Voyage (DCA) Warwickshire provides care and support to people living in 14 ‘supported living’ settings, 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 at 27 individual flats within two supported living complexes and at 12 additional one, two or three bedroomed houses and flats across Warwickshire.

Not everyone using Voyage (DCA) Warwickshire receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. Thirty-eight people were receiving support with the regulated activity of Personal care at the time of our inspection visit.

At the last inspection in December 2015, the service was rated Good overall and in safe, effective caring and responsive. Well-led was rated as Requires Improvement. At this inspection we found the service remained Good in safe, effective, caring and responsive, and had improved from Requires Improvement to Good in well-led. The overall rating remains Good.

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.

Since our previous inspection in December 2015, we have reviewed and refined our assessment framework, which was published in October 2017. Under the new framework certain key areas have moved, such as support for people when behaviour challenges, which has moved from Effective to Safe. Therefore, for this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.

The provider had taken action to improve the management and governance of the service since our previous inspection. Their improvement plan included the dates the improvements would be completed by and named the member of management responsible for ensuring the agreed actions were taken.

The provider had implemented a revised management structure that ensured senior staff were supported to carry out regular quality assurance checks at a specified number of properties. Any issues identified during the audits were collated into a service-wide action plan to enable the whole staff team to learn from each other’s practice.

The provider has supported the registered manager with a recruitment campaign, which had reduced the level of staff vacancies and the need to use agency staff, and thereby minimised the risks of medicines errors. Medicines management and administration was subject to daily, weekly and monthly checks, to ensure any errors, omissions were identified and acted on promptly.

Field support supervisors had been appointed, with defined responsibilities for quality assurance work and supervision of support workers. The provider had implemented an electronic call monitoring system that ensured they knew immediately whether staff had arrived at people’s homes as planned.

People were protected from the risks of abuse because support workers were trained in recognising and reporting any safeguarding concerns. The provider checked support workers were suitable for their role before they started working for the service and made sure there were enough support workers to support people as agreed.

Risks to people’s individual health and wellbeing were identified with the person and their representative and care was planned to minimise the identified risks. People had health action

The inspection was announced and took place on 31 December 2015 and 4 January 2016.

Voyage 1 Limited, is a large provider of care services. Stretton Lodge, is Voyage 1 Limited’s office for its 21 domiciliary care and supported living services provided to people living in Nuneaton, Warwickshire and Stratford upon Avon. The agency provides personal care and support to 41 people in their own homes. The length of care and support hours provided depends upon people’s individual needs, and ranges from 4 hours per week to twenty-four hours daily supported living.

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.

Staff understood their responsibilities to keep people safe and protect them from harm. Staff understood how to raise concerns if following the provider’s safeguarding and whistleblowing policies. The registered manager assessed risks to people’s health and welfare and people’s care records included the actions staff should take to reduce the risk of harm to people.

The provider had faced some challenges with recruitment which meant that agency staff were used to cover a weekly average of 276 care and support hours of the total 3437 weekly care hours provided to people. Plans were in place to recruit further staff to fill the remaining six care staff vacancies.

People told us they had their prescribed medicines available to them and staff supported them to take them. Staff had received further training to refresh their knowledge in the safe handling, administering and recording of people’s medicines.

Staff read people’s care plans and received an induction and training so that they were able to effectively meet people’s needs. Staff felt improvement had been made to the level of detail in people’s care plans and provided them with the information they needed.

The registered manager and senior staff understood their responsibility to comply with the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). Some people supported had complex needs and we saw their families and other health care professionals were involved in making decisions in their best interests.

People were supported with their grocery shopping, to prepare meals and to eat and drink according to their needs. Staff supported people to access healthcare appointments to maintain their wellbeing.

Staff knew about people’s individual likes and dislikes and how they liked to spend their time. Staff were described to us by people as kind and caring. People’s care records told staff how to promote people’s independence whenever possible.

People and their relatives were involved in planning and reviewing care and support. Care was planned to meet individual needs and was person centred.

People’s feedback on the service provided had not been sought by the provider. However, people were asked by staff if they were happy with the care and support they received. People and relatives told us they felt they could raise concerns or complaints if they needed to.

Concerns had been shared with us from the local authority about the provider and we received notifications. These concerns related to a high number of medication errors, medication recording errors and lack of detail in people’s care records. The provider had worked closely with the local authority to agreed action plans to implement improvement. Some improvement had been made and further improvement was planned for.