Nottingham Regional Office

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service has two registered managers, one of which was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. Each of the 'sites' was managed by a service manager who reported directly to one of the two registered managers.

This is the service's second inspection under its current registration. In our previous inspection the service received a rating of 'Good' overall. After this inspection, the service has retained this rating.

Prior to the inspection we had received concerns that some people may have experienced neglect or avoidable harm at the service. During this inspection we reviewed these incidents with the registered manager and found they had taken the appropriate action in relation to these incidents. Most of these incidents were not substantiated, where inappropriate staff action had taken place, this was dealt with through disciplinary or dismissal. We concluded that the provider had the appropriate systems and staff in place to protect people from neglect and avoidable harm.

People had detailed risk assessments that were designed to support people to lead active lives, without unnecessary restrictions, whilst keeping them safe. Most of these were up to date and where they were not, action was taken to address this. People had the support of staff to keep them safe and lead their lives in the way they wanted to. People's medicines were managed safely and staff followed procedures to protect people from the risk of the spread of infection. Processes were in place to ensure if accidents or incidents occurred, they were investigated and preventative measures put in place to minimise the risk of recurrence.

People's received care and support in line with current legislation and best practice guidelines. Staff were well trained and received regular supervision of their role. People were supported to lead healthy lives and

this included making healthy food choices. Effective relationships with external health and social care organisations were in place to ensure people's health was regularly monitored. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People liked the staff and had formed positive relationships with them. Staff treated people with respect and dignity and people were supported to make decisions about their care and support. Advocates were made available if people needed further support. People's diverse needs were considered when care and support was planned for them. People's records were handled appropriately and in line with the Data Protection Act.

People's support records reflected their personal preferences and focused on supporting people's independence. Where a small number of these support records needed updating, the registered manager had acted to ensure this was done. Transition arrangements for people joining the service were effective and well planned. Formal complaints had been responded to appropriately. Information was provided for people in a way they could understand. End of life care was not currently provided; however, efforts had been made to support people with making informed choices about their wishes for end of life care.

People liked where they lived and felt they received the support from staff that they needed. Each service manager that we met, spoke enthusiastically about improving people's lives. The registered managers had a good oversight of each of their sites and took swift action to address any areas of concern. Staff felt valued and could give their views about the direction of service. People were offered the opportunity to comment on the development of their service. Robust quality assurance processes were in place which enabled regular monitoring of each sites performance.

The five questions we ask about services and what we found