This inspection took place on 1, 5, 16 and 28 March 2018 and was announced. The registered provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be at the office to assist with the inspection.

The service was last inspected in March 2017 and was rated Good.

This service 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. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of our inspection 34 people were receiving personal care from 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 time of our inspection the registered manager was on planned leave and we were assisted by the general manager of the service.

People told us staff at the service kept them safe. Risks to people were assessed and plans put in place to reduce the chances of them occurring. Emergency plans detailed how to support people in emergency situations. Policies and procedures were in place to safeguard people from abuse. Staff understood the principles of good infection control. Staffing levels were monitored to ensure there were enough staff deployed to support people safely. The provider’s recruitment processes minimised the risk of unsuitable staff being employed. We found the arrangements for medicines management kept people safe.

We have made a recommendation about the management of some medicines concerning the use of ‘as and when required medicines’ and audits.

Staff received the training needed to support people effectively but improvements were needed in training records. Staff were supported with regular supervisions and appraisals. 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. People received support with managing food and nutrition. People were supported to access external professionals to maintain and promote their health.

People spoke positively about the support they received from staff and told us staff helped them to maintain their independence and to live life as fully as possible. People appeared to be happy and relaxed around staff and were treated with dignity and respect. Staff spoke passionately about their role and were committed to providing high quality care. Policies and procedures were in place to support people to access advocacy services.

Care planning and delivery was person-centred. Some people received support to access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints. At the time of our inspection nobody at the service was receiving end of life care. Procedures were in place to arrange this should it be needed.

Staff spoke positively about the culture and values of the service and said they were supported in their role by the provider and registered manager. The provider and registered manager carried out a number of quality assurance audits to monitor and improve standards at the service. Feedback was sought from people and their relatives in an annual survey. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

This inspection took place on 8 September 2016 and 6 February 2017. The first day of inspection was unannounced. This meant the registered provider and staff did not know we would be visiting. After our first visit we had some questions for the registered provider about the registration of the service, which were answered across October and November 2016. We returned to conclude our inspection on 6 February 2017.

The service was last inspected in April 2015 and was rated Good. However, it was not meeting one of the regulations we inspected. This related to care plans not always being person centred and containing information on their capacity to make decisions for themselves. We took action by requiring the registered provider to send us action plans telling us how they would improve this. When we returned for this inspection we found the issues identified had been addressed. At this inspection we found the service remained Good.

Larchfield Community is domiciliary care service registered to provide personal care to people with learning disabilities and mental health conditions. People receiving personal care live in houses on the service’s farmland premises, though there was no link between the personal care provided and people’s tenancies. Some people lived at the service who were not receiving personal care from Larchfield Community. At the time of our inspection 12 people were receiving personal care from the service. The service did not have a registered manager but there was a manager in place who had previously been registered manager. They were training a care and support manager to be registered manager, and the care and support manager was applying to CQC to become registered manager.

People told us the service was safe. Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring. People’s medicines were managed safely. Policies and procedures were in place to help safeguard people from the types of abuse that can occur in care settings. Staffing levels were monitored by the manager to ensure they were sufficient to support people safely. The registered provider’s recruitment processes minimised the risk of unsuitable staff being employed.

Staff received the training they needed to support people effectively and were supported with regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were protected. People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health.

People spoke positively about the support they received at the service, describing staff as kind and caring. Staff knew the people they were supporting well, including which communication methods the person preferred to use. People were supported to maintain their independence and were treated with dignity and respect. Throughout the inspection we saw numerous examples of kind and caring support being delivered. People were supported to access advocacy services.

Care plans we looked at were person-centred and contained information on people’s personal interests, likes and dislikes. People told us they received the support they wanted and needed. Some people received support to access activities they enjoyed. Procedures were in place to deal with complaints and people told us they knew how to raise issues.

People said they knew who the manager was and would be happy to raise any issues with them. Staff said they were supported in their role by the manager. Staff told us the service had an “open culture” and that links with other organisations that could benefit people living there were encouraged. The manager and registered provider carried out a number of quality assurance checks to monitor and improve standards at the service. Feedback was sought from people and acted on. The manager had informed CQC of significant events in a timely way by submitting the re

The inspection visit took place on 23 April 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

The service was newly registered in July 2013 and therefore had not been previously inspected.

There is 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.

We discussed safeguarding with staff and all were knowledgeable about the procedures to follow if they suspected abuse. Staff were clear that their role was to protect people and knew how to report abuse including the actions to take to raise this with external agencies. There was information all around the service in easy read format for people who used the service to encourage them to speak up if they were concerned about anything. We saw from regular meeting minutes that safeguarding was always discussed to ensure people knew how to recognise and report any issues they may have.

There were policies and procedures in place in relation to the Mental Capacity Act (MCA) 2005. The registered manager had the appropriate knowledge to know how to apply the MCA and to seek Court of Protection authorisations if required. The Deprivation of Liberty Safeguards were not applicable to this service but we saw that staff had policies and training to ensure they were aware of legislation to ensure people’s rights were upheld.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control, food hygiene as well as condition specific training such as working with people with epilepsy and providing person centred support. We saw from the training matrix that the new care services manager had compiled where staff required training or this was out of date and these were booked in or in the process of arranging with external providers. We found that the staff had the skills and knowledge to provide support to the people who needed personal care who lived at Larchfield Community. People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. Staffing was provided flexibly with people working across different houses and supporting people at workshop sessions during the day.

There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify their personal and professional development. We also saw a regular programme of staff meetings where issues were shared and raised.

The service encouraged people to lead a safe and active lifestyle. People were supported to be involved in the local community as much as possible. People were supported to access facilities such as the local G.P, shops and leisure facilities as well as to use the facilities within the service such as the kitchen for cooking meals. Several people had their own flat and were supported by staff to be as independent as possible.

There was a system in place for dealing with people’s concerns and complaints. One person told us they would talk to staff if they were unhappy with anything. The staff we spoke with all told us they could recognise if people they supported weren’t well or were unhappy and what measures they would take to address any concerns.

People were encouraged to help prepare food with staff support if they wished and on the day of our visit some people had helped prepare a corned beef pie. We saw people had nutritional assessments in place and people with specific dietary needs were supported. Specialist advice was sought quickly where necessary not only for nutritional support but any healthcare related concerns.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create care plans which were detailed and person centred. Care plans were regularly reviewed and involved the person as far as possible.

We reviewed the systems for the management of medicines and found that people received their medicines safely and there were clear guidelines in place for staff to follow.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the home and there was plenty of personal protective equipment to reduce the risk of cross infection. We saw that audits of infection control practices were completed.

We saw that the manager utilised a range of quality audits and used them to critically review the service. They also sought the views of people using the service and their families on a regular basis and used any information to improve the service provided. This had led to the systems being effective and the service being well-led.

Accidents and incidents were also reviewed by the registered manager and appropriate measures taken to reduce the risk of any further re-occurrence.

We saw that staff members were recruited safely using appropriate identity checks and people were involved in the recruitment process.