This announced inspection took place on 1, 2 and 8 November 2018.

The service 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. Some people using the service lived in a ‘house in multi-occupation’ that could be shared by four people. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. Another person lived alone in a house in a residential area with staff support.

At the time of our inspection, there were two people in receipt of personal care support. The service provides support to adults with autism, learning disabilities and mental health needs.

Not everyone using Midlands Supported Living receives 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.

There was 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 last comprehensive inspection on 15 and 19 September 2017, we found the service to be rated ‘Requires Improvement’ and the provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements in relation to the governance of the service and the administration of medicines. The provider submitted an action plan detailing the improvements that they would make to comply with the regulations; they stated that they would be compliant by 15 December 2017.

Staff demonstrated their understanding of MCA and the need to ensure that people's care and support was provided in the least restrictive way. However, the provider had not ensured that recorded MCA assessments and best interest decisions were carried out with people. Where people had other professionals involved in their support, for example to provide medical care, assessments were in place.

There were safe systems in place for the administration of medicines and people received their medicines as prescribed. Regular audits ensured that medicines were stored and administered appropriately and any errors would be identified promptly.

Quality monitoring systems and processes were in place and audits were taking place within the service to identify where improvements could be made.

People were supported in a safe way. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. All the staff we spoke with were confident that any concerns they raised would be followed up appropriately by senior staff. People had risk assessments in place to cover any risks that were present within their lives, but also enabled them to be as independent as possible.

Staff supported people in a way which prevented the spread of infection. Staff used the appropriate personal protective equipment to perform their roles safely.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staffing levels were suitable to meet people's needs, and the staffing rotas showed that staffing was consistent.

Staff attended induction training where they completed mandatory training courses and were able to shadow more experienced staff. Staff were well supported by the registered

This announced comprehensive inspection took place on the 15 and 19 September 2017. Tracscare Supported Living Office provides personal care and supported living for people living in their own homes. At the time of this inspection the service was providing support to nine people.

There was a person registered as a manager with the Commission however, this person was no longer in post as the manager of the Service. 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 could not be assured that they would receive their prescribed medicines safely. We found examples of missed medicines and errors in the recording of the administration of people’s medicines that had not been identified or acted upon by the provider.

The providers’ quality assurance systems had not been effective at identifying or addressing shortfalls in the care and support that people received. The providers quality assurance systems had not identified that people’s medicines were not managed safely or that accidents and incidents had not been reported or acted upon appropriately.

Accidents and incidents had not been reported appropriately by staff and this had resulted in action failing to be taken in response to incidents.

The provider needed to review the deployment of staff to ensure that people received personalised packages of care and that people consistently received their commissioned one to one care. Staff felt supported in their role however, they did not have access to regular formal supervision.

People were safeguarded from harm as the provider had systems in place to prevent, recognise and report concerns to the relevant authorities. Staff were confident in recognising and raising concerns if they felt people were at risk.

Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and had applied that knowledge appropriately. People were supported to make decisions for themselves and their consent was actively sought by staff.

People were supported to have sufficient amounts to eat and drink to maintain a balanced diet. Staff monitored people’s health and well-being and ensured people had access to healthcare professionals when required.

Staff had access to an on-going programme of training to aid their professional development.

People had detailed plans of care that they had been involved in developing to guide staff in providing consistent person centred care and support. People had the information they needed to make a complaint and the service had processes in place to respond to any complaints.

There had been continued instability in the management of the service however, the provider had taken action to try and provide a period of stable leadership to implement improvements in the care and support people received.

At this inspection we found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

This inspection took place on the 3, 4, 7 and 8 August 2016 and was announced. Tracscare Supported Living supports people with learning disabilities, mental health difficulties and physical disabilities. The service is registered to provide personal care to people living in their own homes or shared accommodation when they are unable to manage their own care. There were nine people using the service when we inspected.

At the time of the inspection there was no 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. There was a manager in post who was in the process of applying to become the registered manager.

There had been some instability in the management of the service which had meant that the systems in place to monitor the quality and standard of care had not always been effective; people had not always felt they had been listened to and their concerns addressed in a timely way. The new manager had begun to take action to address some of the concerns and the provider was in the process of introducing a system to monitor more closely the quality and effectiveness of the service. At the time of the inspection we were unable to assess the consistency or success of the new system.

People had not always been supported by staff who had the skills and knowledge to meet their needs nor who had received regular supervision. Action had been taken to address this and staff had had the opportunity to undertake specialist training; there was a programme in place to ensure all staff received consistent and regular supervision.

People had detailed support plans which were reviewed to ensure that people lived as fulfilled and enriched a life as possible. The new manager was committed to ensuring that people’s needs were being met by staff that were well trained and experienced in supporting the individual.

People who could verbally communicate told us that they felt safe and secure in their own home with the staff that supported them. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times they needed. The recruitment practice protected people from being cared for by staff that were unsuitable to work in their home.

Support plans contained risk assessments to protect people from identified risks and helped to keep them safe; they provided information for staff about the identified risk and informed staff of the measures to take to minimise any risks.

People were actively involved in decisions about their care and support needs. Staff understood their role in caring for and supporting those people who were unable to communicate their needs and who lacked capacity to make specific decisions under the Mental Capacity Act 2005.

Staff had good relationships with the people who they supported and promoted people’s independence and were committed to providing a high standard of care and support.

The manager was approachable and was focussed on ensuring that there were effective systems in place to monitor the quality of the service provided. Staff and people felt confident that the manager would address any issues they had.