Social Care inspector. The registered manager was given 48 hours notice of our intention to visit the service. This was to ensure there would be someone available to provide us with the information we required, when we arrived.

Through the inspection we were assisted by the registered manager who was also the provider of 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.

Throughout this inspection we received extremely positive feedback about the service provided by Freedom Care and Support from people who used the service, their relatives or main carers and external professionals. Everyone we spoke with was highly complimentary about the service provided and spoke highly of the registered manager and staff team.

People’s comments included, “We were very unhappy with our last service, but the service with Freedom is excellent. We are very, very happy with the service we get.” “They made a lot of promises at the start and I have to say they have kept them all and delivered more besides.” “We are very pleased. We cannot thank them enough. I didn’t know there were services like this out there. I hope you help other people get to know about them.” “I could not wish for it to be any better.” “Wonderful! I couldn’t ask for more.” “When I first got this service I thought, ‘This is brilliant’. And it’s still brilliant now!”

We found that people who used this service received highly personalised care based on their individual needs, wishes and goals. People were fully involved in the development of their care plans throughout the whole process.

People received their support from staff they had personally chosen and who were well trained and supported by the registered manager.

People were provided with safe, effective care. Any risks to their safety or wellbeing were carefully assessed and staff had a good understanding of action required to keep people safe.

People felt their support staff were kind, caring and respectful. People were provided with support in a way that promoted their independence and enhanced their opportunities to make daily choices and decisions.

The registered manager maintained supportive relationships with people who used the service and their families. People felt able to express their views, raise concerns and were extremely confident in the registered manager to respond appropriately.