About the service: This service is a domiciliary care agency providing personal care to younger adults and older people. The service specialises in supporting people with a learning disability or autistic spectrum disorder, a physical disability or who may be living with dementia. Thirty-six younger adults and older people were receiving support at the time of this inspection.

People's experience of using this service: People were happy with the support staff provided. Staff were kind and caring; they provided person-centred care to meet people’s needs.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the ways staff promoted inclusion, choice and control and supported people to gain new skills and become more independent.

People told us they felt safe or acted in a way which showed us they were comfortable and at ease with the support that staff provided. Staffing levels met people’s assessed needs. Staff had been trained to recognise and respond to risks and signs of abuse. People felt comfortable speaking with staff if they were worried, concerned or needed to make a complaint.

Staff understood people’s needs and the risks to their safety. Risk assessments guided staff on how to safely meet people’s needs.

We have made a recommendation about recording more consistently detailed information about how accidents and incidents were managed.

Staff spoke with people in respectful way and supported people to maintain their dignity. People routinely made choices about their care and support. Staff understood the importance of consent; people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

We have made a recommendation about developing documentation in relation to mental capacity assessments and best interest decisions.

Staff had regular training, and a system of supervisions and appraisals helped the registered manager to monitor their performance and support their professional development.

Care plans provided detailed information about people’s needs to support staff to provide person-centred care. Plans were in place to guide staff on how best to support people who might become anxious or upset. Staff worked with professionals and responded to their advice to make sure people’s needs were met.

Staff supported people to take part in regular meaningful activities and to pursue their hobbies and interests.

The registered manager used audits to monitor the quality and safety of the service. They listened to people’s feedback and responded to issues and concerns to continually improve the service.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection: At the last inspection service was rated requires improvement (report published 26 February 2018).

Why we inspected: This was a planned inspection based on the pervious rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The Wilf Ward Family Trust Domiciliary Care Harrogate and Northallerton is a domiciliary care agency. They provide personal care to younger adults and older people. The service specialises in supporting people who may be living with a physical disability, learning disability or autistic spectrum disorder.

The service provides care and support to people living in 14 ‘supported living’ settings so that they can live as independently as possible. In supported living, people’s care and housing are provided under separate contractual agreements. The Care Quality Commission (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 38 younger adults and older people using the service. People who used the service lived in a mixture of bungalows and ‘houses of multiple occupation’ across Harrogate, Knaresborough, Ripon and Northallerton. Houses of multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. Some supported living houses included accommodation for staff who were available to provide support throughout the day and night if needed. The personal care service provided in these supported living houses was managed from offices in Ripon.

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.

Inspection site visit activity started on 23 November 2017 and ended on 8 December 2017. This was our first inspection of this service since it was registered at a new location in December 2016. The service was previously inspected when registered at a different location and was rated ‘Good’ in December 2015.

At the time of our inspection, the service had a registered manager. They had been the registered manager since December 2016. 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.

During this inspection we found examples where risk assessments required more specific guidance on how risks should be managed. People were supported to take their prescribed medicines. Protocols for medicines prescribed to be taken only when needed did not consistently contain important information to guide staff on when to administer them.

We made a recommendation about developing record keeping in relation to mental capacity assessments and best interest decisions.

We received positive feedback about the skills and experience of staff and saw courses were planned to update gaps in staff training. Appraisals and supervisions (known as ‘staff development sessions’) had not been consistently completed as frequently as was required under the provider’s policies and procedures.

Whilst audits had been completed and continuous improvements plans were in place, work was on-going to address the issues the provider had identified. At the time of our inspection, further progress was needed to address the variations and inconsistencies we found across the supported living services.

People told us they felt safe using the service. Staff understood their responsibilities to safeguard people from abuse or neglect. Sufficient staff were deployed to meet people’s needs.

People told us staff were kind and caring. We observed staff provided person-centred care and were attentive to people’s needs. Staff supported people to maintain their privacy and dignity. People said staff listened to them and respected their decisions. We observed staff routinely offered people choices and encouraged them to make decisions. Staff promoted people’s indep