This inspection took place on the 11,12, 14 and 15 December 2017. The visit was announced.

The provider for Support for Living Domiciliary Care Agency is Certitude and is often referred to as either Support for Living Limited or Certitude. During this inspection report we will refer to the provider as Certitude.

Support for Living Domiciliary Care Agency provides personal care to people with learning and physical disabilities and mental health needs living in their own houses and flats in the community and specialist housing.

This service provides care and support to people living in ‘supported living’ settings, 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. At the time of our inspection there were one hundred and six people being offered a service in twenty four supported living schemes across four local authorities.

At the last inspection, the service was rated Good. At this inspection, we found the service had continued to make improvements and had introduced innovative practices and ideas in many aspects of the service to further enhance the experiences of people using it. We have therefore rated the service as Outstanding. There was 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.

People and relatives said that staff were kind, thoughtful and helpful. Staff were enthusiastic and passionate about their work, speaking very positively about people and wanting the best outcomes for them.

It was a strength of the service that staff had been trained in the use of different methods of communication to ensure people were understood. People were well supported to express their views in a variety of ways that were tailored to their individual needs.

The provider had an internal intensive support team and there was good use of speech and language therapist’s and other healthcare professionals to support staff to reach the best outcomes for people. Staff were innovative in their use of technology to support people to express their views and to live more independent lives.

Staff supported people to remain healthy both physically and mentally, there was an emphasis on supporting people’s emotional well- being. Community health care professionals visited people and staff supported people to attend routine appointments and hospital clinics. When people found hospital visits difficult staff worked alongside with health professionals to support them to attend.

People had person centred care plans that gave very good background information about them. Often there were photos of childhood and earlier adult life that showed the person in the context of their life. Care plans reflected their wishes and preferences.

Care plans described people’s circle of support and informed staff how people wanted their care and support provided. Staff supported people to attend a variety of meaningful activities of their choice. Staff explored new activities with people to widen their life experiences this included trips to see sporting events and holidays abroad. Staff demonstrated they believed in making people’s lives as full as possible seeing opportunities rather than the limitations.

People had end of life plans, some of which contained specific information with regard to their end of life care. We saw some excellent work had been undertaken in one service when supporting a person who chose to have their home as their final place of treatment.

The registered manager and the provider Certitude encouraged f

At the time of the inspection there were one hundred and thirteen people using the service. We spoke with nine staff, fifteen people using the service and two relatives.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

During our inspection we observed and found people were receiving care and support that met their individual needs and preferences. We saw that people had choices in all aspects of their daily lives. We heard people laughing and engaging in positive banter with the staff. People confirmed they were happy and well looked after.

People told us they did not have any concerns, but if they did they would feel confident to speak with the staff about them. A relative we spoke with said “my family member is absolutely safe” and “you could not ask for anymore”.

People told us they were involved in providing feedback about the quality of the service, through one to one review meetings, house meetings and by completing the annual survey.

This inspection took place on 28, 29 October and 4 November 2015 and was announced. The provider was given 72 hours’ notice because the location provides a domiciliary care service to people in supported living services and we needed to be sure that someone would be available. At the last inspection of the service on 29 November 2013 we found the provider was meeting the regulations we checked.

There was 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.

Support for Living is registered to provide personal care to people with learning disabilities, living in their own homes. Some people lived in individual flats and others in shared accommodation where they shared communal areas with other people. People had a tenancy agreement and rented their accommodation. The support hours varied from a few hours per day/week or 24 hour support. With this support people were able to live in their own homes as independently as possible.

People using the service told us they felt safe and we saw there were systems and processes in place to protect people from the risk of harm. The risks associated with people’s support were assessed, and measures put in place to ensure staff supported people safely. Staff had been trained to recognise and report any incidents of harm to people.

Safe arrangements were in place for the management of medicines and staff had been trained and assessed as competent in medicines administration.

There were sufficient numbers of staff to support people to live a full, active and independent life as possible in the home and community. Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

People were supported to maintain good health and wellbeing, and to access health and social care support as required. The Mental Capacity Act (2005) had been appropriately applied and the best interest decision making process followed to ensure decisions about people’s care were made collectively by more than one person.

People received individualised support that met their needs. The service had systems in place to ensure that people were protected from risks associated with their support, and care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences.

People’s individuality and diversity was taken into account. People were supported to access their local community, take part in social, recreational and educational activities of their choice. People were supported to build and maintain social relationships so they led fulfilling lives.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

There were systems in place to monitor the quality of service people experienced. Checks and audits were carried out and took appropriate action if any shortfalls or issues with the quality of service were identified.

The service promoted a positive and inclusive culture in which people and their carers felt able to share their views and experiences of the service and how it could be improved.