This announced inspection took place on the 20, 21, 22 and 23 February 2018.

Our last inspection of the service was carried out on 10, 11, 15 & 16 December 2014. At that inspection we rated the service as ‘Good’ overall. We rated the ‘effective’ domain as ‘Outstanding’ with the remaining four domains as ‘Good’. At this inspection in February 2018 we found the service remained ‘Good’ overall and ‘Outstanding’ for the ‘Effective’ domain. As the last inspection was rated Good, at this inspection we found the 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.

This service provides care and support to people living in ‘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; this inspection looked at people’s personal care and support. The agency office is located near the centre of Chorley and is readily accessible for people who use the service and staff, if they wish to visit. The service provides personal care and domestic support to people who live in ‘supported living’ houses over a wide radius. At the time of our inspection care and support was being provided within 44 services across Lancashire, Blackburn with Darwen, Wigan and Greater Manchester. The service was supporting 203 individuals and delivering 10,621 hours of support per week. Lifeways Paragon Limited (Lifeways) was employing 339 Support Workers and Team Leaders to provide this care and support.

Due to the size of the service Lifeways registered two managers with the Care Quality Commission (CQC) who each covered a given geographical area. A registered manager is a person who has registered with the CQC 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 spoke with both registered managers throughout the inspection process, who were cooperative throughout.

The service had systems in place to record safeguarding concerns, accidents and incidents and necessary action was taken, as required. Staff had received safeguarding training and they understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and support needs.

People received their medicines as prescribed and when needed and appropriate records had been completed. People spoken with did not raise any concerns about the management of their medicines.

Staffing levels were seen to be sufficient to meet the assessed needs of people. The majority of people and relatives told us that staff were consistent.

People had been 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 practice.

Staff we spoke with had a good understanding of protecting and respecting people’s human rights. Staff spoke positively about confidentiality, privacy and dignity and this came through when speaking with people.

The service had information with regards to support from an external advocate should this be required by those who used the service.

Care plans contained a good level of person centred information wit

People who use the service told us they were happy with the support they received and said they were actively involved in community activities. One person said, "On Tuesdays we attend keep fit at the local leisure centre and in March we are all going to watch the Lion King in Manchester and stay over for the night".

Medicines were being managed well, so that those people needing assistance with their medication were protected from ay associated risks.

In this report the names of two registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection (David Gillies and Clive Palmer) . Their name appears because they were still registered managers on our register at the time”.

We found that people were very happy with the care workers who visited them and that they were competent in their role. All of the people we spoke to told us they were happy with the care and support they received. One person said, "I feel safe here and know how to get hold of a member of staff if I needed to in the night".

People also knew how to comment on the service they received and felt that any suggestions or improvements were acted upon by the management of the service.

We did not speak to people using the service because our Inspection was focused on how the Provider was responding to matters of concern and how they were managing Safeguarding referrals. We also reviewed how staff had been trained in recognising possible abuse and how to report any concerns.

We gathered evidence of peoples' experiences of the service by reviewing the annual satisfaction survey carried out by the Provider which included comments from the people who use the service and their relatives. We found that overall there was satisfactory feedback from people who use the service.

We used a number of different methods to help us understand the experiences of people using the service, including talking with the local authority contracts office.

Lifeways Paragon Limited head office is situated close to Chorley town centre. The service offers 24-hour domiciliary support, including personal care, and domestic support, for adults with a learning disability and mental health needs, who live in homes within a wide radius, including Chorley, Manchester, Salford and East Lancashire. The majority of people who use the service are tenants in supported living arrangements. At the time of our inspection the service was delivering over 12000 hours of support per week to nearly 300 people.

This inspection was carried out over a four day period on the 10, 11, 15 and 16 December 2014 by two inspectors from the Care Quality Commission (CQC), one of whom was the lead inspector for the service, and an ‘expert by experience’. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The provider had been given short notice of our planned visit, in accordance with our inspection methodologies of Domiciliary Care Services.

Due to the size of the service the provider registered two managers with the CQC who cover specific geographical areas. At the time of our inspection one of the registered manager posts was vacant due to the previous post-holder changing roles within the organisation, an appointment had been made and that person was going through the process to become registered with the CQC. The other registered manager for the service was on duty at the time of our inspection. A registered manager is a person who has registered with the CQC 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 and associated regulations about how the service is run.

We spoke with sixteen people who received a service from Lifeways Paragon Limited, twelve relatives, fifteen members of staff and the registered manager for the service.

We received positive comments from most of the people we spoke with. We looked at a wide range of records, including looking at eight care plans in detail and the personnel records for six members of staff. When we visited people in their homes we observed how staff interacted with the people they supported.

People who used the service were safe. The staff employed by the service were well trained and had good support from local and senior managers. People were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who used the service.

Records showed that relevant checks had been made to ensure new staff members were suitable to work with vulnerable people.

People’s care was based on an assessment of their needs, with information being gathered from a variety of sources. Evidence was available to demonstrate that people had been involved in making decisions about the way care and support was delivered.

We saw that regular reviews of care were conducted and any changes in people’s needs were documented and strategies had been put in place to address any further needs. People’s privacy and dignity were consistently respected. We saw that people were comfortable in the presence of staff and their healthcare needs were supported by staff.