3 Trees Community Support

This service is a domiciliary care agency. Some people using the service live in a 'supported living' setting, so that they can live in their own home 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. Other people using the service lived at home with their family.

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.

There was a registered manager in place. 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 service was Outstanding in its responsiveness to people's individual needs and preferences. Staff had in depth knowledge of the people they supported, enabling them to deliver a highly person centred service. Working with people's particular communication needs and with understanding of their particular behaviours, staff supported people to manage their anxieties and related behaviours.

Staff were kind and caring and proud of the achievements of the people they supported. People were treated with dignity and respect and given privacy when they wanted it.

People using the service were safe. There were sufficient staff to meet people's needs. Where there were gaps in rotas, these were covered by existing staff so that no agency staff were used. There was a positive approach to risk taking, which meant people didn't experience necessary restrictions in their lives. For one person, staff had worked with the police and local shopkeeper to help make the local environment safe for them to go out independently. Support was given for those people who were prescribed medicines. When these were administered, it was recorded on a Medicine Administration Record (MAR) chart.

The service effectively met people's health needs, working with healthcare professionals when necessary. People were supported nutritionally to maintain a healthy diet and weight. For some people this involved working with the community dietician. People's rights were met in line with the Mental Capacity Act 2005 (MCA). We viewed records of Mental Capacity Assessments and Best Interests decisions.

Staff were well supported in their work, attending supervision regularly. They told us they felt able to raise issues and concerns and that senior staff were approachable. Staff were also positive about the training they received. They told us the training enabled them to meet the complex needs of people they supported. The provider demonstrated the importance they placed on training by sending staff on 'train the trainer' training for certain topics that were difficult to find courses for.

The service was well led. The registered manager and directors were involved at all levels of the organisation. There was a culture of continual improvement within the service and the provider had clear ideas about how they wanted to improve. There were systems in place to monitor the quality of the service provided.

The five questions we ask about services and what we found