Loxley House Children's and Adult Community Care Services provide people using the service with the opportunity to be part of a family. Carers are employed by the service to provide either a long term or short term placement within their family home. People using the service were living with a learning disability, autism, or had communication needs. At the time of our inspection 30 people lived in a long term placement and 35 people used the service to receive a short break.

People using the service know it as ‘Shared Lives’ and this term is therefore used in the following report when referring to carers. This clarifies our statements for those reading the report who also use the service.

At our last inspection we rated the service 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.

Loxley House had a registered manager. 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 service supported people who had varied and often very complex needs to live a safe and fulfilled life in a caring family home environment. Assessed risks to people were reduced or eliminated to support the safety of people using the service. People and carers were 'matched' to ensure they shared similar interests and people's needs could be supported in the carer's home.

There were audits and spot checks in place to make certain staff worked correctly and that people received the appropriate support at a good standard. People using the service and their relatives had various ways of sharing their views and this was encouraged.

People’s support plans reflected their individual choices and goals. People were placed with a family that supported them to achieve these aims. Carers were supported to understand and meet the needs of the people they cared for. There was regular contact between the organisation and families providing support to people.

We found there were sufficient staff employed to meet people's needs, who had the appropriate training and support to deliver good quality care, which included training to meet people's health care needs.

People told us they felt safe when they were supported by staff and trusted them. All staff had regularly completed training in safeguarding to enable them to recognise signs of abuse and know who to report such incidents.

People were supported to have maximum choice and control of their lives and support was provided in the least restrictive way possible. Staff understood and followed the Mental Capacity Act 2005 guidance. Staff asked for people's consent before providing any support.

The service monitored people's care and support needs and looked at people's aims and ambitions to develop new skills and interests. Carers and people using the service knew how to make a complaint and had no concerns about doing so, carers said the service listened to them.

We carried out an announced inspection of the service on 24 September 2015.

Nottingham Shared Lives aims to provide people using the service with the opportunity to be part of the family and community of a Shared Lives carer. Carers are employed by the service to provide either a long term or short term placement. People that used the service were living with a learning disability, autism, or had communication needs. At the time of our inspection 32 people lived in a long term placement and 28 people used the service to receive a short break known as respite.

Nottingham Shared Lives is required to have 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. At the time of our inspection the service had a registered manager.

We inspected this service in September 2014 and found at this inspection the service was compliant with the regulations we looked at.

At this inspection people we spoke with and the feedback received from professionals said carers provided a safe environment. This included care and support that met people’s individual needs safely. Whilst people received their prescribed medicines we found that action was required to ensure safe practice was maintained. Medication records were not audited in a timely manner and carers had not received observational competency assessments of administering medicines. The registered manager took immediate action to address this.

The provider had a robust and safe recruitment procedure in place that ensured people were cared for by suitable carers. Carers were appropriately supported, which consisted of formal and informal meetings to discuss and review their training and support needs.

CQC is required by law to monitor the operation of the Mental capacity Act 2005 (MCA.) This is legislation that protects people who are unable to make specific decisions about their care and treatment. It ensures best interest decisions are made correctly and a person’s liberty and freedom is not unlawfully restricted. We found people’s human right were protected because the MCA were understood by the registered manager and carers.

People were supported with their dietary and nutritional needs and supported to access both routine and specialist healthcare services.

People that used the service and feedback from professionals told us that they found the carers to be caring and compassionate. People were supported to lead full and active lives. This included participating in a variety of activities, interests and hobbies. Carers understood people’s needs and what was important to them.

People’s support plans included information about what was important to them including preferences and routines. People and significant others such as the person’s social worker were involved in the development and review of support plans. Carers provided a service that was responsive to people’s individual needs showing a person centred approach to care and support. People had access to information about how to make a complaint and people we spoke with told us who they would talk to if they had any concerns.

People that used the service including feedback from professionals were positive about the leadership of the service. Carers and staff within Nottingham Shared Lives were described as very supportive, approachable and knowledgeable about people’s needs.

As part of the providers quality assurance checks people had been asked for their feedback about the service they received. Systems were in place that checked the quality and safety of the service people received.

At the time of this inspection the service was providing a shared lives service in Nottingham to people with a learning disability within approximately 50 households. Placements for people were organised with shared lives carers on both a permanent and respite basis.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary, please read the full report.

We spoke with three shared lives carers who were registered with the service and provided both permanent and respite care to people. We also spoke with three members of head office staff. We looked at written records, which included copies of people's care records held in the office, personnel files for the shared lives carers and their families and quality assurance documentation.

Is the service safe?

People were protected by safe, extensive and rigorous practices in the recruitment of shared lives carers.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

Is the service effective?

People were cared for by shared lives carers who were properly trained and supported by the shared lives provider. Some of these placements were long term and had been successful for many years. Placements were monitored regularly, both in the form of formal reviews and spot checks.

Is the service caring?

We spoke with three shared lives carers who had been recruited by the provider. One carer said, "The shared lives staff are a very good team. I find them open and honest people who are easy to work with." Another carer said, "The team care very much, not only about us as carers but about the people we support." In relation to taking people for respite care, one carer said, "I never feel under any pressure to take anyone. It's all about discussion and negotiation." All of the shared lives carers we spoke with stated they felt well supported by the shared lives team.

Is the service responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes.

All the shared lives carers we spoke with told us the people within the shared lives team were approachable and they would have no difficulty speaking to them if they had any concerns about the service. The provider took account of complaints and comments to improve the service.

Is the service well led?

Staff said that they felt well supported by the manager and the provider and they were able do their jobs safely. The service had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

The staff and carers we spoke to had a good understanding of how people’s needs should be supported and of safeguarding arrangements. Carers also told us that they felt supported by the Shared Lives team and that there was always someone available to speak to if they had concerns. Two of the carers told us how they had reported safeguarding concerns and that they felt Shared Lives had taken their concerns seriously and acted on them.

We found that the service needed to make improvements to the information included in people’s care plans and that care plans needed to be reviewed more regularly. Additionally the service needed to demonstrate that people and or their advocates had been involved in the development of their care plan.

We found that service had robust systems in place for the appointment of carers and that the service monitored the quality and suitability of placements.