This announced inspection took place on 4 November 2016.

Natural Breaks is an organisation which provides support services to people with a range of needs such as a learning disability, mental health issue, physical disability or an acquired brain injury. The service has two strands offering both a domiciliary care service to people living in their own home and support for people to access social and leisure activities within their local community. The service is located in Liverpool and covers a large geographical area across the North West.

We last inspected this service on 13 February 2014 and found they were compliant in all areas.

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.

Everyone we spoke with told us they felt safe being supported by the staff and staff were able to describe the course of action they would take if they felt someone was being harmed or was at risk of harm. Staff told us they would not hesitate to whistle blow to the registered manager, the local authority or CQC.

Risks which compromised people’s health and well-being were appropriately assessed reviewed when needed and contained a high level of detailed information.

There was a procedure in place for recording and analysing incidents and accidents.

Rotas showed there were enough staff employed by the organisation to deliver a safe, consistent service. Each person had the required number of staff working with them to help keep them safe and access the community.

We viewed medication administration records (MAR) sheets for some people we were having their medicines administered by staff, and saw they were accurate and complete. Staff were trained in medication administration, and were subject to regular spot checks to help ensure they were competent with regards to administering medicines.

Staff were recruited safely and checks were carried out on staff before they started work at the organisation to ensure they were suitable to work with vulnerable people.

Staff completed an induction as well as other training courses selected by the provider to enable them to have the skills needed to complete their role.

The registered manager and staff we spoke with were aware of their roles in relation to the Mental Capacity Act 2005 and associated legislation. Staff understood the need to respect people’s choices and decisions if they had the capacity to do so. Assessments had been carried out and reviewed regarding people’s individual capacity to make care decisions. Were people did not have capacity, this was documented appropriately and decisions were made in their best interest with the involvement of family members where appropriate and relevant health care professionals. This showed the provider understood and was adhering to the Mental Capacity Act 2005.This is legislation to protect and empower people who may not be able to make their own decisions.

Staff we observed delivering support were kind and compassionate when working with people. They knew people well and were aware of their history, preferences and dislikes. People’s privacy and dignity were upheld. Staff monitored people’s health and welfare needs and acted on issues identified. People had been referred to healthcare professionals when needed.

Care plans with regards to people’s preferred routines and personal preferences were well documented and plainly written to enable staff to gain a good understanding of the person they were supporting. Care plans contained a high level of person centred information. Person centred means the service was tailored around the needs of the person, and not the organisation.

We discussed complaints with the reg

We met with 11 people who used the service and they gave us good feedback about all aspects of their support. People told us they felt listened to and respected by staff and they told us they felt supported to make their own decisions and to be as independent as possible. People’s comments included: “Staff always ask my permission before they help me” and “I make my own decision’s, staff help me if I get stuck.”

People's needs were clearly reflected in their care plan and staff presented as having a good understanding of people's needs.

Systems were in place to protect people from the risk of abuse. Staff had undergone training in safeguarding and they were clear in their responsibilities to report concerns.

Checks had been carried out on staff before they started working for the service. These aimed to ensure people were supported by staff who had the appropriate qualities, skills and experience they needed to carry out their roles.

Staff felt well supported and appropriately trained. Communication across the staff team was good and staff were being provided with regular supervisions and team meetings.

The provider had a system in place for monitoring the quality of the service and this included asking people who used the service for their views. People who used the service told us they would feel confident to raise any concerns or complaints about the service and we saw that when complaints had been made they had been listened to and acted upon.

We asked people using the service to tell us if they were making decisions about their care and support and people told us they were. People gave us lots of examples of the choices they were making on a daily basis and told us about a range of things they did with the support of staff. This indicated that staff were supporting people to make choices and to use their independent living skills. People told us staff supported them with their health needs and one person described how staff supported them with their diatry and social needs.

We asked people if they felt confident to raise any concerns they had about their service and people told us they did, people also told us they felt safe.

People gave us good feedback about staff. People told us staff were “Good” and “Caring”. One person told us they felt staff were “Really Great ”.

People told us which members of staff were on their team and they told us they had support from the same small group of staff.