This inspection took place on 22, 23 and 28 November 2018 and was announced.

MCCH (Hermitage Court) provides care and support to people living in ‘supported living’ settings, 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 111 people were receiving support from the organisation across the South East and London areas. It provides a service to a range of people including adults that have learning disabilities, physical disabilities, profound and multiple disabilities and autism spectrum disorder.

At our last inspection on 16 and 17 February 2016 we rated the service good overall with the safe key question rated as requires improvement. We recommended that gaps in staff’s employment records were explored and recorded. A comprehensive audit of the entire workforce recruitment records had been completed. At this inspection we found that additional improvements had been made, sustained and embedded; the service was now rated as ‘outstanding’ overall and in the responsive and well-led key questions. The safe key question had improved to good. The evidence continued to support the rating of good in the effective and caring key questions.

The individual services had been developed and designed in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service could live as ordinary a life as any citizen. These values were seen in practice throughout each service.

There were two registered managers in place that covered different geographical areas. 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.

People receiving support from MCCH (Hermitage Court) received highly individualised person-centred care. There were innovative and creative ways of promoting people’s well-being and self worth. People were supported to achieve positive outcomes and fulfil their dreams and aspirations, such as moving on to independent living and overcoming communication barriers.

Support plans were detailed and personalised to meet people’s needs. People were supported to have a full and meaningful life. People were supported to fulfil their goals to enhance their well-being. Staff went over and above to make sure people had opportunities to meet new people, make friends and build relationships.

People were empowered to take ownership over their safety. The safety of people was promoted and links were made with the local community professionals to protect people. Keeping people safe and protecting them from harm and abuse was at the forefront of people and staffs’ minds. Staff worked alongside the local authority safeguarding team to promote people’s understanding about their safety.

The vision and values of the organisation played an integral role to ensure people were at the heart of the organisation. These had been integrated into everyday practice, people living with learning disabilities were able to achieve what they wanted in their lives and had the right support overcame obstacles to achieve positive outcomes.

People were supported to make decisions about their care and support. People were given maximum choice and control over their lives. There was clear and detailed guidance for staff on how to meet people’s individual needs and to support them to develop their confidence and have their preferences met.

The recruitment of staff was indi

We inspected this service on 16 and 17 February 2016. The inspection was announced. The provider was given two working days’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available at the location’s office to meet with us.

MCCH Hermitage Court is a domiciliary care service providing personal care for people in homes managed by the MCCH Society Limited. At the time of our inspection they were supporting approximately 70 people.

The service is provided at a number of premises throughout the Kent, Medway, East Sussex, Sutton, Hampshire and East London. The service caters primarily for people who have a learning disability.

There were two registered managers in place that covered different geographical areas. 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.

Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support. However, gaps in potential staffs employment had not always been explored. We have made a recommendation about this.

People experienced a service that was safe. They received support and assistance from enough staff to fulfil their expected care packages and meet their needs. Staff and the management team had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and measures put into place to manage any hazards identified.

Where staff were involved in assisting to managing people’s medicines, they did so safely. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely.

Staff had received the training they required to meet people’s needs. Staff had a clear understanding of their roles and people’s needs. Staff were supported in their role from the management team and were given the opportunity to complete additional qualifications to support their role.

People were treated with kindness and respect. People’s needs had been assessed to identify the care and support they required. Care and support was planned with people and reviewed to make sure people continued to have the support they needed. People were encouraged to be as independent as possible. Detailed guidance was provided to staff about how to provide all areas of the care and support people needed. People, if required were supported to eat and drink enough to maintain good health.

Systems were in place for monitoring the quality and safety of the service and assessing people experiences. People were actively involved in the development of the service they received. The provider had a clear vision and set of values for the service which staff were aware of and followed.

Before people received any care or treatment, they were asked for their consent and the provider acted in accordance with their wishes. People we spoke with understood the care choices available to them. One person said, “We were kept in the loop and very well informed”. Another person said, “I was always able to ask questions and get responses quickly” and “Care is excellent”.

People said their support needs were met and they had confidence in the staff members who visited them. Comments from the people we visited and spoke with on the telephone included, “It has been absolutely good. I have been well pleased” and “They do more than expected and they are friendly”.

People’s health, safety and welfare were protected when more than one provider was involved in their care and treatment.

There were effective systems in place to reduce the risk and spread of infection. We visited two homes with staff where services were provided and saw that the communal and domestic areas of the homes looked clean and hygienic.

There were effective recruitment and selection processes in place.

The provider had an effective system to regularly assess and monitor the quality of service that people received. People we spoke with commented on the service provided by MCCH Hermitage Court and said, “Staff were very respectful to all of us and when they visited, they are always helpful” and “Staff have always respected our confidentiality”

We found that the service was committed to providing personalised support for each person with their own team of staff. The people that we talked with spoke very positively about the service with comments such as “Happy with the support, if I am not happy I would tell someone”, “Staff are kind and friendly” and “Happy with the service provided”.

People told us that someone from the agency had visited them before the service to them commenced. They said that they were treated with dignity and their privacy was respected by staff. People told us that they had regular community support workers. They said that they knew who to go to if they had any concerns, but that they had no concerns.

We saw that individual plans of support were tailored to each person’s needs, and were reliably updated and maintained.

The service obtained people’s views on a day by day basis via their support staff; and retained people’s comments on cards, letters, and concerns and suggestions forms. Completed 2012 surveys received from relatives included comments “I have no complaints they are like a family to me”, “Always very caring and helpful and always make out family very welcome when we visit” and “The permanent carers are excellent”.

People who used this agency were not able to engage directly with the review process during this review. We spoke with family members of two people who used the service. They told us their relatives were very happy.