This inspection took place on 14 and 15 May 2018 and was announced.

Royal Mencap Society – Domiciliary Care Services – North London is a domiciliary care service that provides care and support to people living in supported living schemes with learning disabilities and complex healthcare needs in and around North London. At the time of our inspection the service was supporting 37 people.

At our last inspection we rated the service ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Each person’s individualised risk was identified and assessed to ensure people’s safety. Risk assessments were comprehensive and gave guidance on how to reduce or mitigate people’s risks.

The service continued to ensure that people received a safe service. Safeguarding policies and procedures were in place, understood and followed by all staff.

Medicines were managed and administered safely. Policies and processes in place ensured people received their medicines safely and as prescribed.

The provider ensured robust recruitment procedures were followed to ensure the recruitment of staff assessed as safe to work with vulnerable adults.

Care staff were supported through regular training, supervisions and annual appraisals.

A comprehensive pre-admission assessment was completed to ensure that the service was able to meet the assessed needs of the person.

People chose what they wanted eat and planned their own menus for the week. People decided the level of their own involvement with the preparation of their meal and where they required support. People had access to a variety of healthcare professionals and were supported by care staff where needed.

We observed caring and positive interactions between people and support workers that supported them. Relationships had been formed based on trust and mutual respect.

The provider and service demonstrated responsive practices on how people were supported in their daily lives which was highly responsive to their needs, choices and wishes. Staff that had been trained to deliver positive behaviour support which supported people emotionally and practically looked at triggers and previously known behaviours and then worked with people in response to their needs to so that they were supported within any possible environment in the least restrictive way.

Care plans were person centred, comprehensive and detailed how people wished to be supported in order to meet their desired outcomes.

Care staff spoke with people with respect and promoted their independence. People were involved in all aspects of the care and support that they received especially through regular review meetings.

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.

Complaints received were recorded and investigated according to the provider's complaints policy. People and relatives knew who to complain to if they had any concerns to raise.

A clear management structure was in place which allowed oversight and monitoring of service provision at each of the supported living schemes where people were supported with the regulated activity of personal care. A number of systems were in use to ensure that continuous monitoring, learning and improvement of services was implemented.

Further information is in the detailed findings below.

This inspection took place on 30 December 2015 and 4 January 2016 and was announced. We told the provider two days before our visit that we would be coming. We gave the provider notice of our inspection as we needed to make sure that someone was at the office in order for us to carry out the inspection. At our last inspection on 7 August 2014 the service met the regulations that were inspected.

The service provides personal care for people living in eight supported living schemes in and around North London. At the time of our inspection the service was providing care to 44 people with a learning disability.

At the time of our inspection there was a registered manager in post who was registered with the Care Quality Commission. 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 inspection was carried out over two days. On the first day of the inspection we visited the service’s main office and one supported living scheme. On the second day of the inspection we visited a further two more supported living schemes. We saw that two of the schemes that we visited were relaxed and had a homely feel about the home. The third scheme we visited supported people with a very high level of need in relation to their learning disability especially for those who were on the high end of the autistic spectrum. The service had encountered difficulties in ensuring that the service was able to meet their needs especially as some of the people required one to one support.

People that we spoke with were positive about the service that they received and about the staff who supported them. Staff were aware of people’s individual needs and how they were to meet those needs. People were encouraged to build and retain their independent living skills.

Policies and procedures were in place to help ensure people were protected from abuse or the risk of abuse. These included robust staff recruitment, staff training and risk assessments that considered the individual potential risk for each person using the service.

We saw suitable arrangements were in place in relation to the recording and administration of medicines.

People received personalised care that was responsive to their needs. Care plans were person centred, detailed and specific to each person and their needs. People were consulted and their care preferences were also reflected.

Staff had the appropriate knowledge and skills to carry out their role effectively. All staff received regular supervision where they could discuss their work with people using the service, personal problems and any training or development needs. Care staff spoke positively about their experiences of working at the service and felt well supported by their colleagues and the registered manager.

People were able to make their own choices and decisions. The manager and staff were aware of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). All staff were able to demonstrate a good understanding on how to obtain consent from people and were able to provide examples. They understood the need to respect a person’s choice and decisions where they had the capacity to do so.

Positive caring relationships had developed between people who used the service and staff. People were treated with kindness and compassion. People were being treated with respect and dignity. Staff provided prompt assistance but also encouraged and promoted people to build and retain their independent living skills.

People using the service and their relatives knew the registered manager and scheme managers and felt able to raise and issues or concerns they may have had. We found the service had a clear management structure in a place with the registered manager, scheme managers and the care staff team. The service had an open and transparent culture where people were encouraged to have their say and staff were supported to develop and improve their practice. The agency also had systems in place to monitor and improve the quality of the service.

A single inspector carried out this inspection. We spoke with three people who used the service, five relatives and two members of staff. We reviewed the care records in place and looked at how the service was managed in relation to the standards we inspected. We did not have an opportunity to visit people who received support in their own homes due to the distance between the registered office and where people lived.

The focus of the inspection was to answer the five key questions : is the service safe, effective, caring, responsive and well-led?

Is the service safe?

The service was safe because safeguarding issues were dealt with appropriately and referrals and notifications were made where necessary. For example, we were told staff who were investigated and found to be working unsafely were no longer able to work in the organisation and a Disclosure and Barring Service (DBS) referral was made.

When we spoke with people who received support, they all felt the service was keeping them safe. Relatives of people receiving support also felt their family members were safe.

Staff had received safeguarding training and there was a focus on regular discussion of any safeguarding issues at team meetings.

Is the service effective?

The service was effective because people receiving support felt they were receiving a very good quality of support.

The service had high quality support plans and risk assessments in place which helped to ensure people's care and welfare needs were being met.

Relatives gave very good feedback on the quality of support being provided for their family members by staff.

Is the service caring?

The service was caring because people receiving support felt they were respected and involved in their support. There was a need, however, to ensure people receiving support were always involved in recruiting new staff to work with them as this had happened less consistently recently than in the past.

The service had taken time to understand and plan to meet people's needs and was focused upon ensuring they were treated well at all times.

Is the service responsive?

The service was responsive because it dealt with complaints quickly and effectively.

The service was also responsive because it responded quickly when safeguarding concerns were raised and it acted swiftly to ensure any vulnerable individuals were immediately protected from any potential further harm once the concern was known about.

Is the service well-led?

The service was well-led because quality systems were in place ensuring effective quality monitoring took place to make sure services delivered were of a high standard at all times.

Managers appeared to be proactive, person-centred and committed to working with all parties to ensure people who received support got a consistently high quality service.

We saw staff had found out what was important to people and this was recorded in care plans. One person said, "my care plan is all about me finding a job, working with animals."

We found that the manager had co-operated with other services she liaised with, such as social services and healthcare professionals.This meant that people using the service were assisted to obtain appropriate health and social care support.

The provider had a safeguarding policy in place. All five staff we spoke with were fully aware of the policy, and what signs might suggest someone was being abused or being neglected.

We reviewed staff training records and this confirmed staff were up to-date with mandatory training. People we spoke with rated staff highly. One person said, "they help me every day with all my emotional stuff."

The provider recently issued surveys to people to check on the quality of their service. Responses were all positive about the service. We saw that the service was monitoring the quality of the care regularly.

The people we contacted were happy with the service. They described staff as "caring, kind and friendly". People said that staff explained how they were going to carry out a task and asked people how they wanted the task such as bathing completed.

People that use the service and staff told us that people were involved in making decisions about their care.

The people we spoke with knew how to raise concerns. People said they felt safe.

Staff told us and training records showed that staff had up to date training and felt supported. There was a system in place for checking the quality of care delivered.