This inspection took place on 8 and 9 October 2018 and was announced. We gave the provider 48 hours' notice of this inspection to ensure that the registered manager would be available to support us with this process.

In November 2017, the provider changed its name and legal entity from HCS (Enfield) Limited to HCS Domiciliary Care Limited. This is the service’s first comprehensive inspection under the new provider name. Under the previous provider registration, the service had been inspected in December 2015 and had been rated ‘Good’.

This service is a domiciliary care agency. It provides personal care to people with physical and learning disabilities and mental health issues. The service provides care and support to people living in three ‘supported living’ settings, so that they can live in their own home as independently as possible. Each person has their own room and bathroom facilities and share communal lounges, kitchen and laundry facilities. 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 this inspection there were 30 people using the service.

A registered manager was in post at the time of this 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.’

Throughout the inspection we observed positive interactions between people and staff which promoted person centred care, choice, respect and dignity. Care staff were clearly aware of the needs of the people they supported and how these were to be met. People who could communicate with us told us that they were happy with the care and support that they received.

As part of the inspection we visited all three schemes and whilst two were seen to be well-managed, at the third scheme we identified some concerns around the lack of management oversight which had failed to identify care plans not being reviewed in a timely manner, lack of awareness of a DoLS (Deprivation of Liberty Safeguards) authorisation and poor decoration and condition of the scheme.

The provider and registered manager had a number of checks and audits in place to monitor the quality of care and support that people received so that appropriate improvements and learning could be recognised. However, not all of these checks were recorded.

The providers safeguarding policy clearly defined the different types of abuse people may experience and the steps to be taken to report any identified concerns. Support workers demonstrated the steps they would take to report any concerns to keep people safe and protected from abuse.

Information within care plans included people’s identified risks associated with their health, care and support needs. Risk assessments listed people’s identified risks and the steps to be taken to reduce or mitigate people’s known risks to ensure their safety.

People needs and choices were assessed before a package of care was agreed so that the service could confirm that people’s needs could be effectively met.

The providers medicines policy and management processes for the administration of medicines ensured that people received their medicines safely and as prescribed.

Recruitment processes were robustly followed to ensure that only support workers assessed as safe to work with vulnerable adults were employed.

Support workers told us and records confirmed that they were appropriately supported in their role through induction, regular training, supervision and annual appraisals. However, the provider did not always provide training which addressed the specialist nature of the service provided to people with learning disabilities.

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