A single inspector carried out this inspection. Due to the complex needs of people using the service we were not always able to speak to people. To help us understand the experiences of people using the service, we observed staff providing support and we spoke with two staff and the manager about the people who used the service. This helped to answer five questions; Is the service caring? Is the service responsive? Is the service effective? Is the service well led.Below is a summary of what we found.
Is the service safe?
There were systems and processes, policies and procedures in place to support safe care delivery. Staff told us and we saw up to date risk management plans clearly documented in the personal support plans.
People who used the service appeared happy and comfortable in their surroundings. They appeared relaxed with the staff in their interactions with them.
There were systems in place to demonstrate the manager and staff recorded incidents, accidents, complaints and concerns. We saw examples where staff had learned from these events.
Staff we spoke with told us they had received training in administration of medicines. They were able to describe in detail the procedure they followed when administering medicines. This assured us that people were protected against the risks associated with medicines.
Recruitment procedures were thorough. We also found staff were supported and monitored in their working practice. Training, supervision and appraisal programmes were in place.
We saw food stored in the fridge that had been opened, but not dated or labelled. We asked the provider to address this practice immediately.
Is the service effective?
People's health and care plans had been assessed and reviewed and care plans were in place. There was evidence of people and their relatives being involved in assessments of their needs and care planning.
Mencap dependency ratings were in place for all people who used the service. This is a system where each person's level of dependency is rated to assist staff to identify the level of care each person needs. Specialist dietary needs were assessed, waterlow scores were being recorded, weekly weight checks were being completed and falls assessments were in place.
Some of the care plan reviews we saw were a few weeks overdue overdue. There was evidence that some information held in the health care file had not been transferred to the personal support plan. The provider told us they would update their documentation immediately to address this omission.
Is the service caring?
Our observations of the service showed care staff spoke with and interacted with people in a patient and pleasant manner. Care staff supported people in a sensitive way using differing methods of communication to ensure people understood what was going to happen.
People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey, and staff acted on concerns raised.
Our observations of the service showed people were involved in a wide range of community-based activities tailored to meet their individual needs. We saw evidence people and their relatives were being listened to and their views and choices were taken into account.
One person told us: 'staff are good here.'
Is the service responsive?
Complaints procedures were found in each person's care file. Staff were aware they could make a complaint if they wanted to. They told us that if they needed to make a complaint, they felt the manager would act on their concerns.
We looked at incident and accident forms. We saw the completed forms were forwarded to the area manager. We saw any investigations required as a result of an incident had taken place in a timely manner. We saw recommendations had been acted on. This assured us that investigations had been thorough and completed in line with the provider's policy.
Is the service well-led?
The staff we spoke with said the manager was very supportive and approachable. They told us if they had any concerns or witnessed poor practice they would report their concerns to. They were confident managers would act on their concerns.
The service had quality assurance systems in place. Records showed any shortfalls identified during audits had been addressed. There were systems in place to ensure staff were able to give feedback to their managers. These systems included: supervision, appraisal, staff meetings and managers meetings. This assured us that staff knowledge and experience was being taken into account on an on-going basis.