This inspection took place on 11 and 12 December 2018. We announced the inspection 24 hours in advance so the manager was able to ensure there were staff available at the office to assist us with the inspection.

Shared lives is a model of care where care is provided by approved carers (providers) in their own home or in shared houses with the approved carer living off site. The service matched people (called citizens by the service) with a care need with providers who supported them according to their assessed needs. Providers either supported citizens on a long term basis or for short breaks.

At the time of our inspection the service supported a total of 144 citizens. Not everyone using the Manchester Shared Lives receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. The service was supporting 48 citizens who needed support with ‘personal care’ at the time of our inspection.

The service had a registered manager in place. 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.

At our last inspection in May 2016 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 ongoing 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.

Citizens said they felt safe living with their providers. Citizens and providers said they were well supported by the shared lives team.

Citizen’s care needs, any risks they may face, interests and preferences were assessed and regularly reviewed to ensure they reflected their current support needs. There was a thorough assessment procedure in place for potential providers. Citizens were matched with providers based on these assessments.

Citizen’s finances and medicines were safely managed. Citizens were supported to take part in a range of activities, work placements and holidays, either with their provider or independently.

Provider training had been improved. Placement workers had the training and support to fulfil their roles.

A quality assurance system was in place, with placement workers undertaking regular monitoring visits. New monitoring forms were being introduced to make these visits more robust. The registered manager checked a sample of each placement workers care files prior to their supervision meetings.

Incidents and accidents were reviewed to reduce the risk of further incidents occurring. The few complaints received, both formal and informal, had been responded to appropriately.

The service was engaged with Shared Lives Plus to keep up to date with developments and good practice within the Shared Lives field. Peer reviews by a manager of another local shared lives service had been completed.

Capacity assessments and best interest meetings were completed where required.

The service sought feedback from providers and citizens to look at ways for further improvements to be made through annual surveys and provider focus groups.

Further information is in the detailed findings below.

We inspected Manchester Shared Lives on 17, 18 and 19 May 2016. As this was a ‘shared lives’ scheme, we contacted the registered manager the afternoon before the inspection. This was so that she could arrange visits for us to meet the people in their placement homes. At the last inspection in October 2013 we found the service met all the regulations we looked at.

At the time of our inspection, 79 people were being supported by the shared lives scheme as long term placements. A further 18 people used the service for respite care. ‘Shared lives’ describes the arrangement whereby people either live with or near self-employed care providers who support them according to their assessed needs.

The homes care providers shared with people were located across Manchester; up to three people were supported per household. The Manchester Shared Lives office team consisted of the registered manager and six placement workers. They supported the care providers, assessed prospective care providers and matched new people to care providers who had a vacancy in their home.

The service 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.

We saw that one ‘as required’ medicine did not have a medicine protocol and was not recorded on the person’s medicine administration chart. Other than this, medicines were managed properly by the care providers that supported people.

The support plans of one person who had problems swallowing food had not been updated with this information and they had no swallowing risk assessment. Two of the homes we visited did not contain copies of people’s risk assessments. Risk assessments in other people’s homes and at the office were appropriate and people were supported by care providers to take positive risks if the benefit of the activity outweighed any potential risk identified.

People we spoke with told us they felt safe in their placement homes. The relatives we spoke with agreed. The care providers and placement workers could describe the forms of abuse people using the service might be vulnerable to and said they would report any concerns appropriately.

The recruitment process for new care providers was robust; we saw all the required checks had been made and documentation was in place. There was a disciplinary policy which the registered manager had followed when addressing an issue with a care provider.

The homes where people were placed were assessed for safety and cleanliness at regular intervals.

The service complied with the Mental Capacity Act 2005; staff had a good working knowledge of the principals and how they applied to the people using the service. People were given choices and supported to make their own decisions.

Staff received the training they needed to support people safely. They also received regular supervision and an annual appraisal, all of which was documented properly. Care providers said they felt supported by their placement workers.

People told us they enjoyed the meals they had in their placement homes. People and their relatives said that people were supported to access a range of healthcare professionals and care providers showed us how they arranged and documented this for the people.

People and their relatives told us that the care providers were caring. Care providers described people as members of their families and the interactions we observed were warm and friendly.

Care providers gave us examples of how they promoted the independence of the people they supported. We saw that placement workers made referrals to advocacy services if people needed independent help or support to make decisions.

People’s support plans were individualised and person-centred and prod