The Moorings Supported Living Service was inspected on the 09 October 2018 and the inspection was announced.

This service provides care and support to people living in a ‘supported living’ setting, so that they can live 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. People using the service lived in their own individual apartments which were in one housing development near the village of Garstang. Car parking is available at the development and there is access for people who have mobility challenges.

The care 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection in August and September 2017 the service was rated as ‘Requires improvement’. We identified a breach of Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) 2014. We found systems were not operated effectively to ensure medicines were managed safely. We also found staff did not receive annual reviews of their performance. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, the Care Quality Commission is required to be notified of certain occurrences. We found a notification had not been provided to us in a timely manner. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We took regulatory action and served requirement notices for these breaches in regulation. We asked the registered provider to take action to make improvements to the areas we identified. The registered provider sent us an action plan which indicated improvements would be completed by December 2017.

At this inspection in October 2018, we found improvements had been made. Medicines were managed safely and staff received annual appraisals. We found notifications were provided to the Care Quality Commission (CQC) in a timely manner.

At the time of the inspection visit there was a manager in place 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.

Recruitment checks were carried out to ensure suitable people were employed to work at the service and training was provided to enable staff to maintain and increase their skills and knowledge.

Care records contained information regarding risks and guidance for staff on how risks were to be managed. We found information in two care records required updating as further information was required regarding the needs of the people they related to. The registered manager could demonstrate the records were in the process of being updated.

The registered manager told us they did not currently provide end of life care at the service. They explained that should this be required a policy was available to guide staff.

People told us they were supported to access medical advice from external healthcare professionals and their healthcare needs were met. Documentation we viewed confirmed this. People and relatives told us they were happy with the care at support provided by The Moorings Supported Living Service.

People told us they could raise their views with staff and these were listened to. The registered manager told us they sought verbal feedback from people who used the service and meetings were held with them

This comprehensive inspection was carried out on the 30 August and 07 September 2017. As the agency is small we gave 24 hours' notice of our inspection. This was because the registered manager has responsibility for other care services and we needed to ensure they were available to speak with us.

The Moorings Supported Living Service is situated on a private development on the outskirts of Garstang and provides support for twelve people who require assistance due to physical or other disabilities. People who use the service live in independent apartments on the development. Care and support is provided by Leonard Cheshire Domiciliary support services.

People who use the service are facilitated to live independently through the 24 hour on site support service available to them.

There was a registered manager in place. 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 inspected The Moorings Supported Living Service in August 2014. We identified no breaches in the regulations we looked at.

During this inspection visit carried out in August and September 2017 we asked people if they felt safe. People we spoke with told us they did. However, systems were not operated effectively to ensure medicines were managed safely. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We checked to see if staff were supported in their role. Staff told us they received supervisions to enable them to discuss any concerns. They told us they did not have annual reviews of their performance and they would welcome these. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Care Quality Commission is required to be notified of certain occurrences. We found a notification had not been provided to us in a timely manner. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We looked at the auditing systems used by the service to drive improvement. We found checks on medicines, care records and the environment were carried out. We saw evidence that accidents and incidents were monitored and the registered manager could explain actions taken to minimise reoccurrence. However, the audit system in place had not identified the lack of submission of the required notification to the CQC or that staff required refresher training and competency assessments for supporting people with their medicines. We have made a recommendation regarding this.

We discussed staffing with people who used the service. They told us staff were busy and at times they had to wait for support. People also said they had noticed a lot of new staff. One person said, “There’s a lot of agency here.” Relatives we spoke with also told us they felt a lot of agency staff were used. The registered manager told us they were actively recruiting staff and looking at ways of improving staff retention. We have made a recommendation regarding this.

The registered manager provided guidance and advice by visiting the service and providing on- call support. We have made a recommendation regarding this.

We reviewed staff files and found there were processes that ensured staff were suitably recruited.

During the inspection visit we found some documentation required further information regarding people’s needs. We raised this with the registered manager. Prior to the inspection concluding we were informed documentation had been updated.

People told us they were involved in their care planning and we saw documentation in care records which confirmed this.

We checked to see if people without mental capacity were lawfully depri

People told us:

"I think it's fantastic here!...I get the support I need...I'm encouraged to be independent."

"Staff always knock before they come in and ask before they start to do anything...They encourage me to do things myself...Staff do what i need them to do...I'm very well supported."

We found people gave their consent before any support was delivered to them. Staff had been trained on the Mental Capacity Act 2005 and were aware of their responsibilities.

People's needs were properly assessed and person centred plans of support were drawn up following consultation with people, their families and other people involved in their care. People spoke positively about the support they received and told us their needs were being met.

Medicines were managed appropriately. The service ensured staff underwent training and assessed them to ensure that people were protected against the risks of inappropriate administration of medication.

The provider had comprehensive policies and procedures in place which we saw were followed in practice with regard to ensuring staff were suitable for the role. People felt staff were supportive and knew what they were doing.

We found there were systems in place to monitor and assess the quality of the service provided for people. These measures helped to ensure that people were safe and the service was meeting their needs. This included a comprehensive complaints policy and regular meetings with people.

People we spoke to told us they were very satisfied with the level of care they receive from their support workers. Comments included, “I haven't been here long but the care I get is very good", " I have my own key worker and other volunteers to help me do things in my home and when I go out".

Staff we spoke to told us they enjoy their jobs and feel it is very rewarding. Comments included, "I have worked for the agency for some time and feel we work well together as a team". " We get to know the needs of people using the service and we work well with them"

We spent time with a number of people using the service. They told us they like the fact they can call upon staff if they need to and feel secure in the knowledge there are always agency staff in the building.

People we spoke to told us they think staff respect their privacy and dignity, by always calling or knocking on doors before entering. We saw this occur during our visit.

People told us that whilst they have designated times allocated for various tasks, staff are flexible and changes can be made if necessary, so people have some choice.

One person we spoke to has only recently come to live as a tenant. They told us they thought the manager and staff have been very helpful in assisting them to settle into the apartment. "They have been really helpful with all the changes I have gone through".

People told us they feel they are safe and secure using the service. "I trust the staff totally". People using the service told us staff were very kind and treated them well.

Staff we spoke to told us they have received training in safeguarding people and this is part of the agencies mandatory training programme. They told us they felt confident about using the procedures available to them should they suspect abuse of any kind had taken place.

People we spoke to told us that they are often asked for feedback about the care and treatment they are receiving, "I am often asked about things, and I can fill in a feedback form in my care plan", " We have meetings where we can say things about the service if we want to, some of us do and some never say anything, but I think they listen to us".

Staff told us they gain information about people using the agency formally through records and informally by talking to people. “We talk to people about all sorts of things and they usually like to share things with you".

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This inspection was a routine scheduled inspection and was announced.

Previous inspections had been carried out in December 2012 and August 2013. No concerns were identified and we found the service was meeting all standards inspected at that time.

The Moorings Supported Living Service is situated on a private development on the outskirts of Garstang. It is a modern development of 12 two-bedroom, fully accessible flats contained in one building. The service, under the umbrella of Leonard Cheshire Domiciliary support services provide support for the12 people, who live there under their own tenancy agreements and require support due to physical or other disabilities. Care and support is provided by staff who work from an office on the ground floor of the same development and rented from the same landlord as the tenants.

During the visit, we spoke with five people who used the service, four support staff and the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.

Not all of the people we spoke with told us they felt safe. People were happy and felt safe with the care and support provided but there had been one ongoing issue which had caused two people not to feel safe. We saw good evidence of proactive measures taken by the registered manager to address this concern with the landlord and other agencies responsible. Steps had been taken to reassure people they were safe. Staff we spoke with had received training in the safeguarding of vulnerable adults and were able to tell us what they would do if they witnessed or had allegations of abuse or bad practice reported to them.

The registered manager and staff demonstrated a good understanding of the legal requirements of the Mental Capacity Act 2005 (MCA), and we saw evidence where this had been used. This meant the rights of people who lacked capacity to make decisions about their care were protected.

We found staffing levels were adequate to meet people’s needs. There had been a high usage of agency staff due to unavoidable staff absences. Some people we spoke with raised concerns about this but the provider of the service was able to demonstrate to us that new permanent staff had been recruited and people had returned to their posts. Robust recruitment procedures were in place which enabled the service to check on the background of staff before they were allowed to work with vulnerable people.

Staff had been trained to handle medication and care plans gave detailed information about individuals’ medication requirements. Records and audits were in place which ensured people received their medication in a safe manner.

People’s needs were assessed, planned and delivered in line with their individual care needs. The support plans contained a good level of information and were focussed on the person’s indivual needs. Staff we spoke with knew people well. People who used the service were happy with the care and support received and confirmed staff had sufficient knowledge about them. As people who used the service lived in their own flats it was difficult to fully observe support provided. Those people who we did see receive support were treated with dignity and respect.

We observed interactions between staff and people using the service were kind and respectful. Staff told us they enjoyed their jobs and said they were well supported within their roles. Not all staff had received regular formal supervision or appraisals. The registered manager had made us aware about this in the information provided prior to the inspection. We were shown a schedule and plan to resolve this however it was ongoing and some staff had yet to receive formal support.

We saw people were assisted to attend routine health appointments. The service worked well with other agencies and visiting professionals to provide continuing specialist support for people who used the service. This meant that when people’s needs changed, referrals were made quickly to other relevant health services. Each care plan that we looked at contained a detailed record of professional contacts and visits.

People who used the service held tenancy agreements with a housing association for their own flats which meant there were no restrictions for relatives and other visitors to people who used the service. Customer surveys were distributed on an annual basis, and the service had several methods of obtaining the views of people who lived at The Moorings.

All of the people we spoke with during our inspection knew how to make a compliant and had been given sufficient information about the process.

People who used the service all knew who the registered manager was and referred to this person by their first name. Staff we spoke with told us the registered manager was always available. The Moorings sat under the umbrella organisation of Leonard Cheshire Disability and as such the support of the larger organisation was always available for staff and people who used the service alike.

The registered manager informed us regular checks of the service were undertaken by the national quality assurance team from Leonard Cheshire. The registered manager used a range of checks and audits to ensure the quality of the service provided.