Gateshead Supported Living 1 and 2 provides personal care and social support to people living in their own homes. At the time of our inspection there were 29 people using the service across eight households which were staffed by support workers 24 hours a day.

This inspection took place on 4 October 2017 and was announced. We spoke with people, relatives and staff in the following days and concluded the inspection on 9 October 2017. We previously inspected this service in March 2015 and overall we rated the service as good. At that time, we identified the service required improvement to be completely effective and recommended that the provider reviewed the guidance for consent to care and treatment in the Mental Capacity Act (MCA) 2005. At this inspection we found the service remained ‘Good’ and met all of the fundamental standards we inspected against.

Two established registered managers were in post and this has not changed since our last 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.

We found staff understood the principals of the MCA and their responsibilities when they assessed people’s capacity. Decisions that were made in people’s best interests had been appropriately taken with other professionals and relatives involved. Detailed care records were maintained which described why an assessment had been carried out and what action had been agreed.

People spoke very highly of the staff who supported them to live at home. They told us they felt safe and comfortable with the support workers and they received a good service. Policies and procedures were in place to safeguard people from harm and the staff we spoke with understood their responsibilities. Records were kept about concerns of a safeguarding nature and timely investigations had taken place.

Detailed risk assessments were in place to protect people from any risks they may encounter in their daily lives. Accidents and incidents were appropriately reported to the office staff and these had been recorded and monitored.

Recruitment checks continued to be carried out to ensure that staff were suitable to work with vulnerable people and there were sufficient numbers of staff deployed to meet people’s needs. A robust induction process was in place and staff training was up to date. Records confirmed that suitable training was available to ensure staff were knowledgeable and skilled.

Staff confirmed they received regular supervision and appraisal and team meetings were held within each household. Staff felt there were enough of them employed to manage each household with consistent support workers.

People's nutritional needs were met and they were supported to access healthcare services as required. Medicines were managed safely and in line with best practice.

Care records showed people were involved in their care and support. People were supported to have choice and control of their lives and staff supported them to be as independent as possible. Staff sought people’s consent before carrying out any care or support.

We observed a lot of positive interactions between staff and people who lived at the services where privacy and dignity was promoted and protected. The staff we spoke with displayed caring attitudes. All of the people we spoke with said they were treated with dignity and respect and that staff were nice and friendly towards them and their families. The relatives we spoke with confirmed this.

Comprehensive person-centred care plans were in place to support staff to provide an exceptionally personalised service. Records demonstrated that regular reviews were carried out of the support people received. Staff supported people to enjoy a range of meaningf

This was an announced inspection which took place over two days, 24 and 25 March 2015. The last inspection took place on 19 December 2013. At that time, the service was not meeting regulations on record keeping. People were not protected from the risks of unsafe or inappropriate care because accurate and appropriate records were not maintained. The provider submitted an action plan on how it intended to improve the service.

Gateshead Supported Living Service 1 and 2 is made up of 8 houses in total which accommodated up to 38 people with a Learning Disability. The houses were managed by a Landlord, (Bernicia) and the people living there were tenants who received their support from St Anne’s Community Services. It is registered to provide personal care. The service has an administrative office which is located centrally, with all the houses being in a ten mile surrounding radius.

The service had two registered managers to effectively manage the number of houses. 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.

Peoples care was delivered safely and in a way of their choosing. Staff were knowledgeable about the needs of people they supported and had risk assessments in place for activities which balanced their rights against risks. An example being where people were supported to remain in their home as their needs changed and became more complex.

We saw that people’s medicines were managed well. Staff watched for potential side effects and sought medical advice as needed as peoples condition changed.

Relatives we spoke with were all complimentary of the service, and were included and felt involved by the staff and registered managers. They told us their relatives could not be supported better anywhere else.

We found the staff were knowledgeable about the needs of the people they worked with and were able to support them as individuals due to training received and care plans being personalised. People were supported to be healthy and access health care services. There was some inconsistency in how people’s capacity to make decisions was assessed and how best interest decisions were made. Not all recording was in line with the principles of the Mental Capacity Act 2005 (MCA).

People were supported to maintain a healthy diet and good nutrition, and supported to lose weight if they wished or supported to access professional advice to maintain their health.

Staff were seen to be caring and to have a strong relationship with people. Relatives said the staff team knew how to care and were innovative in finding ways to improve people’s quality of life. People told usthe staff team was consistent and knew them well.

One registered manager told us complaints were not common, but we did see that staff sought the views of people and their relatives regularly. Relatives told us they knew who to complain to and felt if they did their concerns would be addressed.

We saw that when people’s needs changed staff took action, seeking external professional help and incorporating any changes into their care plans and working practices. Staff worked to support people’s long term relationships and keep them involved in activities that mattered to them. Relatives thought that staff were open and transparent with them about issues and sought their advice and input regularly.

The service had two registered managers to cover the number of houses and both were considered approachable and supportive by people, relatives, staff and external professionals. People and their relatives told us the registered managers helped to bring the person led values of the provider into the services through support and mentoring of the staff.

We saw that the registered managers visited the services regularly to seek the views of people, staff and to audit and check records. The area manager also visited services throughout the year and undertook audits and made improvement actions.

St Anne's Community Services took over a number of established services to form Gateshead Supported Living Service 1 and 2. Roslin transferred to the service in June 2013.

Family members told us they were happy with the care their relatives received. One family member said they were, “Thrilled with the service, the staff are very friendly and helpful. X has settled very well.”

We found there was a consistent staff team who knew and understood people's needs. We found the staff team has had a number of vacancies since the service transferred to a new provider and staff were working additional hours to cover the shortfall. Family members commented, “The staff are most helpful and most co-operative”; “They (staff) have all pulled exceptionally well as a team. We have spoken to them regularly. They are a much improved and cohesive team. They have improved in every way”, and, “The service is more friendly and professional now. The staff are more informative and seem to have a better, closer relationship. X is still really happy living there.”

We found that some key records, particularly care plans, had not been updated or reviewed since the service transferred.