This inspection took place on 26 and 27 January 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be available in the office.

Opportunities for Adults and Children provides personal care and support to people in their own homes. At the time of our inspection the agency was providing a service for 36 people with a variety of care needs, including people living with a learning disability or who have autism spectrum disorder. The agency was managed from a centrally located office base in Andover.

The service had a registered manager. 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 currently in the process of registering the manager for the regulated activity of personal care.

The manager oversaw the running of the service and was supported by five support managers who were allocated a geographical area to manage. Support managers were responsible for individual parts of the service, for example support to people in a supported living unit or support to people living in their own home.

Some family members felt staffing levels needed to be improved. The manager was aware of our concerns and actions to address them had already been put in place. The agency was actively recruiting to fill staff vacancies and agency staff had been used appropriately to ensure all planned shifts were covered.

People and their families told us they felt safe and secure when receiving care. Relevant recruitment checks were conducted before staff started working at Opportunities for Adults and Children to make sure they were of good character and had the necessary skills.

Staff received training in safeguarding adults and children. They completed a wide range of training and felt it supported them in their job role. New staff completed an induction designed to ensure staff understood their new role before being permitted to work unsupervised. Staff told us they felt supported and received regular supervision and support to discuss areas of development. Staff meetings were held every other month.

The risks to people were minimized through risk assessments and staff were aware of how to keep people safe and the information provided staff with clear guidelines to follow. There were plans in place for foreseeable emergencies.

People who used the service felt they were treated with kindness and said their privacy and dignity was respected. People received their medicines safely. Staff had an understanding of legislation designed to protect people’s rights and were clear that people had the right to make their own choices.

Staff knew what was important to people and encouraged them to be as independent as possible. People were supported to lead full and varied lives and encouraged to make choices.

Staff were responsive to people’s needs which were detailed in people’s care plans. Care plans provided comprehensive information which helped ensure people received personalised care. People felt listened to and a complaints procedure was in place.

Staff felt supported by the manager and could visit the office to discuss any concerns. There were systems in place to monitor the quality and safety of the service provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

During our inspection we spoke with seven people who used the service. We also spoke with the registered manager, seven members of staff, five relatives of people who used the service and three relatives who were visiting the centre to use day facilities. The summary is based on our observations during the inspection, speaking with people and from looking at records.

We used this inspection to answer five key questions; is the service safe, effective, caring, responsive and well led?

Is the service safe?

People told us they felt safe. Safeguarding policies and procedures were kept up to date and under regular review. Staff knew how and when to report any concerns.

We saw people's rights and dignity were respected and they were included in the decision making process.

Systems were in place to make sure managers and staff learned from events such as accidents, incidents and complaints.This reduces the risk to people and helps the service to continually improve.

Staff knew about risk management plans and we observed elements of risk management being carried out. This demonstrated to us people using the service and staff were not put at unnecessary risk. People had access to choice and remained in control of their care and lives.

Staff were well supported by their line managers and received regular training, supervisions and meetings.

Is the service effective?

People's health and care needs were assessed by a suitably qualified person and people were involved as much as possible in the decision making process. Care plans we looked at were up to date and reflected people's current care needs.

We saw people had access to an advocacy service and on the day of our inspection an advocacy meeting was being held with a person who used the service. Information about advocacy services was clearly displayed on notice boards and easily accessible to people.

Is the service caring?

We spoke with five people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example; "The staff are lovely", "They are my friend" and "We always have fun".

Staff we spoke with knew the needs and wishes of people and it was clear they genuinely cared for the people they supported.

People using the service and their relatives completed an annual satisfaction survey. We saw that issues raised were dealt with in a timely manner and actioned appropriately.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Complaints procedures were available in written and pictorial representation so that everyone could understand them. We saw complaints had been dealt with in an appropriate manner and were recorded in detail. There had been no complaints since the last inspection.

Is the service well led?

Quality assurance systems were in place which enabled the service to continually learn from and improve the quality of service provided.

Staff told us they were clear about their roles and responsibilities and understood the quality assurance processes. This helped ensure people received a good quality service at all times.

At our last inspection we identified that staff had not always received appropriate supervision and appraisal. We carried out this inspection to check on the improvements the provider told us they had made.

We found that all staff who had worked for the provider for more than 12 months had received an appraisal. We looked at the Continuing Professional Development records for a selection of staff. We saw that there was a clear record of the formal supervisions they had received. These meetings between staff and their line manager gave both people the opportunity to discuss any issues relating to their role or day to day duties.

We spoke with five people who use the service, or their relatives. Everybody told us that they were happy with the support they received. They said they usually had the same support workers which they appreciated as they were able to build up a relationship with them. They also felt that this meant the support workers knew their support needs and the things they liked to do. One person told us that the interaction between the staff and their relative was good.

Three of the people we spoke with said that the support workers were very reliable. “They are very reliable XX comes on the stroke of seven.” However one person who uses the service was concerned that sometimes the times for their visits are changed at the last minute which they didn’t like. The relative of one person said they would like to change the time the support workers called but despite requesting the change on more than one occasion the service had not been able to accommodate their request.

Two relatives commented on the way the support workers carry out their duties. “They are excellent; they treat my daughter with dignity and respect.” Another said The ladies that come are excellent; you couldn’t believe they are as good as they are.

For this inspection we spoke with the registered managers and 12 members of staff. We also spoke with six people who use the service or their relatives by telephone.

The people we spoke with said that communication between themselves and the office was very good. One of the relatives we spoke with said:“I have had excellent service; I know there is somebody at the end of the line 24 hours. I am never made to feel I am bothering them.”

People we spoke with all spoke very highly of the support workers who visited their homes. One relative said that when the support worker was with their relative: “All I can hear is laughing.”

Staff felt that due to their knowledge of people they hoped they would be able to detect any changes in their personality which could indicate a concern. The staff we spoke with explained the procedure they would follow if they suspected any type of abuse was occurring.

Generally staff felt supported by their coordinators, the level of contact they had with other members of their team and the communication with the office. However we had concerns that staff had not had the opportunity to take part in a formal appraisal. This meant that staff had not received support through a formal appraisal system to further their professional development.

Each staff team had regular meetings were any concerns or worries were discussed. One member of staff told us: “It is nice to get together and be able to discuss what is working and what isn’t.”