The inspection took place on 7 and 10 April 2017 and was announced. We gave the registered manager 24 hours notice of the inspection to ensure that the people we needed to meet with were available.

The service was provided to people who lived in the Westbury Fields retirement village. There are 51 apartments within the extra care housing building called Sommerville plus purchased, leaseholder housing, built around a central cricket field. At the time of our inspection a care and support service was provided to 56 people and the service employed 26 care and support staff.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People said they were safe. Staff received safeguarding adults training and knew what to do if there were concerns about a person’s welfare. Where they needed to move people from one place to another they were supported safely by staff who followed correct procedures. Staff were recruited following robust recruitment procedures which meant unsuitable staff could not be employed. Any risks to people’s health and welfare were well managed and strategies put in place to reduce or eliminate the risk. Where required people were supported to take their medicines safely.

People received an effective service. They received the service they expected and had agreed upon. Staff were knowledgeable about the people they supported and received the appropriate training and support to enable them to undertake their roles effectively. Where identified in the assessment process, people were provided with support to have food and drink. People were supported to access health care services if needed.

People received a caring service. The care and support staff were kind and caring – they treated people with kindness and respect. Staff had good relationships with the people they were supporting and also any family members who were supporting that person. People were involved in having a say about the support they received and how their service was delivered.

People’s individual care and support needs were assessed and then a package of care put together that met those needs. This ensured that each person received the service they needed. Their preferences and choices were respected. People were provided with copies of their plans and knew what service was provided. People were asked to express their views about the service they received and were listened to. There care plans were regularly reviewed and amended as and when necessary.

People received a service that was well-led. The registered manager and other two senior staff provided good leadership and management for the care and support team. The quality and safety of the service was regularly monitored and used to make improvements. The service had a plan for making improvements.

We undertook an announced inspection of Care and Support Services – Westbury Fields on Tuesday 9 December 2014. When the service was last inspected in December 2013 there were no breaches of the legal requirements identified.

Care and Support Service - Westbury Fields provides personal care to people living in their own homes within the provider’s Westbury Fields site. People within the accommodation have either purchased their property under lease-purchase arrangements or have a private tenancy and are accommodated within a one or two bedroomed self-contained apartment. All of the people at the service have 24 hour access to staff in the event of an emergency and there were additional facilities such as restaurants available to people. There are 51 apartments within the Sommerville complex. At the time of our inspection the service was providing personal care and support to 35 people. There were 15 people living completely independent lives requiring no personal care or support from the service.

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.

The provider had failed to notify the Commission, as required, of a serious injury sustained by a person who used the service.

People told us they felt safe within their accommodation and the provider had made appropriate arrangements to identify and respond to allegations of abuse. Staff told us how they would respond to actual or suspected abuse. The provider had a safeguarding adults policy for staff that gave guidance on the identification and reporting of suspected abuse.

People said their scheduled care appointments were undertaken by the staff at the service as arranged and said they felt there was sufficient staff available to meet their needs. Staff told us that generally the staffing levels were sufficient and told us the current staffing arrangements worked well.

People told us they received their medicines on time. The service had suitable arrangements in place for the ordering and disposal of medicines. This allowed people to maintain their independence with their medicines. People’s medicines were stored appropriately and risk assessments were in place to help ensure people’s safety. Medicines records had been completed appropriately and the provider had an auditing system to monitor people’s medicines.

People who received support from the staff at the service praised the level of care they received from the staff. Staff told us they were provided with regular training and opportunities to undertake additional training to meet people’s needs were available. The provider had a staff appraisal and supervision process and staff told us they felt supported.

People told us that staff asked for their consent before any care was provided and that staff acted in accordance with their wishes. Staff told us how they sought people’s consent prior to providing people with care, and told us how they provided care whilst respecting people’s privacy and dignity. Staff demonstrated they understood their obligations under The Mental Capacity Act 2005 and how people should be supported to make safe and informed decisions. Within people’s care records, where people had nominated a power of attorney should their health deteriorate, this had been recorded and the associated documentation was present.

There were reviews of people’s health and care needs; however we did find the service had failed to ensure an assessment had been undertaken following a person’s stay in hospital. A staff member told us there was a minor change in the person’s needs however this was not reflected in the person’s records due to the absence of a review. We have made a recommendation about the reassessment of people’s needs.

People were able to see healthcare professionals where required and records showed that staff responded promptly to people’s changing needs. Records showed that in the event of a person’s health deteriorating, or if staff had identified a change a person’s needs, appropriate interventions had been made. Any subsequent guidance from healthcare professionals was recorded within people’s care records and staff demonstrated they were aware of people’s changing needs.

There were positive and caring relationships between staff and people at the service. People praised the staff that provided their care and we received positive feedback from people’s relatives and visitors to the service. People said they were involved in decisions about the care package they received and spoke positively about the communication from staff within the service. People’s care records reflected people’s involvement and the decisions made in their care planning.

People told us they received the care they needed and when they needed it. All said their agreed care package met their needs and some gave examples of where care had been adjusted to meet any changes in their needs. The provider had a complaints procedure and people said they felt confident they could complain should the need arise. We received positive feedback from people who gave examples of where the service had responded to a concern they had raised.

The registered manager and the deputy manager were spoken of highly by the staff, relatives and visitors we spoke with. Staff told us they worked in a supportive environment and told us they felt they were listened to. The registered manager had an auditing system to monitor the service provision and the provider undertook internal quality monitoring measures.

We found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with three people who use the service at Care and Support, Westbury Fields. They told us that they agreed their care plan with the manager. We saw that they had signed the care plan which demonstrated their consent to receive care, treatment and support from the service.

People told us that they were very satisfied with the care they received from the staff. They told us that staff usually arrive on time, but if there is a delay then they receive a telephone call to explain. We saw that the assessment and care plans were comprehensive and written in a person centred way which showed us that care is delivered according to peoples individual needs.

People told us that the medication system worked well and we saw the evidence to demonstrate this.

We saw the staff rota which showed us that there were sufficient staff to meet the needs of the people using the service.

We saw the quality assurance system which was comprehensive and showed us that the provider sought the views of people who use the service when making decisions about the running of the service.

We spoke with four people who received a service from the care and support service at Westbury fields. They were all very positive about the service they received. One person we spoke with told us “the staff take notice and involve me in what they are doing. They always listen to what I have to say and I feel very involved in my support”.

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 that 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 “It’s a safe place to live, we have good security and the staff are always around if you need them.”

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.

The manager told us that the service had trustee assurance visits four times a year to look at the quality of the service provision and suggest improvements.