This service provides care and support to people living in 20 supported living settings, so 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; therefore this inspection only looked at people’s personal care and support.

At the time of inspection the regulated activity of personal care was carried out in 13 of the 20 tenancies, with only 24 people receiving support with their personal care requirements out of the 68 people who used the service.

At our last inspection, although we rated the service as good overall, it was rated as requires improvement in the KLOE effective, as we identified a breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff supervision sessions had not always been carried out in a timely way. During this inspection we found improvements had been made and the service was now meeting all requirements of the regulations.

At this inspection we found evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People told us they felt safe in their own homes. Appropriate safeguarding processes were in place and staff knew how to keep people safe and raise concerns if they suspected someone was at risk of harm or abuse.

Risk assessments were in place and personalised. They highlighted possible risk of harm to a person or staff member around areas such as people's lifestyle choices or behaviours. Care plans were also tailored to people’s individual requirements and updated regularly to reflect people's changing needs.

Staffing levels continued to be appropriate and people received care in line with their preferences.

The service had a training matrix to monitor the training requirements of staff. Staff received appropriate training, supervision and appraisal to support them in their role. Appropriate documentation was maintained to confirm when these sessions had taken place.

The management of medicines was safe. Staff received training in medicines administration and the service had detailed policies to guide staff on how to ensure a person received safe support in this area.

People were supported in line with the Mental Capacity Act 2005 (MCA). 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 support this practice.

People's consent to care and treatment was sought prior to care being delivered and they were encouraged to make decisions and choices about their care and had their choices respected.

The service continued to support people to remain as independent as possible and maintain maximum choice and control over their daily routines. This included accessing the community and employment.

People were encouraged to maintain a nutritionally balanced diet and had access to sufficient amounts to eat and drink, at times that suited them.

Further information is in the detailed findings below.

This was an announced inspection carried out on the 04 April 2016.

The service is registered to provide personal care to people within a home environment via supported tenancies. A supported living service is where people live in their own home and receive care and support in order to promote their independence. The support that people receive is often continuous. People who use the service are tenants in their own right and live with support in various types of accommodation provided by a variety of different landlords. The service is currently made up of 16 homes, providing support for 53 people who live in the Salford and Stockport areas. The office is within walking distance of Eccles town centre, which has facilities such as banks, post office and shops. There is a large car park at the front of the office.

There was a registered manager in place at the time of our 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.

This service was last inspected in December 2013, when we did not identify any concerns with the care and support provided to people who used the service.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We looked at the training and professional development staff received to ensure they were fully supported and qualified to undertake their roles. When we looked at staff personnel files, we found limited evidence of regular supervision including annual appraisals. We looked at the service supervision policy, which stated ‘The care service is committed to providing its care staff with formal supervision at least four times a year.’ We found no supporting evidence that this policy was being adhered to.

Whilst other staff confirmed they received regular supervision, on the whole we found supervision was inconsistent and not in accordance with service policy. The manager told us that they were aware of the inconsistent application of supervision policy, but with the appointment of two locality managers covering each local authority areas, these concerns would be addressed.

This is a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, because the provider could not demonstrate the appropriate support and professional development of staff.

People or their relatives told us that they believed they or their loved ones were safe with Home Focus.

We found appropriate criminal records bureau (CRB) disclosures or Disclosure and Barring Service (DBS) checks had been undertaken and suitable references obtained. This meant staff were safe to work with and provide care to vulnerable adults.

We looked at the service ‘safeguarding service users from abuse or harm policy’ and ‘whistleblowing’ policy and found there were suitable safeguarding procedures in place.

We looked at how the service managed people’s medicines and found that suitable arrangements were in place to ensure the service was safe. In the houses we visited, medication was kept securely in a locked cabinet in the staff bedroom / office. We saw that each house undertook a daily stock count of medicines. We found records supporting and evidencing the safe administration were complete and accurate.

We found all new members of staff underwent an induction programme. Staff told us they received an induction when they started working at the service, which included classroom based training and shadowing more experienced staff.

We found people had access to healthcare professionals to make sure they received effective

Home Focus provided support to adults with a learning disability, some of who may also have behaviours that may challenge. The service also supported people with mental health problems and physical/sensory impairments.

Support was provided 24 hours a day with staff on site at night either sleeping or awake depending on need. At the time of the inspection the service had within the previous few weeks acquired a number of new tenants and additional properties. The service supported 34 tenants with 47 staff.

During the inspection we visited two locations and spoke with six tenants, one tenant's relative, the manager, deputy manager and four support workers. Staff spoken with told us tenants were given information to enable them to make decisions and choices around their day to day care and tenants confirmed this.

Tenants told us their privacy and dignity was respected and staff asked the tenant's permission before providing support.

People we spoke with expressed confidence that the manager would address any issues and make improvements for tenants who used the service.

We found there was a system in place to ensure staff were recruited safely with appropriate checks made before commencing employment.

We looked at the systems in place to both monitor the quality of service provision effectively. We found there were several methods in place such as regular auditing, staff meetings and the use of a complaints log and policy and procedure.

Home Focus provided support to people with a learning disability and challenging behaviour to live independently.

Support was provided 24 hours a day with staff on site at night either sleeping or awake depending on need. At the time of the inspection the service supported 33 tenants between the ages of 24 and 71 years respectively.

We visited one location and found six people lived there; five from the six had lived there for over three years.

People who used the service assist with household chores and were responsible for the cleaning of their bedrooms.

Tenants we spoke with told us: "I am always helping with washing up and things I like it". "I have a job part time and enjoy it". "I like it here I have been here for years, I have my favourite staff but like them all really". "We go out to lunch sometimes its great". "We make our own sandwiches if we want to otherwise the staff will do it for us".

Staff told us: "We encourage independence and sometimes have to cajole tenants but on the whole they like to be involved". "We know them so well we know if they are not well without them telling us.”It's like having an extended family; they know all my family members by name and ask everyday about them. I try to be a friend to them rather than a carer and it works well". "I really enjoy my job, I don’t mind which house I work at but this is my usual one".

During this visit we spoke with four people living in two houses and we spoke to the relatives of four people who use the service.

People using the service told us they received a good service and they were happy with the care and support they received. They felt they were looked after by staff who they had got to know well. One person told us: "The staff are always kind and help me." Another person told us:

"The staff are all very kind, they do their best for me. I am very happy here."

Four relatives said they were very pleased with the support and help provided by the service and the staff were: "Absolutely brilliant."