The inspection took place on 31 October, 1 and 6 November 2018. The provider was given 48 hour notice as the location provides a community based service and we needed to be sure that a member of the management team would be available on the day. We spent time in the office and a day visiting people. We then returned to the main office on 6 November 2018 and provided feedback to the senior management team.

Milestones Supported Living Service provides personal care and support to people with a learning disability and/or mental health needs to live in their own homes either on their own or sharing with others in supported living services. A supported living service is one where people receive care and support to enable them to live independently. People have a tenancy agreement with a housing provider and receive their care and support from Milestones Supported Living Trust.

As the housing and care arrangements are separate, people can choose to change their care provider and remain living in the same house. At the time of the inspection the service was supporting 244 people across 186 locations across Bristol and South Gloucestershire. Of the 244 people they were supporting, 43 people were receiving support with personal care, as defined in the Health and Social Care Act 2014 regulations. They also provided and supported people to access leisure and day care services. This part of the business does not fall within the scope of registration.

There were two teams that worked separately from each other in supporting people with either a learning disability or a mental health condition . The registered manager had the legal responsibility to support and manage both teams. 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 was not always responsible for people’s accommodation, however we found they had ensured people’s homes were safe and comfortable, through effective liaison with the landlords and other relevant agencies. The Care Quality Commission’s role in these settings was to focus on the regulated activity of personal care and we had no regulatory responsibility to inspect the accommodation for people living in these settings. Environmental risk assessments had been completed.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management and safe recruitment processes. There were policies in place for lone working for staff.

Staff were extremely caring and supportive and demonstrated a good understanding of their roles in supporting people. People were very much the centre of their care and involved in the recruitment of their staff teams. Where people shared a service a compatibility assessment was completed to ensure living in shared accommodation was right for them. Staff were committed to providing a service that was tailored to each person they supported. Staff were enthusiastic and worked with people to enable them to achieve positive outcomes. They understood their roles in relation to encouraging people’s independence whilst protecting and safeguarding people from harm.

Systems were in place to ensure open communication including team meetings and one to one meetings with their manager. Staff were trained and supported in their roles.

People were involved in the day to day running of the service. People were valued and supported to be as independent as possible. People’s rights were upheld, consent was always sought before any support was given. Staff were aware of the legislation that ensured people were protect

The inspection took place on 21,22, 25, 27 July and 2 August 2016. The provider was given 48 hour notice as the location provides a community based service and we needed to be sure that a member of the management team would be available on the day. We spent two days in the office, two days visiting people and speaking to people on the telephone. We then returned to the main office on 2 August 2016 and provided feedback to the registered manager and head of service.

Milestones Supported Living Service provides personal care and support to people with a learning disability and or mental health needs to live in their own homes either on their own or sharing with others in supported living services. A supported living service is one where people receive care and support to enable them to live independently. People have a tenancy agreement with a housing provider and receive their care and support from Milestones Supported Living Trust.

As the housing and care arrangements are separate, people can choose to change their care provider and remain living in the same house. At the time of the inspection the service was supporting 244 people across 183 locations across Bristol and South Gloucestershire. Of the 244 people they were supporting, 34 people were receiving support with personal care, as defined in the Health and Social Care Act 2014 regulations. They also provided and supported people to access leisure and day care services. This part of the business does not fall within the scope of registration.

There were two teams that worked separately from each other in supporting people with either a learning disability or mental health needs. The registered manager had the legal responsibility to support and manage both teams. 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 were receiving care that was responsive and effective. Care packages were bespoke and tailored to the person. Care plans were in place that clearly described how each person would like to be supported. People had been consulted about their care and support. The care plans provided staff with information to support the person effectively. Other health and social professionals were involved in the care of the people. Safe systems were in place to ensure that people received their medicines as prescribed.

The service was not always responsible for people’s accommodation however we found they had ensured people’s homes were safe and comfortable, through effective liaison with the landlords and other relevant agencies. The Care Quality Commission’s role in these settings was to focus on the regulated activity of personal care and had no regulatory responsibility to inspect the accommodation for people living in these settings. Environmental risk assessments had been completed.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management and safe recruitment processes. There were policies in place for lone working for staff.

Staff were caring and supportive and demonstrated a good understanding of their roles in supporting people. Staff received training and support that was relevant to their roles. Systems were in place to ensure open communication including team meetings and one to one meetings with their manager. Staff were committed to providing a service that was tailored to each person they supported. Staff were enthusiastic and worked with people to enable them to achieve positive outcomes. They understood their roles in relation to encouraging people’s indepe

We visited the agency on 29 March 2012 and spoke with two people that used the service and who told us how staff supported them. They gave us examples such as being helped with their personal care, household tasks and activities.

We saw that people were actively involved in making decisions about their care. We were given an example of when people had made choices about which staff they wanted to support them.

Staff confirmed that people had been involved in the recruitment of their staff. This helped to ensure that people who used the service had a say in how the service was delivered.

We spent the day in the agency’s office on the first day of our inspection. We spoke with the manager who assisted us with providing information. We looked at three people’s care files and various policies and associated records, and were shown how people were supported with their medicines and how the service monitored the care people received.

On the second day we visited five people in their home to find out about their experiences of being supported by Milestones Supported Living Service. We looked at the care files kept in their home and people spoken with gave us positive comments including “they (the staff) are good as gold” and “(they) take my abuse” and “not cheesed off with none of them”.

Other comments made by people we spoke with included “the management do a good job” and “they (staff) are really helpful”, and that staff were “brilliant” , “respectful” and “we get on well”.

There were enough qualified, skilled and experienced staff to meet people’s needs. We spoke with and observed six staff who supported the people we saw in their homes. Staff demonstrated a good understanding of people’s needs, giving examples of how people communicated their feelings and wishes.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.