The inspection took place on 6 November 2018. We gave the provider notice of our intention to visit so that they could prepare people with complex needs whose routines might be disrupted by our inspection process.

South Hill provides care and support to people with learning disabilities and complex needs in a ‘supported living’ setting, so that they can live in their own home 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 service comprised 11 studio flats in a large detached house with additional communal living areas, and is in Harrow. At the time of this inspection the service provided care for nine people. The people using the service had learning disabilities and varying complex needs and needed a range of support including personal care, prompting and monitoring.

Although the service accommodated more than six people, the service could demonstrate that they followed the principles and values in Building the Right Support guidance, and met the fundamental standards and other relevant regulations. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was employed at the service. 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, the service was rated Good. At this inspection we found the service remained Good.

Appropriate policies and procedures ensured people who used the service were safe from abuse and harm. People told us they felt safe. Their support plans contained various risk assessments and management plans, which ensured they were protected from harm in relation to their care. The service monitored accidents and incidents and learning from these was used to improve the service. Staff employed were appropriately checked to ensure they were suitable to work with people. There were concerns from some staff relating to staffing. They told us at times they were short staffed but we judged this was being addressed. Medicines were managed safely. People received their medicines on time.

Staff had the skills, knowledge and experience to carry out their roles. They had access to a variety of training. CQC monitors the application of the Mental Capacity Act 2005 (MCA) and deprivation of liberty safeguards. We saw that people's rights were protected because the service ensured that the requirements of the MCA 2005 were met. Applications to deprive people of their liberty lawfully had been made to prevent them from coming to any harm where they lacked capacity. Regular supervisions and appraisals were provided to support staff. People had choice of a nutritious food. Their health was monitored and if required external health care support was sought to ensure their health and wellbeing was maintained.

Staff were kind and caring towards the people they supported. They respected people’s privacy and dignity. They also recognised people's rights to confidentiality, consistent with General Data Protection Regulation (GDPR) law. Staff had a clear understanding of people's individual needs, preferences and routines. These qualities were acknowledged by people, who confirmed their privacy, dignity, independence, and preferences were respected by staff.

People’s information and communication needs were met in line with the Accessible Information Standard policy. Support plans contained clear communication guidelines explaining how each person communicated.

People received care that was responsive t

The inspection took place on 31 March 2016 and was announced. South Hill is a supported living service providing personal care support for up to 11 people with learning disabilities and complex needs. The service comprises 11 studio flats in a large detached house with additional communal living areas, and is located in Harrow.

The service did not have a registered manager in place at the time of 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.

At this inspection an existing deputy manager had been assigned to temporarily manage the service, with support from the regional director.

People told us that they felt safe within the service. We saw positive, friendly and enabling interactions between staff and people. People were treated with dignity and respect.

People and where necessary those who mattered to them were involved in care planning. They assisted staff in identifying needs, and how people preferred to be supported. We saw that staff provided personalised care and support.

Staff knew what to do if people could not make decisions about their care needs. Where possible, people were involved in decisions about their care and how their needs would be met. Otherwise, arrangements were put in place for relatives or other representatives who could represent their best interests.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet those needs.

People's risks were anticipated, identified and monitored. This ensured that people had control and independence in their lives. Risks were regularly reviewed and updated promptly following any changes in need.

Medicines were administered safely and on time. Staff had completed training in medicines administration. People were supported to become independent with their medicines in a structured and safe way. People understood what their medicines were and why they had been prescribed.

There were systems to monitor important aspects of the service. This ensured the services continued to receive internal and external audit, which were used to monitor quality and to make improvements.

We spoke with three people who used the service, and observed the care and support provided. Each person told us they were happy with the support they received. One person said “I really like it here. I go out and do everything I like and the staff help me”. Another person said “This is much better than the last place I stayed. The staff speak nicely and help me and my room is big”. A staff member told us “You really develop a bond with the service users. It’s up to us to make sure they are safe, healthy and can be part of their community”.

We found that staff ensured information was presented in ways that people could understand, so they could make informed choices about their care and support. We saw that the support provided met people’s needs and encouraged people to participate in their communities and develop the skills they needed to live as independently as possible.

People were encouraged to make healthy choices, and supported to cook and eat nutritious food. Medicines were managed appropriately and safely, and people benefitted from good cooperation with service providers and other stakeholders involved in their support.

We found that staff were appropriately vetted, and qualified and experienced for their roles. We saw that records were up-to-date and accurate.

We spoke with four people who use the service and four staff members.

The provider had processes in place to ensure that consent was obtained from people before any care or treatment took place. People said they had chosen to live at South Hill and were able take part in activities and tasks they wanted to which was supported by staff when required.

All the people we spoke with told us they were happy with the care they received at South Hill. They were all able to describe the activities they enjoyed, that they felt safe living there and would recommend it. Care and treatment was provided in a way that ensured people's safety and welfare.

People were happy with their rooms but we found the premises was not adequately maintained or operated.

The provider had policies and procedures in place to ensure people were protected from the risk of abuse and responded to incidents appropriately. None of the people we spoke with had any concerns regarding how they were cared for by staff.

People who use the service told us that staff were always available to assist them when they required support with their needs. There were appropriate numbers of staff on duty to enable the service to meet people's needs. However some staff training required updating.

The provider undertook checks of the service to ensure they could meet people's needs. Although the provider made attempts to get feedback from staff and people who use the service, they had not done any surveys.

People said they were happy with the support they received. They told us they were able to express their views and staff listened to them. People said staff treated them in a respectful manner. They told us they were able to make choices, for example with menus and with activities.

People told us they liked staff accompanying them on outings and supporting them in the community, for example, when they went for healthcare appointments. People said they could talk to their key workers and the management if they had any concerns.

People said staff were available to support them with their daily activities. They expressed satisfaction with their key workers and said they could communicate well with them.