This comprehensive inspection took place on 24 and 25 August 2017 and was unannounced. The last inspection took place on 19, 20 and 25 July 2016, when we identified a breach of Regulations relating to safe care and treatment because the registered person did not always assess the risks to the health and safety of service users receiving care and did not ensure the proper and safe management of medicines. We rated the service ‘Requires Improvement’ in three of the key questions we ask providers and overall. During the 24 and 25 August 2017 inspection, we saw improvements to the service had been made.

Glenister Gardens is a supported living service for adults with learning disabilities. The service supports people with a range of day to day tasks including personal care, medicines administration, meal preparation and accessing the community.

People had their own flats and tenancies. Paradigm Housing provided housing support and CCS Homecare Services Limited provided care and support to people using the service. At the time of the inspection there were 12 people being supported by the service, nine of whom required support with personal care.

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 we spoke with knew how to respond to safeguarding concerns. They had the relevant training and supervision to develop the necessary skills to support people using the service and there were sufficient numbers of staff on duty to meet people’s needs.

People had risk assessments and management plans in place to minimise risks and any incidents and accidents were recorded appropriately.

Medicines were administered and managed safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s dietary requirements were met and we saw evidence that relevant health care professionals were involved to maintain people’s health and wellbeing.

People, and their families where appropriate, were involved in their care plans and making day to day decisions. People told us they had developed positive relationships with staff. The service arranged regular activities for people but feedback from relatives indicated they would like more community based activities for people using the service.

People using the service, staff and most relatives said the team leader was accessible and responded to concerns.

The service had a number of systems in place to monitor, manage and improve service delivery. This included a complaints system, service audits and satisfaction surveys.

The announced inspection was carried out on 19, 20 and 25 July 2016. The provider was given two working days’ notice because the location provides a domiciliary care service and we wanted to make sure someone from the management team would be available to speak with us. This was the first inspection of the location under their current registration with the Care Quality Commission.

Glenister Gardens is a supported living service for adults with learning disabilities with a range of needs. The provider offers care and support to people who require help with day to day routines including personal care, meal preparation, housework, accessing the community and companionship. People using the service live in their own flats and each person has a tenancy agreement with the landlord. There is one communal room on the ground floor. The service has care workers on duty at all times. At the time of our inspection there were seven people receiving personal care.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 area manager had submitted an application to CQC to register as the manager of the service.

The majority of risks were assessed and action plans put in place to minimise them. However, risk assessments in relation to the environment were not carried out comprehensively to minimise the risk people faced such as the risk of falling from a height.

Staff understood medicines management procedures and provided the support people required to take their medicines safely. However, discrepancies in the medicines stock recording had not been identified so action had not been taken to address this. PRN (as required) procedures were not robust enough to clarify when PRN medicines should be given.

Staff understood and respected people’s rights to make choices about their care and knew to act in their best interests but the service did not fully understand the principle around depriving people of their liberty. We have made a recommendation that the provider review guidance in relation to the Mental Capacity Act (2005) for people living in their own homes.

Although the provider had comprehensive monitoring systems in place, some aspects of the service were not being monitored effectively so shortfalls were not always identified and addressed in a timely way.

Procedures were in place and being followed by staff to safeguard people against the risk of abuse.

Staff recruitment procedures were in place and being followed. There were enough staff to meet the needs of people using the service. Staff received training and supervision so they had the knowledge and skills to provide the care and support people required.

People were supported with eating and drinking to maintain their nutritional intake. Staff recognised changes in people’s healthcare needs and knew the processes to follow so people received the input from healthcare professionals that they needed.

People told us staff were caring and treated them with dignity and respect. Staff shadowing procedures did not always ensure that people’s privacy was adequately maintained.

Care records reflected people’s individual needs and wishes and staff understood these and cared for them in a person-centred way.

People’s care and support was planned and reviewed when any changes were identified so people’s needs continued to be met.

Procedures for raising complaints were in place and were followed. Complaints were recorded and responded to, however relatives did not always feel improvements were consistently maintained.

The majority of people were happy with the way the service was being managed. Staff found the team leader and ar