We undertook an inspection of Avondown House on the 31 January and the 2 February 2018. The inspection was announced, which meant that the provider knew we would be visiting. This is because we wanted to ensure that the provider, or someone who could act on their behalf, would be available to support the inspection. The service registered to provide a regulated activity with the Care Quality Commission in October 2011.

At the last inspection the service was rated as Good. At this inspection we found the service remained Good.

Audits were undertaken although some changes to the management structure meant that shift leaders were now responsible for the auditing of care plans and medicines administration. Audits undertaken had identified shortfalls and actions although we found some shortfalls during the inspection.

The service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

At the time of the inspection there were five extra care buildings. These were Avondown House, Hawthorne Court, St Johns Court, Greenacres Court and The Orchard. During this inspection we visited Avondown House and Hawthorne Court.

We raised with the registered manager that the other sheltered housing schemes where the provider supported people with care could be a location and require registering with us. This matter is being dealt with separately from this inspection.

A registered manager was in post at the time of our inspection. 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.

People felt they were not always familiar with the staff who visited them however people received their calls when required.

People were supported by staff who had checks undertaken prior to starting their employment.

People felt safe and were supported by staff who were able to identify abuse and knew who to go to should they have concerns. Risk assessments identified any concerns and any actions to reduce the risk.

Staff had access to personal protective equipment and wore an ID badge and uniform.

People were supported by staff who had received training to ensure they were competent in their role. Additional training was identified and provided as and when required.

People’s care plans confirmed if people had capacity in different areas of their care.

Staff received supervision and an appraisal. People were supported by staff with their nutrition and hydration although people had mixed views on what was available to them.

People felt supported by staff who were nice and kind staff demonstrated a good understanding of equality and diversity and how to promote people’s independence.

People felt respected and confirmed they felt they had choice in their care although some people expressed a different choice in the gender of their carer this was not always respected.

People felt able to complain, no formal complaints had been received. Positive compliments had been received from family and staff who had left the service.

People and staff felt the management were supportive and accessible and felt able to raise concerns with them.

The inspection took place on 16 September 2015 and was announced. We gave the service 48 hours notice of the inspection. This was to ensure that people who lived at the service were available to meet with us and also that the registered manager and staff were available.

The service was last inspected in July 2014 and met with legal requirements at that time.

Avondown House is a sheltered housing service. Sirona are registered to provide a domiciliary care service to older people who live there. People are tenants in their own flats and receive personal care according to their needs from staff. We inspected the care service provided by Sirona.

There was a registered manager for the service. 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 provider had systems in place to minimise risks to people and to protect them from abuse.

People told us that all of the staff who visited them were always kind and caring in manner. People who lived at the service interacted in a positive and warm way with the staff who provided them with personal care and other support.

People were assisted with their needs by staff who were monitored and supervised in theirwork. People also benefited because they were supported by staff who were well trained to understand their needs.

People spoke highly about the care and support they received from the staff. Examples of comments we were told included, "They’re adaptable, they’re great” and "We are very happy, the carers are respectful that this is my home ".

Care records were informative and clearly showed what to do to effectively assist people with their personal care needs.

People were well supported to make complaints about the service the agency provided if they needed too.

There was a system in place to ensure that regular checks on the quality of care and service were carried out. If it was needed actions were put in place to improve the care and service people received.

We carried out this inspection in response to information of concern we had received via our website. The purpose of the inspection was to ensure people were being provided with an effective service by the provider.

We saw detailed person centred care plans were in place which had been signed by the people using the service. The care plans included the times and tasks which staff were allocated to help the person with. We discussed care plans with people who used the service and they all agreed their care plans reflected the services they received.

Staff were able, from time to time, to obtain further relevant qualifications. We talked with staff about their training. All the staff commented they thought the training was “excellent”, “really effective”, “the best available”.

We looked at the arrangement for staff training in relation to the management of medicines, and we viewed training records held on the service’s computer. These did not fully record the medicines training that staff had undertaken. The manager informed us the registered provider, Sirona, had introduced revised medicine training and that all staff had either completed, or were due to complete this by the end of 2014. We saw a record of the dates of this training.

We spoke with four people who used the service, one relative, four members of care staff, the acting manager and the registered manager.

One person who used the service said, “I have jolly good care from Sirona”. Another person said, “I am so well looked after” and commented that the best thing about their care was that they had autonomy.

Everyone we spoke with said they felt they were listened to and respected by staff and that they had been involved in drawing up their care plan. One person said, “The care plan is what I want”.

Another person who used the service said that sometimes the carers were rushed and sometimes they were late. Another person said they found that the carers “Will always go that extra mile”.

We found that Sirona Care and Health had systems in place to promote the welfare and safe care of people who used the service.

Sirona Health and Care had systems in place to promote successful partnership working with other health and social care service providers.

There had been no complaints this year to Sirona Care and Health’s customer care team about its service provision at Avondown House.

During the inspection, we met with five people who received a service from Avondown House, and reviewed their records. We also met with three of the care workers. We met with the manager and reviewed management records, including training and quality audit records.

People were appreciative of the care provided. One person told us “I couldn’t fault them at all,” and another “they do what you need.” People told us they had been involved in drawing up their care plan. One person said they knew “all about” what was in their care plan.

People told us they felt safe and the provider listened to them. One person explained “I just go straight down and see the manager,” if they weren’t happy with something. The provider had full systems for regularly auditing the quality of service provided.

Staff told us they felt supported in their role. One care worker described the “loads” of training provided, and another said “we get all sorts of training.” Records showed all staff were trained and supervised in their roles.