United Response is a domiciliary care service providing supported living to people in their own homes. They support people living in multi occupancy accommodation, single dwellings and those living with family (outreach support). The service supports adults who have learning disabilities, physical disabilities and mental health needs. Although it supports people with complex health needs, it does not provide nursing care. The support provided aims to enable people to live as independently as possible. At the time of the inspection there were 21 people receiving a personal care service. Some people required 24 hour support which was provided by the service.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good overall although people received responsive care that was outstanding. This was because the service provided highly personalised care that identified people’s individual’s goals and aspirations. People received support to live a meaningful life that created opportunities to access work, the community and social events. Staff enabled people to achieve skills that would improve their quality of life.

Why the service is rated good:

Staffing levels were safe to meet people’s needs. The staff team were trained and received support from the management.

Staff were kind and caring. People felt staff respected their privacy and gave them choice and control about their care and support.

Medicines were stored and administered safely. Risk assessments were in place to support people safely whilst ensuring people’s independence was retained. Staff were knowledgeable about how to safeguard people from abuse.

People’s health needs were met and people benefited from support from staff relating to all medical and well-being appointments.

Care plans were person centred and gave clear guidance to staff on how to support people. Feedback was sought from people, relatives and professionals. Systems were in place to monitor and improve the quality of the service.

The service had a positive and person centred culture. People were at the centre of the service and were involved with interviews and the local community. Positive feedback was received about the registered manager from people, relatives and staff.

We undertook an announced inspection of United Response on Thursday 18 December 2014. We told the provider on Monday 15th December 2014 that we would be coming. This service had not been previously inspected since registering with the Commission in June 2013.

United Response is a national charity which supports people who have a learning disability, mental health needs or any physical disabilities. They help with financial support, personal care, community activities or in getting a job. The service supports people to be as independent as possible, live how they want to live and to take control of their lives. This United Response branch of the charity is situated in Nailsea and provides help and support to people in the close surrounding area.

The service provides supported living services. Supported living services involve a person living in their own home and receiving care and/or support in order to promote their independence. The care they receive is regulated by the Commission, but the accommodation is not. At the time of our inspection the service was providing personal care and support to 13 people. There were other people who received support from the service but the level of support they required is not regulated by the Commission.

A registered manager was in post at the time of 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.

Although we received positive comments about the registered manager from some people’s relatives, we found the service had not communicated the management structure to people’s relatives and there was not a clear understanding of this and who was responsible for the management of the service. The registered manager was unable to demonstrate a comprehensive understanding of all of the people the service were responsible for providing care to.

People told us they felt their relatives were safe with the staff employed by the service and the provider had made appropriate arrangements to identify and respond to allegations of abuse. Staff knew how to respond to abuse both internally and externally. The provider had a safeguarding and whistleblowing policy for staff that gave guidance on the identification and reporting of suspected abuse.

People’s relatives said the staffing levels were sufficient and staff told us told us the current staffing arrangements met people’s needs. We received mixed comments from people’s relatives about agency support staff used by the service. The area manager explained the service was currently recruiting to reduce the use of agency staff. The provider had suitable recruitment processes in operation.

People received their medicines on time. There were arrangements in place for the ordering and disposal of medicines which promoted people’s independence. People’s medicines were stored correctly and risk assessments were in place to help ensure people’s safety. Medicines records had been completed appropriately and the provider had an auditing system to monitor people’s medicines.

People’s relatives spoke highly of the staff at the service and praised the level of care provided by the staff. Staff felt they received sufficient training and the provider had a staff appraisal and supervision process and staff told us they felt supported. An induction process was undertaken by new staff to ensure they had sufficient knowledge and skills to provide care to people.

Staff demonstrated they understood their obligations under the Mental Capacity Act 2005 and how it had an impact on their work. They told us they supported people to make safe and informed decisions. Within people’s care records, we found the service had acted in accordance with legal requirements when decisions were made when people lacked mental capacity to make that decision themselves.

There were reviews of people’s health and care needs and people accessed healthcare professionals where required. Records demonstrated staff had responded promptly when a concern had arisen about people’s health and appropriate referrals were made.

People’s relatives praised the caring nature of the staff at the service. People and their relatives were involved in the planning of their care and support. Where necessary, people’s relatives were involved in decisions about the care package people received and spoke positively about the communication from staff within the service. People’s care records reflected people’s involvement and the decisions made in their care planning.

People’s relatives told us the care provided met the needs of the person who received it. We saw within people’s care records significant information was recorded about people. This included how they liked to be supported, what was important to them and how to support them if they became anxious and displayed behaviour that may be challenging. The provider had a complaints procedure and people said they felt confident they could complain should the need arise.

There were systems in place to obtain the views of people who used the service and their relatives. A staff survey had been undertaken by the provider and staff generally commented positively about their employment in the results. The registered manager had an auditing system to monitor the service provision and safety.