Plymouth Support Service is a domiciliary care service registered to provide personal care. The service provides personal care and support to adults of all ages living in their own homes within the Plymouth area. It provides a service to people with a learning disability who may also have a physical disability and people living with sensory impairment.

Plymouth Support Services also provides care and support to people living in a 'supported living' setting. Where people live in their own home and receive care and/or support in order to promote their independence. If there is genuine separation between the care and the accommodation, the care they receive is regulated by CQC, but the accommodation is not. The support that people receive is often continuous and tailored to their individual needs. It aims to enable the person to be as autonomous and independent as possible, and usually involves social support rather than medical care.

The service supports some people on a 24 hour basis and others who may require support with personal care needs at specific times of the day and/or night. At the time of this inspection, seventeen people received support with their personal care needs from the agency including people in the shared houses.

The service had 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.

At the last inspection in April 2016 the service was rated Good. At this inspection we found the service Required Improvement.

Why the service is rated Requires Improvement.

We visited and spoke to 15 people in their own homes and observed the interaction between them and the staff supporting them. People were not all able to fully verbalise their views, so staff used other methods of communication, for example visual choices and sign language.

The service was not consistently safe. When asked, people from one shared house said they did not feel safe. They raised concerns about a person who lived nearby. This person and the people living in the shared house had to gain access to their front door via the shared car park/garden area. People did not feel safe leaving their own home, some people missed appointments if the person concerned was outside of their home as they felt too frightened to leave. Staff also felt intimidated either going off duty or if they were leaving with people they were supporting to access the community if this person was outside in the shared car park/garden area. The service manager was currently in talks with the local safeguarding team over this issue.

People and relatives also raised concerns over a second provider currently providing overnight care for people in one of the shared houses. They were not happy with the level of care and one person commented; “Not sure if they are going to turn up.” The provider was due to stop providing care shortly.

Staff highlighted an issue with one person and their current funding level to help keep them safe and well cared for. This person’s care records all clearly showed they required two to one staffing to assist them to the toilet. At times this person was in the shared house with only one member of staff. Staff told us of an occasion that this person had to wait 45 minutes to be taken to the toilet. This could have caused this person a lot of discomfort and the Commission reported this to the local safeguarding team. The service manager overseeing this service said they were in the process of trying to obtain additional money to fund extra hours to support this person whose health had deteriorated over time due to increasing age. However records showed this person had been receiving over 700 minutes of additional care hours currently pro

The inspection took place on 18 and 19 April 2016 and was announced. The provider was given 48 hours’ notice because the location was a domiciliary care agency and we needed to be sure that someone would be present in the office.

Plymouth Support Service is a domiciliary care agency providing personal care and support to people with a learning disability who live in their own homes or supported living accommodation. People may also be supported who are living with conditions associated with sensory impairment and mental health needs. The service supports some people on a 24 hour basis and others at specific times during the day and night. On the day of the inspection 17 people were supported by Plymouth Support Service with their personal care needs.

The service had 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.

On the day of the inspection staff within the office were relaxed, there was a calm and friendly atmosphere. Everybody had a clear role within the service. Information we requested was supplied promptly, records were clear, easy to follow and comprehensive.

People spoke highly about the care and support they received, comments included, “I love it here, all my friends are here and the staff are lovely and very helpful”, “Staff are lovely and caring, when I was in hospital they visited me every day” and “Staff are friendly and really nice to me”. Care records were personalised and gave people control over all aspects of their lives. Staff responded quickly to people’s change in needs. People or where appropriate those who mattered to them, were involved in regularly reviewing their needs and how they would like to be supported. People’s preferences were identified and respected.

Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and practice was person focused and not task led. Staff had full appreciation of how to respect people’s individual needs around their privacy and dignity.

People’s risks were managed well and monitored. People were promoted to live full and active lives. Staff were highly motivated and creative in finding ways to overcome obstacles that restricted people’s independence.

People medicines were managed safely. People received their medicines as prescribed, on time and understood what they were for. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, social workers, occupational therapists and physiotherapists.

People told us they felt safe. Comments included, “I am safe”, “I feel much safer here than I did in the community, I was neglecting myself. Here I feel so much safer having my support around me” and “I feel really safe, the staff help me feel safe”. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were supported by staff who had a good working knowledge of the Mental Capacity Act (2005). Staff made sure people were involved in decisions about their care and helped ensure people’s human and legal rights were respected.

People were supported by staff teams who had received a comprehensive induction programme, and tailored training that reflected their individual needs. A health care professional commented, that staff followed guidance and provided effective support.

People were protected by the service’s safe recruitment practices. Staf

People who use this service and staff told us they receive the support they needed to help them lead fulfilling lives. They were able to engage with the local community and were helped to develop the skills they would need to live more independent lives in the future.

Staff were knowledgeable about people's physical and mental health needs and were aware of the support plans and networks in place for the people that use the service. Where people were being supported by different health professionals or organisations it was clear that staff communicated with each other to make sure that people were safe and supported appropriately.

Staff received the training they needed to enable them to carry out their role effectively and safely. They underwent regular supervision sessions, had annual appraisals and told us they felt supported by the manager of the service.

There were quality monitoring procedures in place and people were aware of their responsibilities in relation to maintain and improving quality.

Records were stored securely, contained up to date, relevant information and were fit for purpose.