We conducted an announced comprehensive inspection at Milestones Outreach Support Team (MOST) on 21 August 2018. MOST supports adults with learning difficulties, with autism, with mental ill health, with physical disabilities and with dementia.

MOST provides care and support to people living in ‘supported living’ settings within the local communities, so that they can live in their own home as independently as possible. While MOST supports 51 people, and provides accommodation for some, only six of these received support with personal care, which is an activity requiring registration. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living therefore this inspection focused on the care and support provided to those six people. We also take into account any wider social care provided.

This is the first time the service has been inspected since the provider has changed to Aspens Charities. The service was previously provided by Larkfield With Hill Park Autistic Trust Limited and was rated as Requires Improvement. At the last inspection on 10 and 11 October 2016, we asked the provider to take action to make improvements within safe, effective, responsive and well-led.

At our last inspection we found risks to people’s safety were not managed as they had not followed up on actions needed from accidents and incidents; risks to people were not consistently managed and risk assessments were not up to date; safeguarding alerts were not consistently monitored and followed up; and staff did not receive medicines competency checks in line with the providers policy. At this inspection we found people were kept safe, they had comprehensive risk assessments and the provider had ensured environmental risks were managed and people were protected from the risk of infection. Staff understood their responsibilities in relation to safeguarding people from abuse, had identified concerns between people within shared homes and consequently worked with people to manage their relationships with the other people they lived with. People’s medicines were managed safely. There were enough staff to keep people safe, staff were recruited safely and had the training and skills required to meet people’s needs.

At our last inspection we found the provider had failed to ensure the principles of the Mental Capacity Act 2005 (MCA) were followed, and staff induction processes were not consistent. At this inspection we found the provider was working within the principles of MCA. People were 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. The provider had trained and supported staff to understand the requirements of the Mental Capacity Act. The managers ensured staff had the right induction, training and supervision to fulfil their roles. People’s needs were assessed, kept up to date and care was delivered to meet their needs. This included supporting people with their communication needs, complex health needs and with their behaviour which could be challenging. We made a recommendation that the provider seeks advice and guidance from a reputable source on implementing Accessible Information Standards.

The service 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. Staff were caring and respected people’s privacy and dignity. We observed that people were treated with kindness and respect. There was a strong person centred culture at the service, people were involved with their support and encouraged to remain as independent as possible.

At our last ins