This inspection was carried out between 11 and 23 July 2018. The inspection was announced as the provider was given short notice of the visit to make sure someone would be available.

This service provides care and support to nine people living in six small ‘supported living’ settings, so 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.

This inspection had been brought forward due to concerns. This was because staff had raised concerns about safeguarding incidents that had occurred. These had not been reported to the local authority or to the Care Quality Commission, and had not been investigated by the provider. This meant vulnerable people had not been protected and safeguarding adults’ protocols had not been followed. Also, the provider’s quality monitoring processes were not effective in identifying gaps and shortfalls in the quality and safety of the service.

People were supported with their medicines in a safe way but there was no guidance for staff about when to support people with over the counter or ‘when required’ medicines. We have made a recommendation about this.

Staff told us they had not always felt well supported and had not received some of the training they needed. We have made a recommendation about this. Individual supervisions with staff had not been held in a confidential way. On-call management arrangements had not always been supportive to staff who worked with people who used the service. The provider showed us how these issues were being addressed.

There had been a registered manager at the service but they retired in November 2017. A new manager had applied for registration but left the organisation during this inspection. Another manager (from the organisation’s education department) was acting as manager in the interim until a new manager could be appointed. 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 care service has 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 can live as ordinary a life as any citizen.

People were fully included in their local community and lived ordinary, fulfilled lives as local citizens. They took part in meaningful occupations, such as farming and gardening. They also enjoyed a number of individual leisure activities that they were interested in.

People were treated with dignity and respect. They were encouraged to make their own decisions and to lead as independent lives as possible.

People who could express a view felt the staff were caring and kind. People said they “liked” the support workers and described them as “nice”.

Staff were extremely knowledgeable about individual people and were aware of their individual preferences. People were supported to do their own shopping and make their own meals, with support only where needed.

The service was working within the legal requirements of the Mental Capacity Act 2005 (MCA 2005). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; they understood the need to obtain consent when providing care. Staff had completed training in relation to the MCA 2005.

Senior manager had recently identified a number of areas for improvement and development. The organisation was committed to implementing those improvements and

This inspection took place on 18 and 19 August 2016 and was announced. We last inspected this service in February 2015 and found no breaches of regulations at that time.

Natural Ability is registered with the Care Quality Commission as a supported living service which provides care and support to people in their own homes who have a learning disability or autistic spectrum disorder. A registered manager was in post who was also the registered provider of the service.

At the time of our last inspection there was only one person in receipt of personal care and support from the service on a supported living basis (living in their own home and in the community), and this number had increased to a total of six people at this visit. There were a further two young adults/children with disabilities receiving personal care in the pursuit of activities in the community, on a respite/outreach basis. The day farming service was attended regularly by groups of between one and six adults on weekdays.

People told us they felt safe when they received care from the service. Most staff had received training in the safeguarding of vulnerable people and they were aware of their individual responsibility to report matters of a safeguarding nature. Records showed there had not been any safeguarding incidents since our last inspection and the local authority safeguarding team confirmed that there were no on-going safeguarding cases.

Risks that people had been exposed to in their daily lives and within the environment of their own homes had been assessed and mitigated against. Regular health and safety checks were carried out. Accidents and incidents were monitored, analysed and measures were put in place where necessary to prevent repeat events.

Staffing levels within the service were tailored to the needs of the people in receipt of care, and as much as possible, staff worked in teams around the care of each individual. Staff files demonstrated that the provider’s recruitment and vetting procedures of new staff were appropriate and protected the safety of people in receipt of care from the service. Medicines were managed safely and appropriately. Most staff were trained in key areas relevant to their role, such as manual handling and emergency first aid, and also in areas such as epilepsy awareness which was relevant to the needs of some of the people they supported. One staff member's training had been overlooked and we have made a recommendation that the provider "Reviews all staff member's training to ensure they are all fully equipped with the skills they need in respect of the role they carry out within the service". There was an induction package in place and supervisions and appraisals took place but had fallen behind in recent months.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The Mental Capacity Act 2005 (MCA) was appropriately applied and the service understood their legal responsibility under this Act. Documentation around capacity assessments and decisions that were made in people’s best interests in line with procedures set out in the MCA, were not well maintained. People's capacity was informally assessed by the service when their care commenced and on an on-going basis when necessary. The provider told us that records in this area would be improved in future.

People were supported to eat and drink in a way that allowed them to remain healthy. Monitoring tools were used to ensure that any changes in people's health and wellbeing could be identified and actions taken where necessary to identify any changes in people's conditions. For example, food and fluid charts were used to promote healthy eating and people were weighed regularly. People were also supported where necessary to access healthcare appointments in order to maintain their overall health and wellbeing.

Staff and people enjoyed good relationships and we observed friendly, caring and respectful engagem

This inspection took place on 2 February 2015 and was announced so that the provider could speak with the person in receipt of care from the service about the inspection. We last inspected this service in August 2013 and found no breaches of regulations at that time.

Natural Ability is registered with the Care Quality Commission as a supported living service which provides care and support to people who have a learning disability or autistic spectrum disorder. The service also provides respite and outreach services to children with learning disabilities, which involves supporting them to attend activities within the community, and a holiday support service is offered where adults with learning disabilities can use the care and support services of Natural Ability whilst staying at a hostel in the Allendale area. A day-farming horticultural service operates on weekdays where adults with learning disabilities or autistic spectrum disorders from local communities can attend to develop their life skills and experiences, through a variety of different outdoors community projects such as tree planting and garden renovations.

At the time of our inspection there was one person in receipt of regular care and support on a supported living basis (in their own home and in the community), and three children with disabilities who were supported to pursue activities within the community on a less frequent basis. The day farming service was attended regularly by groups of between one and six adults on weekdays. The respite, outreach and day activity services provided by Natural Ability did not fall under the registration criteria set by the Commission.

The service is required to have a registered manager in post and the provider had registered herself in this role with the Care Quality Commission. A registered manager is a person who has registered with the 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 provider told us that she planned to relinquish her registration as the registered manager of this service, as soon as practicable, in favour of a manager who now oversees the day to day operation of the service.

The person in receipt of care told us they felt safe in the presence of staff and fully supported in their daily life. The registered provider had systems in place to limit the risk of abuse, including financial abuse. Assessments of risk had been undertaken to ensure that the person remained as safe as possible whilst living their life as fully and independently as possible. Regular checks on the person’s own home were carried out so that they were not exposed to dangers of a health and safety nature. Medicines were managed appropriately and safely, and records related to medication were well maintained.

Staff records showed that recruitment processes were robust and staff were vetted before they started working for the organisation to ensure that they were suitable to work with vulnerable people. Other records related to the operation of the service and the person’s care records were well maintained.

The person told us that staff supported them to achieve goals in their life and to make informed choices. Care plans contained detailed information about what the person needed support with and how staff should provide this support. Staff had the relevant information they required to provide effective care, and the person’s care records were regularly reviewed and updated. Training records showed that staff were trained in areas relevant to their role and this training was up to date and monitored.

The registered provider and the manager both had an understanding of the Mental Capacity Act (2005) and it was evident in the person’s care records that they had the capacity to make day to day choices in their life. Where bigger care based decisions were made, the service had involved the person’s relative and local authority care manager, so that a communal decision could be reached in the person’s best interests, with their agreement.

The ethos of the service was very much about promoting people’s independence and developing their potential to live their lives as independently as possible. Evidence showed that the service achieved this and the person’s relation said they were thrilled with the progress they had made since receiving care and support from the service. The person was actively involved in the local community and pursued a variety of different activities such as attending clubs and choir practice, which promoted their well-being.

The person was supported to maintain their own home so that it was safe and quality assurance checks on tasks undertaken by staff were carried out by the manager. Staff meetings took place regularly and the manager met with the person in receipt of care on a regular basis to obtain their feedback about the service they received, and to address any issues that may have arisen or changes that were necessary. The person confirmed that they were very happy with the service and the staff who supported them.