This inspection took place on 25 and 26 of September 2018 and was unannounced. It was planned because we had been given some information of concern which, upon inspecting the service, we did not find to be substantiated.

The Italian Lodge (which is also known as Support 2 Independence) is a domiciliary care agency providing personal care and support to people who live with mental health problems, progressive neurological conditions, learning disabilities, acquired brain injuries, alcohol related conditions, autism, or a combination of these. It works in close collaboration with a housing association to provide tenancies and support for those people who live or who want to live in that accommodation. People’s care and housing are provided under separate contractual arrangements. The housing association provided accommodation, in blocks of flats or in converted houses, on the Wirral peninsular. CQC does not regulate such premises; this inspection looked at people’s personal care and support. At the time of our inspection the service supported approximately 90 people.

At our last inspection we rated the service as good. At this inspection we found evidence which demonstrated ongoing and continuous improvements in the care, responsiveness and leadership of the service and therefore the overall rating is now outstanding.

We saw that staff were very caring and treated people with great kindness, consideration and respect. Staff promoted people’s privacy and dignity and enabled and encouraged them to be involved in decisions about their care. People contributed to their care plans and these were available in a format which was accessible to them.

People’s care was entirely person centred and their care plans written with contributions from them, their relatives and any health or social care professionals involved in their care and reviewed regularly. The information included for example, people’s dietary, sexual, histories, cultural preferences and choices and the outcomes they wanted to achieve.

Staff and management were fully committed to ensuring that people’s communication needs were met. Many communication methods were used, including modern technology, easy read and pictorial information and human translators. The service told us they would cater for any communication needs and that they would use innovative and effective ways to communicate and follow each person’s wishes on their preferred method of communication.

A wide variety of educational, employment and voluntary activities were offered and there were many leisure activities arrange for the people who used the service. People were encouraged to learn new skills by attending training sessions, such as learning how to cook.

There was a complaints policy which all the people we spoke with knew about and there were processes in place to deal with any complaints. People told us that any issues they had were resolved through discussions with staff and the management of the service.

The management team were open and transparent during and after the inspection visit. We were supplied with thorough documentation which showed that effective systems and quality assurance processes were in place to provide and monitor the service. The management team were clear that they wanted to provide a service which met the needs of the people they were supporting and which achieved good outcomes for them.

The managers fully engaged with the people who used the service, their relatives’, health and social care professionals and staff to consult with them and obtain their views about the service.

The service has been developed and designed in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion and that people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Policies and systems supported people to have maxim

We carried out an announced inspection of The Italian Lodge on the 28 October and 3 November 2016.

The Italian Lodge is the head office of Support 2 Independence and is situated in the Prenton area of Merseyside. The location is registered as a domiciliary care agency and provides support to people living in their own tenancies in the community with learning disabilities, acquired brain injuries and/or mental health needs. A varying level of support is provided depending on people’s individual need.

A registered manager was in post and had been since 2011.. 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.

We last visited this service on 29 January 2014. At that time the registered provider met all the regulations we used to assess the quality of support.

People told us that they felt safe with staff team ad felt that their financial interests were safeguarded. Staff demonstrated a good understanding of the types of abuse that could occur and how any concerns could be reported. Staff were aware of how to report concerns to external agencies.

The process for recruiting staff was robust and subject to checks which assessed their suitability to carry out their role. Staffing levels were maintained.

The registered provider took the risks faced by people in their support into account and these risk assessments were up to date and agreed by people who used the service.

People told us that the staff team knew how to support them effectively. Staff had received training relevant to the needs of people who used the service and received regular supervision and appraisals which staff considered to be constructive. Staff were aware of how the capacity of people should be assessed and how this impacted on people’s daily lives.

The nutritional needs of people were taken into account and people were encouraged to follow a healthy eating lifestyle and staff supported them in this.

People told us that the staff team were caring. Staff were aware how the privacy of people of people should be promoted and how confidentiality in respect of personal information could be maintained.

People received information on how they were to be supported and felt involved in the planning of their support.

Care plans were personalised, up to date and presented in a format which assisted people to understand the support they should receive. People felt that they were in control of their support. People were able to pursue work and educational activities with staff support. People knew how to make a complaint.

The registered provider assessed the quality of the support they provided and enabled people who used the service to comment on the standard of support.

The registered provider co-operated with external agencies and sought accreditation from agencies who championed the needs of people who used the service.

We spoke to seven people who used the service who told us they were happy with the support they received. They described the staff positively and said that they listened to them and gave them the support they needed. They told us about a range of things they did with the support of staff which indicated that staff were supporting people to access leisure services, make choices, develop their social skills and to use their independent living skills. Some comments made were:-

“The staff are marvellous. They give me the support I need.”

“The staff are always here to help you. The staff are amazing.”

”It’s a lovely place to be. If I have any worries or fears I can talk to staff.”

We spoke to one relative and one service commissioner who told us they were happy with the service and that a good standard of care was provided.

We found that records showed that the people who used the service had a support plan in place detailing the support they needed and how staff were to minimise risks to their well-being.

People’s nutritional needs were supported.

Staff were supported in their role through the training and on-going support provided.

There were systems in place to respond to complaints and to take appropriate action when necessary.

There were systems in place to ensure records were appropriately managed.

We used a number of different methods to help us understand the experiences of people supported by Support 2 Independence. We were able to speak individually with two of the people who received support who told us they were happy with the support provided to them by Support 2 Independence. Some comments made were, “I am happy” and “I get a lot of support, I need it”. We also spoke with two relatives, who commented:

“They are absolutely brilliant, nothing is too much trouble”.

“To find someone like this is gold dust, they actually care”.

We found people were treated respectfully and given support to have their say in how they wanted to be helped and were supported to do the things they wanted to do.

The people who accessed the service provided by Support 2 Independence were cared for by staff who were appropriately recruited, well trained and experienced at supporting them. The organisation monitored the quality of the service provided on a regular basis.