The inspection of Plymouth Supported Living took place between the 7 and 11 December 2018. We announced the visit 48 hours before. This was to give staff the time to let people know we were coming and why.

When we last inspected the service, we found breaches of the Regulations. This was due to concerns about how the medicines were managed, how staff were being supported and, the leadership and governance. We asked the provider to tell us how they were going to put this right and checked this plan had been adhered to.

On this inspection, we found improvements; with some clarification need around medicines to ensure the records were accurate. These were all in place by the time the inspection concluded.

Plymouth Supported Living provided care and support to 10 people living in a ‘supported living’ setting, so that they can live 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. The people had a learning disability.

People lived in two separate parts of a complex owned by Plymouth Highbury Trust. One building was called the Lodge (where two people lived) and Highbury House (where the other eight people lived).

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should live as ordinary a life as any citizen. This including us checking compliance with the national plan, ‘Building the right support’ and best practice. For example, how the service ensured care was personalised, the person moved on if needed, people’s independence and ensure people were linked with their community.

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. They were supported in this role by the deputy manager and trustees of the parent body Plymouth Highbury Trust.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were assessed in line with the Mental Capacity Act 2005.

People were supported to be accepting of each other and of others. Their faith, sexuality and life choices were respected and explored by staff to ensure people’s right to choose how to live their lives. This included identifying those people who were vulnerable because they could not identify risk in others and putting means in place to make this part of the discussions and care planning with and for people.

People and families felt safe in their homes and with the staff who supported them. Staff knew how to keep people safe from harm and ensured they received a personalised approach to identifying if they were unhappy, depending on their communication and comprehensive abilities. People’s care plans were detailed and written with people or those relatives who knew them well. People’s medicines were administered safely.

There were systems and processes in place to minimise risks to people. These included a robust recruitment process and making sure staff knew how to recognise and report abuse. Staff were available to meet people’s needs in a timely manner.

People received effective care from staff who had the skills and knowledge to meet their needs. Staff monitored people’s health and well-being and made sure they had access to other healthcare professionals according to their individual needs. Staff e

Plymouth Supported Living provides care and support to people living in a ‘supported living’ setting, so that they can live 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.

There were 11 people were receiving supported living services when we inspected. They lived in two separate parts of a complex owned by Plymouth Highbury Trust. One building was called the Lodge (where three people lived) and Highbury House (where the other eight people lived). In relation to Registering the Right Support we found this service was doing all the right things, ensuring choice and maximum control. Registering the Right Support (RRS) sets out CQC’s policy registration, variations to registration and inspecting services supporting people with a learning disability and/or autism.

At the last inspection on the 25 February 2016, the service was rated Good.

At this inspection we found the service to be requires improvement.

Why the service is rated Requires improvement

We brought this inspection forward as we were concerned about reports we had received about how some staff were not treating people in an acceptable way. This included staff speaking to people in a harsh and uncaring manner.

We found the provider had recognised at the end of 2016 that all was not good with how people were being treated at the service. They took action to address this and worked closely with the local authority. They had recognised the leadership and governance was inadequate and they identified some actions to address this. During this inspection we found some actions had been achieved and some had yet to be started. A new manager was employed to oversee the service and develop an action plan. This has been overseen by the provider. As issues were identified, these were being addressed. However, we noted checks of the service were not in place or operating effectively to ensure people always received care that was safe, effective and well-led. The manager and provider told us new auditing systems and quality assurance processes were part of the next phase of developing the service further in 2018.

The service was not being overseen by a registered manager as required as part of their registration with us. The new manager has applied to register with us. 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 previous manager had deregistered with us in October 2016.

Where there had been concerns about staff and this had required action, records were not always kept to state how this was followed up on to ensure the staff member was now working to the required level. Formal supervisions with these staff were not taking place or recorded. There were no records to show how staff were supported by retraining and ensuring they were demonstrating the required level of competency. The manager stated there were often conversations and informal check ins with staff needing extra oversight. New formal systems were being brought in but it was not possible for us to judge this time whether these were being effective.

We found people’s medicines were administered in with how they were prescribed but some expected management tasks had not been completed. We spoke with the manager about how a robust checking tool such as an audit would have identified this.

People felt safe at the home and with the staff who supported them. Family members gave positive feedback about the staff, the safety of people and how staff related to their loved ones.

There were systems and processes in place to minimise risks to pe

The inspection took place on 25, 26 and 29 February 2016 and was announced. The provider was given 48 hours’ notice because the location was a supported living service and we needed to be sure that someone would be present in the office.

Plymouth Supported Living provides a supported living service to people living in their own home who have learning disabilities. On the day of the inspection 11 people were supported by Plymouth Supported Living 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.

During 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.

People and their loved ones spoke well of the care and support they received, comments included, “The staff are very caring, they are like our extended family”, “The staff are very caring and show genuine concern for […]” and “Staff care so much, I have even known them to be in floods of tears when […] has been unwell. They have a very caring nature”. Care records were personalised and gave people control over all aspects of their lives. People’s preferences were identified and respected. Staff responded quickly to people’s change in needs. People or where appropriate those who mattered to them, were involved in reviewing their needs and expressed how they would like to be supported and by whom.

People were supported by staff who put them at the heart of their work. Staff showed a kind and compassionate attitude towards people. Relationships had been developed and staff had an 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 gave people information about risks and actively supported them in the choices they made, so that people had as much control and independence as possible.

People had their medicines managed safely. People received their medicines as prescribed, received them 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 speech and language therapists.

People and their relatives told us they felt safe. Comments included, “He is as safe as he could possibly be”, “I feel […] is definitely safe, very much so” and “[…] is very safe, I have no worries about that”. 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 protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

People were supported by staff who had received a thorough induction programme and on-going training to develop their knowledge and skills.

People were supported by staff who confidently made use of their knowledge of the Mental Capacity Act (2005), to make sure people were involved in decisions about their care and their human and legal rights were respected.

The service had a policy and procedure in place for dealing with any concerns or complaints. No written complaints had been received since our last inspection.

Staff described the management to be supportive and approachable. Staff tal

We spoke with the manager and deputy manager, two team leaders and four members of staff. We also spoke with and met people using the service.

People we spoke with told us they were very happy with the service they received from the agency and they were enjoying their lives. One person told us "I love it here we get to do so much. I get to cook and go out, I couldn't do that before". Another person said I like to have other people around me but I like to have private time as well. They listen to me here and let me have quiet time"

We saw that people had specific and individualistic care plans. These were updated daily in accordance to people's wishes. Care plans were easy read with pictures and colour coded charts. This demonstrated an awareness of the individual persons understanding and abilities to read and understand their own care plan.

Support staff worked at a level required by the individual and promotion of independence was evident. Staff had all received a thorough core training programme that included safeguarding and attended regular updates.

There were sufficient support workers to meet people's needs and appropriate background checks had been completed on all staff. Audits were in place to continually monitor and assess the quality of care and support provided.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming.

We spoke with three people who lived in the service. We found other people were out in the community or on holiday when we carried out this inspection. We also spoke with the staff on duty.

We saw that people received care and support that met their individual needs. The care records included pictures and photographs to support understanding. Care records were kept up to date and included information about people's needs and preferences.

We observed the way staff interacted with people and saw positive relationships. People told us they were happy with the care they received and one person said, “I love living here, the staff are great and I live here with my friends.”

The staff were able to identify the signs of abuse and knew what to do if they had any concerns. People using the service told us that they felt safe.

There was information to support people using the service to complain or raise concerns if they wished to. One person told us, “I can speak to my family or the staff; I know they would sort it out for me.”