This inspection took place on 21 and 22 March 2018 and was announced. This service provides care and support to people living in their own homes within Monica Wills House. Their 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. A care and support service was only provided to people who lived within

In Monica Wills House there are 71 leasehold flats plus an additional 50 flats where the provider, St Monica Trust, works in partnership with Bristol City Council. People had to be over the age of 55 years and require personal care support in order to meet the criteria for a flat in Monica Wills House. There were 121 flats (no flat number 13) and at the time of our inspection care and support services were provided to 55 people.

There was a registered manager in post however they were not available when this inspection took place due to being on leave. 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 deputy manager and the head of community services were both available during the two day inspection.

The last inspection of the service was completed in January 2016 and we rated the service overall as Good. There were no breaches of the regulations.

People were safe. Staff completed safeguarding adults and moving and handling training to ensure they maintained people’s safety. Risk assessments were completed as part of the care planning process. Where risks were identified there were plans in place to reduce or eliminate the risk. Safe staff recruitment procedures were followed to ensure people were not looked after by unsuitable care and support workers. There were sufficient numbers of care and support workers on duty each shift to meet all care and support needs safely. Medicines were managed safely.

The service was effective. The training for all staff enabled them to carry out their jobs well. New staff completed a five day induction training programme at the start of their employment and any new-to-care staff completed the Care Certificate. There was a mandatory training programme for all staff to complete to ensure they had the necessary skills and knowledge to care for people correctly.

Before people took up residence at Monica Wills House, either as a tenant or a leaseholder, their care and support needs were assessed by the care team. This ensured the service would be effective in meeting their needs. People were provided with assistance to eat and drink well where this had been identified as a care need. The care and support staff worked with other health and social care professionals to ensure people’s health and wellbeing was maintained.

People were supported to be as independent as possible. Their mental capacity was assessed as part of the whole assessment process. People were involved in making decisions and encouraged to make their own choices about their care and support. The service was meeting the requirements of the Mental Capacity Act 2005.

The service was caring. Staff had good working relationships with the people they were looking after and ensured they provided person centred care based on their specific needs. The staff ensured people were always treated with kindness and were listened to.

The service was responsive. The staff were able to provide a flexible service. Care plans and the service delivery arrangements were reviewed on a six monthly basis, or more often if needed and any amendments made as required. People were provided with information abo

We undertook an announced inspection of Care and Support Services – Monica Wills House on 1 December 2015. When the service was last inspected in September 2014 there were no breaches of the legal requirements identified.

Care and Support Service – Monica Wills House provides personal care to people living in privately owned or privately rented apartments within the provider’s retirement community site. The service also provides support to some people nominated by Bristol City Council. All of the people at the service have 24 hour access to staff in the event of an emergency. People who lived within the retirement community have access to facilities such as a swimming pool, gym, a small shop, a hairdressing salon as well as a restaurant area. At the time of our inspection the service was providing personal care to 54 people.

A registered manager was in post at the time of 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 safe and were well cared for by the staff team. People said their scheduled care appointments were completed as agreed. If there were any delays people were contacted and people said they understood the reasons for this. Additional systems to ensure people were safe by the use of a telephone and pendant system were in operation

There were sufficient staff to meet people’s needs and new staff were only recruited following the completion of robust recruitment processes. There were systems that monitored incidents and accidents with the aim or implementing measures to reduce the risk of reoccurrence. Staff understood their responsibilities In relation to safeguarding people and people’s medicines were managed safely.

People told us that staff delivered effective care to them. People said they could gain access to healthcare professionals such as their GP or a dentist. Staff understood the Mental Capacity Act 2005 and demonstrated a good knowledge of the need to obtain consent during the provision of personal care.

Staff received training to deliver effective care and people commented they received personal care from well trained staff. The provider had an induction for new staff aligned to the care certificate and staff received support through supervision and appraisal. People received support when required with their nutrition and hydration needs.

People gave extremely positive feedback and comments about the staff who provided their care at Monica Wills House. Relatives of people had also provided letters and cards of compliments. People felt their privacy and dignity was maintained and gave examples of how the staff at the service achieved this. Staff understood the people they cared for well and people were involved in decisions about their care. People told us that care was delivered in line with their wishes.

People felt the service was responsive. People’s care records were reviewed and contained personalised information about people to meet their needs. People’s autobiographies were contained in their files to give staff key information about people. The service had systems to ensure they could be responsive to people’s changing needs and people had the opportunity to comment on the service provided.

People understood the management structure at the service and spoke positively of the registered manager and senior staff. Staff demonstrated an awareness of the provider’s values and spoke positively about the management of the service and their overall job satisfaction. The registered manager had ways to communicate with staff effectively and there were systems to monitor the quality of service provided.

Is the service safe?

Our inspection of 4 February 2014 found that not all aspects of the service were safe.

People were not fully protected against the risks associated with medicines. Staff recording errors on people’s medicine administration records meant it was unclear if people had taken their medicines or not. The provider wrote to us on 3 March 2014 and told us how they would achieve compliance with the regulation.

During this inspection, we found that improvements had been made. The provider had ensured that people’s medicine administration records were accurate and reflected the actions taken by staff.

We spoke with four people who all told us that they received the support that they needed. They told us that they had been asked for their views about their care and about the service that was provided. They said that they had consented to the care and support in their care plans. All the people said that they would discuss any issues or concerns with the manager and they were confident that these would be addressed. They said that if they activated the call bell staff always came very quickly to see if they needed anything. One person said, “staff are all very nice, excellent and the manager is spot on.”

People told us that they had been involved in developing their care plans and that they had consented to the care and support provided. There were suitable arrangements to manage medication to keep people safe but some attention was needed to the recording of medication.

The staff had had recruitment checks before they were employed to make sure that they were suitable to work with people. They also had provided information about their qualifications and experience to show that they had the skills to work with people. Staff received more training to keep their qualifications and skills up-to-date. Four people told us that the staff were very good. They said that they were well supported by the staff.

There were arrangements to monitor the quality of the service provided and people were asked for their views about service. Improvements were being made to the way people were being asked for their views. There are also arrangements to make sure that risks were managed and people were kept safe.

We spoke with four people who received a service from the care and support service at Monica Wills House. All the people we spoke with were very positive about the service they received.

During our visit we saw care staff interacting with people in a positive and encouraging way.

People’s needs were assessed before they started to receive a service. Care plans we viewed gave clear guidance to staff on how the person liked their support to be provided. Staff we spoke with told us that the care plans were clear and that they were up to date.

People we spoke with told us that they liked the care staff and felt safe. One person we spoke with told us “I feel very safe living here”.

We spoke with four members of staff who were clear on the different types of abuse that they could come across. They explained to us the actions that they would take if they suspected abuse.

Staff we spoke with told us that they felt well supported in their roles. They said that the management were very approachable and supportive.

We viewed the complaints record and saw that three out of the four complaints made in the past year had been dealt with appropriately. One complaint we viewed had not been fully resolved. We found that on the whole complaints received to the service were dealt with appropriately.