The inspection was carried out on 22 & 27 February 2017. We gave the registered manager 48 hours’ notice of the inspection in order to ensure people we needed to speak to were available.

At the last inspection in January 2015 the service was rated as Good. At this inspection we found that the service remained Good.

A registered manager was 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.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Recruitment checks were carried out to ensure suitable people were employed to work at the agency. Our observations and discussions with staff and people who worked for the agency confirmed there were sufficient staff to care for and support people, some having complex needs.

Health care needs were met through peoples’ GPs and the district nursing service when required. We saw that medicines were administered safety and all the records were up date and audited regularly. All staff had completed training in the safe handling of medicines.

Observations during our inspection evidenced people were given choices about how they wanted to be supported and live their lives. Opportunities were given to people to go out into the community, visit their families and go on holiday.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice. This helped to protect the rights of people who were not able to make important decisions themselves.

Support staff knew the people they cared for well. They provided a caring environment for people to live in. People were treated in a dignified manner with their privacy upheld at all times.

Personalised care plans were in place in a format that was suitable through pictures and symbols as well as writing. Care plans were person centred and regularly reviewed to ensure they reflected people's current needs and preferences

People who used the service had a voice through regular visits by the members of the management team to each of the houses. Procedures were in place to investigate and respond to any concerns raised.

There were effective monitoring systems in place to assure quality and identify any potential improvements to the service. This meant people benefited from a constantly improving service.

People told us that they were more than satisfied with the care and support they received.

"I am quite happy. I go out shopping and I go to church and I help out around the house. I love the staff."

"We are happy with the care...we get an early call and all the staff are very good."

"They gave us support ...and helped me through the death of my partner...they are wonderful."

"Since I moved to these flats my life has completely changed and I now have a little job and I go out more and I am much more independent."

We looked at the way any allegations of harm and abuse were managed. We had evidence to show that the management team of this service understood their responsibilities. All of the staff who worked in the service had received training in safeguarding.

We checked on the records of medication and found that these were in order. The management team completed regular audits of medicines managed on behalf of people.

We had evidence to show that staff were suitably trained and supported to do their job.

We look at a wide variety of records and we found these to be kept securely, were up-to-date and detailed.

We learned that people in this service were given suitable levels of care and support. We had evidence to show that they were asked about consent to the way care was delivered and that people were given support when they found decision making problematic.

People who used services were helped with the kind of physical, psychological and psychiatric care necessary for their needs. They were also given lots of encouragement to be as independent as possible and to have the kind of varied and fulfilling lifestyles they wanted.

People told us:

"Most of the staff are really good...they let me do as much as I can for myself."

"The staff conform to what I ask for...I asked for mature staff and they are! They understand what I need...I have the kind of service I want."

The main office for the service was suitable but we asked the provider to consider whether they needed to register some of the other offices they have in the Carlisle area as separate locations.

Staff were recruited appropriately and all necessary checks completed so that vulnerable people were protected from harm. We also had evidence to show that there were enough skilled and experienced staff to provide care to people.

People told us:

"New staff shadow a more experienced member of staff.They are taught how to support me and they learn fast."

"New staff do lack experience...but they get trained. The manager brings new people up to speed quickly."

Complaints were managed appropriately.

We met a number of people who live in a block of flats in Carlisle. They have been receiving support from Walsingham (and other agencies) since autumn 2010 and most of them had previously lived in residential care.

They were very positive about the radical change to their lifestyle and to the support given by Walsingham staff.

"The staff are brilliant".

"I manage a lot by myself now...just need reminders and a bit of support. I have been out to nightclubs with my support worker and am going to do my Christmas shopping at the Metro Centre...".

"At the last place I only went out once every six to eight weeks ...now I go out at least three times a week."

"I have poor sight and the staff here know how to guide me correctly and I feel safe going out with them and they have helped me to get a white stick and learn how to use it properly. I also have my own computer now."

"I am working at my own pace on a care plan that will help me build my future."

This announced inspection took place over two days the 11th December 2014 and the 20th January 2015. The provider was given 48 hours’ notice of the first visit because the location provides a supported living service for people with a variety of needs including, learning disabilities, mental health conditions, physical disabilities and sensory impairments. As the people who used this service often accessed community activities we needed to make sure people were available to speak to us. This service also provides personal care and support to older people living in their own homes.

During our previous inspection visit on the 12 October 2013 we found the service met all the national standards we looked at. Since then there had been no incidents or concerns raised that needed investigation.

There was a registered manager in post on the day of our inspection visit. 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.

The inspection team consisted of one adult social care inspector and an expert by experience. An expert by experience is a person who has used or has experience of the care of people with complex needs.

We found that people who used this service were safe. The support workers knew how to protect people from harm. All staff had completed training in the safety of vulnerable adults and knew the signs to look for and how to report any incidents of concern. There were good systems to ensure people knew the staff that supported them.

Walsingham, the registered provider, had put in place robust recruitment procedures to ensure only suitable people worked in this service. We saw that staffing levels were good throughout all areas of the service. Staff training was up to date. All staff were supported by the management team through regular staff supervision and appraisals.

We found that the service worked well with external agencies such as social services, other care providers and mental health professionals to provide appropriate care to meet people’s physical and emotional needs.

We saw that medicines were administered safety and all the records were up date and audited regularly. All staff had completed training in the safe handling of medicines.

Observations during our inspection evidenced people were given choices about how they wanted to be supported and live their lives. Opportunities were given to people to go out into the community, visit their families and go on holiday.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice. This helped to protect the rights of people who were not able to make important decisions themselves. Best interest meetings were held to assist people who were not always able consent and make difficult decisions for themselves.

Healthcare needs were met through close working relationships with the GPs and district nursing service. Access to external mental health professional services was available.

Support staff knew the people they supported well. They provided a caring environment for people to live in. We saw people being treated in a dignified manner with their privacy upheld at all times.

Personalised care plans were in place in a format that was suitable through pictures and symbols as well as writing. People who used the service had a voice through regular tenants meetings held in each of the houses.

There was an appropriate internal quality monitoring procedure in place. Checks or audits were completed in respect of personal finances, medicines management, care plans health and safety and equality and diversity. These checks ensured people were cared for and supported in the way they wanted to be.