This inspection took place on 15 August 2018, and was announced.

Services for Independent Living provides services that enable people to live independent lives in their own homes within their own community. They support people with learning difficulties, physical impairments, mental health issues including dementia and older people. Services are provided to people living in Herefordshire and the surrounding area. At the time of our inspection the provider was providing personal care and other support for 31 people. Not everyone using Services for Independent Living are at Home receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, the service was providing personal care for 22 people.

At the last inspection on 1 December 2015 November 2015, the service was rated 'Good.' At this inspection we found evidence continued to support the overall rating of 'Good.' This inspection report is written in a shorter format, because our overall rating of the service has not changed since our last inspection.

People continued to feel safe with staff and the support provided by Services for Independent Living. Staff understood their responsibilities to protect people from abuse, discrimination and avoidable harm. Risks to people continued to be managed in a way that protected them and kept them safe from avoidable harm. The provider continued to follow safe recruitment practices to ensure prospective staff were suitable to work with people in their own homes. The provider had systems in place to ensure they reflected on any shortcomings and that improvements were made. The provider had systems and procedures in place to ensure people received their medicines safely and as prescribed.

People continued to receive effective care and support from staff who had the skills and knowledge to meet their needs. People's rights with regards to consent and making their own decisions continued to be respected by staff. People were supported to choose the food and drink they wanted, with regard to healthy diets and balanced nutrition.

Staff who adopted a warm, friendly and caring approach. People felt involved in their own care and staff and managers listened to what they wanted. Staff respected people's privacy and dignity when they supported them and promoted their independence.

People continued to receive care and support that was individual to them. The provider ensured people were provided with information appropriate to their disability, impairment or sensory loss. Support needs were kept under review and people were consulted about whether changes were required. People were encouraged to raise concerns and make complaints and were confident these would be dealt with. People continued to be involved in meaningful and stimulating activities of their choice.

Staff describe a culture in which they were able to speak openly with the registered manager and management team. People were listened to when they gave feedback about the service they received. Systems were in place that continued to be effective in assessing and monitoring the quality of the service provided. When concerns were identified the registered manager addressed these matters with staff at team meetings, where good practice and learning was shared. Staff and management worked to strengthen links with people and the local community.

Further information is in the detailed findings below.

This inspection took place on 1 December 2015 and was announced.

Services for Independent Living provides services that enable people to live independent lives in their own homes within their own community. They are registered to support people with learning difficulties, physical impairments, mental health issues including dementia and older people. At the time of our inspection they were providing care and support for 31 people.

At the last inspection on 13 August 2014, we asked the provider to take action to make improvements to their staffing levels. The provider sent an action plan which was received 1 October 2014. At this inspection we could see the provider had made improvements.

At this inspection there was a registered manager in post who was present throughout this inspection. 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.

People were protected from harm and abuse because they were supported by staff who knew how to recognise and respond to abuse. Staff did not start work until required checks had been made to make sure they were suitable to support people in their own homes. Additional checks and risk assessments were completed when necessary.

People were encouraged to maintain their independence and staff supported this. Staff provided care which was kind, compassionate and respectful. People’s privacy and dignity was promoted by staff. Staff had developed good relationships with the people they supported. People were encouraged to make their own choices and decisions and felt listened to and respected.

Staff felt supported by the management team and received regular one-on-one support sessions. Staff received induction and comprehensive training in order for them to perform their role well. The provider had a staff recognition scheme in place to recognise and reward best practice.

People felt in control of their care and support. They were encouraged to make decisions and choices which were respected and supported by staff. People knew how to make a complaint if they needed to. The provider completed regular quality checks to ensure that good standards of care were maintained. People’s feedback was sought on a regular basis and any areas or improvements identified were acted upon.

People were aware of who the management team were and felt they were approachable and listened to them. The provider undertook regular quality checks to identify changes and drive improvements.

A single inspector carried out this inspection. We had received concerns about the staffing arrangements and how complaints about staffing arrangements had been responded to. The focus of the inspection was to look at these areas and answer the key questions; is the service safe, effective, caring and responsive?

Below is a summary of what we found. The summary describes what people using the service and the staff told us and the records we looked at.

We spoke to four people who used the service, a relative and an advocate of two others and some of the staff.

Is the service safe?

We found that hazards to the people receiving a service and to the staff had been considered and measures put in place to reduce the risk of harm.

The staff and the provider understood the requirements of the Mental Capacity Act 2005, its main Codes of Practice and Deprivation of Liberty Safeguards (as they related to domiciliary care) and put them into practice to protect people.

Is the service effective?

People we spoke with told us they were satisfied with how staff supported them. Their needs had been assessed and their support planned and delivered as they wished. Staff we spoke with understood people's care needs and the support they were to provide.

The service had not always been able to provide staff consistently for some people using the service. The practice of having small teams supporting people meant that only a small number of staff knew each person's needs which limited how responsive the service could be when core staff were absent. In some cases the service had needed to ask relatives to provide the support their family member needed.

Is the service caring?

We found that people's needs were assessed and their support plans had been developed with their full involvement. The plans were detailed and personalised.

People told us that the staff who assisted them respected their wishes and let them plan and control their own lives. One person told us, “I did my support plan with the team co-ordinator, I am always consulted.

People felt that the staff that supported them had the right attitude, were trustworthy and they felt safe with them in their home. A relative said, “Staff have been brilliant, they have good ideas and are very practical”.

Is the service responsive?

People who used the service were asked each day for their views about their support and they were usually acted on.

People told us that they would feel confident talking to the staff who supported them if they were unhappy with aspects of their care.

We saw that comments and complaints were recorded and efforts were made to address concerns raised.

The provider had responded to the staffing difficulties by trying to recruit new staff but the steps taken had not been effective enough to prevent people using the service being affected.

People told us they received a good and reliable service from staff that were respectful, kind and caring. People liked being supported by only a small team of staff who got to know them well. Comments included “I can give my views on any new staff that join my support team” and “They have gone to a lot of trouble to find carers that my relative likes”.

They felt safe and were able to raise any concerns they had.

Everyone had a care plan that was detailed and personalised to their needs and preferences.

Staff were suitably trained and supported in their work. They prided themselves that the service was given in a personalised way.

There were effective leadership systems in place to manage the care service and monitor health and safety risks. Feedback from people using the service was requested at several levels so issues could be picked up and delt with quickly.

We visited the agency office in Leominster and looked at a sample of records held there. On the telephone we spoke to two people using the service and two relatives of people using the service. We talked to people about their experience of the care and service they received from the agency. We looked at the feedback the providers continually gather from people using the service through surveys and monthly meetings to review their support needs. We spoke to three of the care staff by telephone.

We found that people expressed their views and were involved in making decisions about their care and support. One person told us, “The way the service was set up was absolutely fine and they definitely involved me as well as my husband who receives the support. We were given an information pack and agreed with the care needs assessment and support plan. We see the daily notes the staff record. Communication systems are in place and we have found the staff in the office helpful when we ring”.

We found that people who use the service understood the care and support choices available to them. They had signed their care plan and had been involved in monthly meetings to check they were satisfied with the support provided. The care plans made it clear to care staff that the person had control over what the worker was asked to do.

We looked at a sample of recruitment files. These showed that appropriate checks were carried out before staff began work.

We found that on some occasions the agency found it difficult to cover short notice staff absence for some people’s care packages. We were not aware of any negative care outcomes for people using the service from this but it was not desirable. The registered manager told us more staff had been recruited including a team of “floating” staff who were experienced enough to work with a wide variety of people.

We saw records of concerns that people who used the service had raised. The records were detailed and showed that the concerns had been taken seriously, fully investigated and resolved where possible to the person’s satisfaction.