This inspection took place on 29 March and 3 April 2017and was announced

Lewisham Nexus Service provides personal care and support to people with a learning disability who live in their own homes and supported living accommodation. At the time of the inspection the service was providing care support to twenty six people.

The service had 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.

The provider was outstanding in its responsiveness to people’s choices. People received an exceptional level of person centred support. The provider innovatively supported people to engage in the activities that were important to them. People’s lives were enhanced by the support they received to work, socialise, share intimate relationships and participate in politics. Care records identified people’s needs, celebrated their uniqueness and showed how highly valued they were to those around them.

The leadership of the service was outstanding. The empowerment and meaningful participation of people was evident in every aspect of the organisation. Staff viewed the senior management team as role models and said they led by example. Staff were enthusiastic about their work and were given the space by managers to independently discuss ways to improve the service. People actively participated in the provider’s quality assurance processes. The provider worked in a highly collaborative way with a range of organisations including health bodies and other care providers.

Staff were trained in safeguarding people and knew about signs of abuse and the actions to take if they suspected it. People received information and innovative training from the provider to keep themselves safe. People’s risks were assessed and they were supported to take positive risks. Staff providing support were safe and suitable as a result of the provider’s robust recruitment processes and safe staffing levels were maintained. Staff administered people’s medicines safely and in line with the prescriber’s instructions. People were protected by the infection prevention and control practices of staff.

The service was highly effective in meeting people’s communication needs. People received support from supervised and well trained staff and consented to the support staff delivered. People ate well and were supported with timely access to healthcare professionals.

People and their relatives told us staff were king and caring. People had positive relationships with a well-established staff team. People were encouraged to be as independent as possible and skills teaching was used to promote independence. Staff protected people’s privacy and treated people with respect.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. The inspection was announced two days in advance so that senior managers would be available in the office.

Lewisham Nexus Service (LNS) provides support to about 35 people who have a learning disability. Most people who use the service live in eight supported living houses. Some people who use it live with their family. Most people who use the service have complex needs and require support to communicate their views.

There is a registered manager in post who has worked in the service since it was set up over 20 years ago. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

All the people who use the service and their relatives that we spoke with told us LNS had fully involved them in planning the delivery of their support. They said the service had delivered good individual support to people which enabled them to feel well, be happy and keep safe. People told us staff were competent and reliable and treated people kindly and with respect.

LNS had ensured people were supported to communicate their preferences and needs and these were taken into account in the way their individual support was planned and delivered. For example, people were enabled to participate in a wide range of leisure, educational and work activities of their choice. LNS sought out opportunities through ‘community mapping’ of the area around where people lived to identify opportunities for them to become integrated into their local community. The service met the requirements of the Mental Capacity Act 2005. People who may lack mental capacity were given appropriate support to understand and make decisions.

People received appropriate support to access specialist advice and treatment in relation to their health needs. LNS ensured that when people went into hospital they were well supported and their needs were met when they returned home.

The LNS management team undertook regular audits and checks to ensure that each person received safe and effective support. When any shortfall was identified, there was effective follow up action which ensured people received a high quality service. Plans were in place to train people with learning disabilities as ‘quality checkers’ and be part of the audit team to gain more information about how people experienced the service and what further improvements could be made.

A local authority commissioner told us LNS is a service that benefits from a strong and stable management team who have ensured that the service has continued to develop and improve outcomes for people. Staff were very positive about working for LNS and said their managers listened to them. They were well-trained and told us their managers were available for support and advice. The service had received an external award in relation to the development and management of staff.

LNS had ensured that it implemented best practice and introduced improvements to the service. Managers of the service had forged good links with a number of local and national agencies and used these networks to learn about and implement changes which benefitted people using the service.

People using the service were able to make choices about the care they received. We saw people had 'About Me' plans which instructed staff about how the person wished to be supported.

We spoke to several people who used the service, and also to relatives. One person using the service told us "I like it here. The staff are nice, they treat me well". One relative told us "I am very happy with the care, I cannot fault them". Another relative said "They listen to parents. They are absolutely excellent".

Staff were aware of the action to take if they had concerns regarding the safety and welfare of any of the people using the service. They received periodic safeguarding training, and also received regular updates from the registered manager.

At our last inspection we had found the provider did not have satisfactory systems in place to administer and record medicines. On this visit we found that improvements had been made.

We found that staff were supported. They received regular supervision and training.

The provider had systems in place to monitor the quality of the service being provided. Relatives told us that they were more than happy with the quality of the care being given, and that they had no complaints.

People we spoke with who used the service said they had been asked by the agency about the support they needed, and that someone had come to meet them to do this. They said they knew there was a care plan for them, and that they were happy that we examined it as part of the inspection. They said they spoke with the staff when they needed help or advice and staff listened to them. Some people were unable to give their opinion of the service provided due to the nature of their support needs. Relatives were able to speak for them in most instances.

People who used the service told us they usually got supported by the same staff who got to know them. They said the staff were respectful, and they felt safe in their hands when being supported. People told us they saw the manager regularly and that she worked with the staff on a regular basis. They said they felt that they were able to speak with her and talk about any concerns they had. People told us that they were helped by staff to pursue their interests and hobbies and were helped to go on holiday too.

Overall, the feedback we had from people who received support from the agency was positive about the way staff behaved when they came to their homes. They said they generally came on time and usually the same staff consistently came to provide the support.

We found that Lewisham Nexus Service provided care and support that met people's needs. People using the service and their families and friends were listened to and involved in care planning processes. Each person had a person-centred plan in a format that was right for them and that reflected their voice and ambitions. There were clear and relevant risk assessments and guidelines in place to safeguard people's safety and welfare. People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People using the service told us that staff helped them achieve the goals that were important to them, supported them to be more independent and to visit people they wanted to see. A person we spoke with said their keyworker “takes me out, looks after me, helps me”.

However, during our inspection we found that people were not always protected against the risks associated with medicines; there was insufficient evidence that medicines were always administered and recorded safely and appropriately and in line with the provider’s medications policy.

We also found that there was no system in place to ensure that training was refreshed at regular intervals and there was insufficient evidence available that all staff statutory training was in date. This meant there was a risk that some staff were not supported to deliver care safely and to an appropriate standard.