About the service: Northumberland Supported Living Service provides care and support for up to two people living in a ‘supported living’ setting. At the time of this inspection one person was using the service.

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.

Nurses who are employed by Northumbria Healthcare NHS Foundation Trust also work with the people at the service 24 hours a day. The service had operated in this manner for over 12 years and followed an integrated care model.

People’s experience of using this service: The person looked very comfortable and at home in their surroundings. Staff had worked very closely and sensitively with the person to support them to accept more contact with other people and experience a wider range of activities. Staff were friendly and very skilled at working with the person. Most had worked at the service for a long time. The person and staff knew each other very well and they looked at ease in each other's company.

Staff were well trained and knowledgeable about their roles and the care people needed. Feedback highlighted how the person's life had improved since they moved to the service.

Systems and processes were in place and well monitored so the service was safe and run well. Nurses managed all aspects of medicine administration. The registered manager and staff had robust risk assessments and acted appropriately to mitigate any identified risks.

People's rights were upheld. The person was given choice and supported to make decisions. Where people did not have capacity to make decisions, they were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff effectively reported any safeguarding matters. The registered manager thoroughly investigated any concerns, and resolved these matters. All incidents were critically analysed, lessons were learnt and embedded into practice.

The service was well run. Staff told us the registered manager was fair, and good at listening to people and staff thoughts about how to make the service better. The registered manager carried out lots of checks to make sure that the service was delivering a good service.

Rating at last inspection: Good (Report published on 3 June 2016).

Why we inspected: This was a planned inspection. It was scheduled based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 4 and 12 May 2016 and was announced. We announced the inspection 24 hours prior to calling. This was to ensure that people would be at home on the day that we visited. A previous inspection undertaken in November 2013 found there were no breaches of legal requirements.

Northumberland Supported Living Service is based at Sea Lodge, Cresswell. The service provides personal care and support to two people with severe learning disabilities. The location is rented by the two people from a housing association, who are responsible for the majority of the upkeep and maintenance of the property. Each individual has access to their own bedroom, conservatory/ lounge area, bathroom and garden area. There is a shared kitchen and dining area.

The service had a registered manager who had been registered since July 2011. 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 provider had in place a safeguarding policy and staff had received training in relation to the safeguarding of vulnerable adults. They said they would report any concerns to the manager or senior staff. There had been no safeguarding incidents in the service in the previous 12 months. Risk assessments were in place regarding the general operation of the service and also linked to the care delivery for each person living at the home. Regular checks were maintained on the safety of the premises and equipment.

Staffing numbers were maintained at a level that ensured the safety of people who used the service and to deliver individualised care. Proper recruitment procedures and checks were in place to ensure staff employed by the service had the correct skills and experience. Medicines were stored and handled correctly and safely. There were plans in place for the use of “as required” medicines and the use of covert medicines, where necessary.

People were supported to access adequate levels of food and drink. Staff supported people to develop simple cooking skills. People were also supported to visit outside establishments for meals and snacks. Where professionals had given advice or guidance about people’s diet we saw that this was being followed.

Systems were in place to ensure staff had regular training and updating of skills and staff confirmed this was the case. Records indicated that the majority of staff had completed all mandatory training. Staff told us, and records confirmed there were regular supervision sessions for all staff members and each staff member had an annual appraisal.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. Where necessary applications had been made to the Court of Protection to ensure people’s interest were protected. Staff were aware of the need for best interests meetings to take place where decisions needed to be made and people did not have capacity to make their own decisions. Where necessary best interests decisions had been undertaken and recorded.

The home had been adapted to promote people’s independence with easy access to a range of facilities, with the support of the service provider. The decoration was plain in some areas, but staff said they needed to introduce changes carefully.

We observed staff treated people with great patience and kindness and showed a genuine interest in them as individuals and a real concern

The people who used the service had limited communication so we were unable to have conversations with them about the service they received.

We saw the provider ensured people were able to make decisions wherever possible. Documentation was in place where people lacked capacity and decisions had to be made in their best interests. Relatives and health care professionals were involved in this process.

The care records showed people received safe and appropriate care and staff were able to describe how they met people's individual needs.

There were clear procedures in place for receiving, storing and administering medications. Appropriate arrangements were in place to monitor people's condition and review their medications if necessary.

There were sufficient staff on duty at all times to meet people's needs. They received good training to ensure they were competent to carry out their roles.

There was a clear complaints procedure in place and a system was in place to record and monitor complaints. No complaints had been received at this service.

People were unable to communicate with us due to the nature of their learning disabilities and the level of their care needs. Therefore, we used observations found on the day of our inspection to inform our decisions, we spoke with staff and we looked at records held within the service. We saw that people were treated with dignity and respect and their independence was promoted. We found that people's care and support needs were appropriately assessed and their care was planned and delivered in line with their individual care plans. We found that staff were appropriately trained and the service had systems in place to monitor the quality of the service that it provided.