This inspection was carried out on 23 and 28 January 2019. This was an announced inspection, which meant we gave the provider 48 hours' notice of our visit. This was because the service supports people living in the community and we wanted to ensure that staff were available in the office, as well as giving notice to people that we would like to visit them.

At the last inspection on 7 July 2016, the service was rated good. At this inspection the service had not maintained this rating and required improvement. This is the first time it had been rated requires improvement. We also found three breaches of the regulations relating to staff training and supervision, compliance with The Mental Capacity Act 2005 (MCA) and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Knutsford Supported Living Network is run by Cheshire East Council and provides care and support to people living in a 'supported living' setting, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people's personal care and support. There were 23 people being supported by the service at the time of the inspection.

The care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion, so that people with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, we found that people were given choice, their independence was promoted and the service had an inclusive culture.

There was a registered manager in post. 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.

Overall people and relatives were very complimentary and positive about the support they received.

The provider could not demonstrate that all staff had undertaken required training and refresher training. Training was provided by a training department; however we were advised training was not always available or there were limited spaces. Staff had not received consistent and frequent one to one supervisions or appraisals with their line manager. The management team expressed that staffing shortages in the senior team had impacted on this.

Staff understood the need to seek consent and the principles of the MCA. However, records were insufficient to demonstrate where decisions had been made for people, they had been made in accordance with the MCA.

The provider’s audits to monitor the service were not fully effective as they had not identified all the issues highlighted in this inspection. Further improvements to the quality monitoring processes are required to ensure there is a clear overview of practice within the service.

Staff understood the importance of reporting any signs of abuse, knew how to report concerns and felt confident that the registered manager would act on any concerns they raised. We saw one incident which had not been reported to the local authority but had been dealt with by the provider. All other concerns had been dealt with appropriately.

There were sufficient staff to meet the needs of the people they supported. There were some vacancies and staff covered extra shifts to meet people’s needs. The senior team had found this had impacted on their management time.

Policies and procedures were in place to support the proper and safe use of medicines, records demonstrated that people had received their medicines sa

This inspection visit took place at Knutsford Supported Living Network on 07 July 2016 and was announced. We told the registered manager before our visit that we would be coming. We did this to ensure we had access to the main office and the management team were available.

Knutsford Supported Living Network is located in a residential area of Knutsford. It provides domiciliary care to people who live in their own homes. Some people who use the service are tenants of East Terrace, which is a supported living scheme and also the agency’s registered office. The service provides care and support for people with learning disabilities. The office is easily accessible by public transport and rooms are available for training purposes or private meetings. At the time of the visit 21 people supported by the service.

There was a registered manager in place. 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 2014 the service was meeting the requirements of the regulations that were inspected at that time.

We found the service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to provide safe care for people.

There were appropriate numbers of staff deployed in the supported houses to meet people’s needs and provide a flexible service. Staff had been safely recruited to ensure people would be supported by suitable employees. However the application form for employment required updating to ensure a full employment history was obtained for new employees. We have made a recommendation about this.

Risk assessments had been developed to minimise the potential risk of harm to people who used the service. These had been kept under review and were relevant to the support provided.

Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

People were supported by caring staff who were supportive, caring and respectful. One person who lived in one of the supported houses said, “Yes they all very kind.”

Staff knew people they supported and provided a personalised service. Care plans were in place detailing how people wished to be cared for. Relatives and people who lived in the supported houses were involved in making decisions about their care. Records looked at confirmed this.

People who lived in the supported houses were supported to be as independent as possible with food preparation and buying of supplies. People were encouraged to attend to their own dietary requirements as much as possible. Support and guidance was always available if required. One person who lived in a supported house said, “I like choosing what we eat and going to the shops.”

Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People who received a service told us they were comfortable raising any issues, concerns or complaints with their staff and the registered manager. The service had arrangements in place to deal with these appropriately.

We found a number of audits were in place to monitor quality assurance. The registered manager had systems in place to obtain the views of people who lived in the supported tenancy schemes and their relatives.

We spoke with three tenant's using the service. Tenants from the service confirmed that they were treated with respect and their dignity was maintained. Tenant's also advised that they were happy with the standard of care provided and confirmed that their needs were met. Overall people were very happy with the service. They told us they regularly saw the manager as she worked a lot with the staff.

Comments received from people using the service included:

"I love it here, best thing I ever did" and "I know all the staff, they are lovely."

Various quality assurance checks on the service helped to show systems were in place to ensure that the service was effectively managed and had evidence of being compliant and promoted good practices especially in the management of all records maintained. Staff were positive about working for the service and felt they were well managed.

We spoke with four people using the service during our inspection process. All comments received were positive. Those we spoke with complimented the staff team and said they felt safe using the service with their needs being appropriately met.

Comments we received included:

"They (the staff) are fine."

"I love shopping and they take me to do some shopping. We are going to the shops this afternoon."

"I like to keep myself busy, so I clean and hoover. They help me to do this."

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at how they were safeguarded from abuse. Standards relating to staff training and monitoring the quality of service provision were also inspected.

When we visited the agency we spoke with three of the people who used the service. We asked them about their experiences of how the service involved them and kept them informed. They told us that they were treated with respect and were always involved in making decisions about their care and support.

One person who had started to use the service relatively recently told us that the service had improved the quality of their life significantly. They said “the care is fantastic and the service is excellent”. They told us that they had been given information about the service which they could read and understand. This had helped them make an informed choice. They said “the information in care plans is very good and because we agree it and sign it, it helps you feel in control”.

All the people we spoke with told us that they liked the staff. One of the people we spoke with told us that “the service had got the level of care and support just right”.

A representative of the local social work team told us that they had confidence in the staff and management of Knutsford Supported Living because they worked in partnerships with them to ensure that vulnerable people are safeguarded from abuse. They also told us that the service was particularly good at making the best use of resources and were able to offer numerous social activities to the people who used the service.

Representatives from Cheshire East Local Involvement Network visited East Terrace which is part of Knutsford Supported Living on the 4 February 2011. Their report made positive comments about the way the service is staffed and managed. They said it appears to be a well run unit having good relationships between the people who use the service and staff.