This inspection took place over two days, 30th October 2018 and 8th November 2018. The first day of the inspection was announced and we gave the provider short notice that we would be visiting. This is because the regulated activity is provided on site to people in their own homes and we wanted to be sure people would be happy to speak with us.

This 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. The Care Quality Commission (CQC) does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

People using the service lived in a single ‘house in multi-occupation’ shared by 24 people living independently in their own flats. The building also had a number of communal areas that could be accessed by people who lived there for social activities if they wished.

Not everyone living at Clasper Court receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service had a registered manager in place. A registered manager is a person who has registered with the 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.

During this inspection we identified two breaches of regulation, relating to requirements of the provider’s registration and governance. We found that statutory notifications relating to potential safeguarding incidents had not been notified to the Commission as required. We received mixed feedback from staff about the leadership and culture within the service. The majority of staff we spoke with gave negative feedback about the effectiveness of the management and leadership team.

People told us that they felt safe using the service. Staff were trained in, and aware of, safeguarding processes to keep people safe from abuse. There were safe processes in place for the management of medication. The provider had proactively identified some recording issues around medication and these were being addressed at the time of our inspection.

Staff had the necessary skills and experience to deliver effective care to people. People were supported to access other healthcare professionals and services. This included routine appointments and non-routine assistance as a result of emergency situations. People were actively involved in their care and consent was routinely obtained in line with the principles of the Mental Capacity Act.

There were positive and caring relationships developed between staff and people who used the service. This was done in a dignified and respectful way that promoted people’s independence. In addition to this, people were supported to share their experiences and voice their views about the care and support they were provided by the service.

People were involved in the planning of their care and staff recognised the importance of delivering care and support in the way that people wanted. There was a complaints process in place and this was followed to ensure that any complaints received were appropriately investigated.

Staff attended regular team meetings and people who used the service were approached for feedback at set intervals about the service provided to them. Effective audits were in place for most areas linked to the regulated activity of personal care. There was collaborative working with external agencies linked to the service through contractual a

The inspection took place on 26 and 29 April 2016 and was announced. We last inspected the service on 10 December 2015 and found the service met the regulations we inspected.

Clasper Court provides an on-site domiciliary care and support service to people who are tenants within Clasper Court Housing Plus scheme. The scheme can accommodate up to 24 people, at the time of our inspection there were seven people receiving a care service.

The service had a registered manager. 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 told us they were happy with the care they received from the service. One person said, “I am happy, I wouldn’t want to live anywhere else. You couldn’t get any better care. I love it here.”

People said they were cared for by kind, considerate and caring staff who treated them with dignity and respect. One person told us, “The girls, they are nice. They go out of their way to help you.” Another person commented, “They are nice girls, they are caring. Yes they are very good staff.”

People felt safe living at Clasper Court. One person commented, “There is always someone on hand of something happens. It gives you a bit of confidence.”

Records confirmed medicines were managed appropriately. Medicines administration records (MARs) accurately accounted for the medicines people had been given. Trained and competent care workers administered people’s medicines. People said they received their medicines when they were due.

Care workers had a good understanding of safeguarding and whistle blowing. None of the care workers we spoke with raised any concerns about people’s safety. A recent safeguarding concern had been referred to the local authority safeguarding team as required.

People and care workers told us there sufficient care workers on duty to provide care and support in a timely manner. One person told us, “The girls are here in a minute.” Another person told us, “They are very quick when I press my buzzer.” Recruitment checks were carried out to help ensure new care workers were suitable to work with people using the service.

Incidents and accidents were logged and the information analysed to look for trends and patterns. Records provided details of action taken following incidents to help keep people safe.

Care workers told us they were well supported working at the service. One care worker commented, “I am very well supported, manager and staff have been lovely. I love it.” One to one supervision was up to date at the time of our inspection. Training records showed training was up to date for all care workers.

The Mental Capacity Act 2005 (MCA) did not currently apply to people using the service. However, care workers had a good understanding of MCA should people lack capacity in the future. People told us care workers asked for permission before providing care.

Care workers supported people to access external health appointments when required. People were supported to meet their nutritional needs.

People had their needs assessed including gathering information about their life history and care preferences. Personalised support plans had been written which clearly documented the support people wanted to receive. Support plans were reviewed regularly and were up to date.

Staff were positive about the new registered manager and told us they were “approachable”.

There was a range of quality checks and audits in place to check on the quality of people’s care. These had been effective in identifying and resolving issues. The registered provider was working on an action plan from the last local authority commissioning team visit.

People were consulted about the care provided at the servic

We carried out an announced comprehensive inspection of this service on 9 and 16 March 2015. A breach of legal requirements was found because staff had not received some necessary training to enable them to deliver care to people safely and to an appropriate standard. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of the regulations relating to the provision of essential training for staff.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Clasper Court on our website at www.cqc.org.uk.

We found the assurances the registered provider had given us in the action plan had been met.  Training records confirmed staff had now completed the overdue moving and handling, and food hygiene training they needed.  A colour coded matrix displayed on the wall to identify when future update training was required.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

The service was safe. Where staff had identified a potential risk, either during the initial assessment or after admission, a risk assessment had been completed to ensure people remained safe. For example, a risk assessment had been developed for one person who was potentially at risk of financial abuse.

The provider had systems in place to ensure people received their medication safely from trained and competent staff and in a timely manner. People we spoke with confirmed that they received their medication when it was due.

The provider had undertaken checks before staff began work, such as carrying out Disclosure and Barring Service checks and requesting two references, including one from a previous employer.

Is the service effective?

The service was effective. We found that people who were able to had signed their care plans to give consent to their care. People confirmed that staff always asked them for permission before delivering any care. People also said they were never forced. One person said, “I am not forced to do anything.” Another person said, “If you want anything, staff are really obliging.”

Is the service caring?

The service was caring. People told us they received good care and gave us positive comments about the staff delivering their care. People commented: “Great care”; “The carers know more about me than me”; “We can talk to them (staff) and have a bit of fun”; and, “Staff knock on the door before they come in.” One person we spoke with confirmed that they had a support plan.

Is the service responsive?

The service was responsive. We found that care plans were evaluated each month to ensure they remained up to date and reflected people’s current needs. We saw from viewing care records that staff had taken action to respond to people’s changing needs. For example, we saw from viewing one person’s daily notes that they had lost weight and had been referred to their GP for advice.

Is the service well-led?

Some aspects of the service were not well-led. The provider did not have a systematic approach to medication audits in order to identify gaps in people’s medication administration records and to ensure action was taken to address these gaps.

Relevant information, such as details of incidents, accidents, complaints and feedback from residents’ consultation, was not analysed and used to promote learning and improve the care people received.

Feedback from the most recent consultation with residents and relatives was mostly positive. Specific comments included: “Staff tell me everything”; and, “Staff always meet my needs and give choices.”

People we spoke with told us they could speak to the manager if they had any concerns. They said they were happy with their care and they raised no concerns with us. People commented, “If I am worried I talk to (the manager);” “The manager is a lovely person, I can talk to her about anything, she is great”; “The girls are fantastic”; “They (staff) treat you like a queen”; and “I have no concerns with the staff.”

The people we spoke with said that they were well looked after. One person said, “I feel better since I came here to live and I think it is because I am well looked after and don’t have to worry about anything.” Another person said, “The staff look after us very well, although I would prefer to live at home. “I know now I can’t manage living on my own now though.”

People who live at Clasper Court told us they were happy with the care and support they received. One person we spoke with said “staff were caring and nice to talk to”. They felt care was always given to a high standard, and they trusted them to provide the best care”. One person said 'I like living here, this is my home and the staff who work here treat me very well’. Another person said, “The staff are good and I am looking forward to the Christmas festivities in the home".

We found that people looked comfortable and well cared for. One person told us that staff really went out of their way to make sure people were well looked after. Their comments included, "I made the right choice coming here,” and “I’ve no complaints.” We found that staff were very attentive to people’s needs and constantly chatted to all. The staff made sure they let people know what was happening and included them in general conversations. People using the service were encouraged to occupy their time in meaningful activity and to maximise their independence.

The inspection took place on 9 and 16 March 2015. The visit was unannounced and the second visit was announced. We last inspected the service on 2 July 2014 and found the provider had breached one regulation. This was because there were ineffective systems of medicines audits in place to ensure medicines records were completed accurately.

Clasper Court provides an on-site domiciliary care and support service to people who are tenants within Clasper Court Housing Plus scheme. The scheme can accommodate up to 24 people, at the time of our inspection there were 19 people using the service.

The home had a registered manager. 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.

We found the provider had breached Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 18(2)(a) (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff had not completed updated training relating to moving and handling and food hygiene.

You can see what action we told the provider to take at the back of the full version of the report.

The provider had made progress with their action plan and was now meeting the requirements of the regulation they were breaching following our last inspection in July 2014. We found there were audit systems in place now to support the safe management of medicines.

People using the service told us they felt safe and they received good support. People commented, “Yes safe, oh yes they look after you. They are my guardian angels”, “I like living here. I feel safe”, and, “Safe, yes I do [feel safe].” They also said, “Yes I get well looked after”, “The care is fantastic”, and, “Good care as far as I am concerned. I get on alright with the staff. It seems to be ok to me. I am quite happy.” People also gave positive feedback about their living environment. People commented, “Excellent, really nice. Just been all done”, and, “[Building] marvellous, gorgeous.”

Staff knew how to report safeguarding and whistle blowing concerns. They said they would report their concerns to the registered manager straightaway. They said their concerns had been dealt with properly. Staff told us they did not have any concerns about people’s safety.

The provider’s approach to managing risk was inconsistent. Some risk assessments were specific to the person being supported whilst others were generic. There were three different formats in use for undertaking medicines risk assessments. We have made a recommendation about risk management.

People using the service and staff told us there were enough staff. People said, “If I need help, staff come as quickly as they can”, “If I call staff, I don’t wait too long”, “Staff come quickly, I am never left for long”, and, “If I need help staff are quick.” The service followed recruitment and selection processes to ensure new staff were suitable to work with vulnerable people.

Incidents and accidents were logged, investigated and action was taken to keep people safe. Regular health and safety checks were undertaken and these were up to date at the time of this inspection. There were emergency evacuation plans and processes in place to support people in an emergency.

Staff told us they were well supported in their role and had regular supervision and an annual Personal Development Plan (PDP) meeting.

Staff had a good understanding of the Mental Capacity Act (2005). People had support plans in place which detailed the support they needed with making day to day decisions.

People told us staff asked for permission before providing support. They also confirmed they were supported to make their own decisions and choices. Staff also confirmed they always asked people for permission before providing support.

People could either purchase a meal at lunch-time or receive support from staff to make their own meals. Staff supported people with eating and drinking in line with each person’s individual needs. People told us staff supported them with meeting their health care needs. People said, “If I need medical assistance, staff do all that. They are lovely”, and, “When I am bad they are there.”

People said they were treated with dignity and respect. They also said staff were patient and gave them the time they needed. One person said, “Excellent care, staff have time for you and don’t rush you”, and, “They [staff] listen to everything you have to say.”

People were given information both in writing and verbally about how to access independent advocacy. Staff were aware of their responsibilities relating to confidentiality.

Some people did not have up to date care plans that met their current needs. Staff were in the process of updating people’s support plans into a more person centred format. However, a clear timescale had not been set to complete this piece of work. Support plans that had been updated into the new format were personalised to meet people’s individual needs. Support plans were reviewed regularly. However, review records were usually brief and did not provide a meaningful update as to how the person was.

Staff supported people to be as independent as possible. One person said, “I do as much as I can and staff do everything else.” Staff knew the people they supported well. One person commented staff, “Know more about me than I do.”

People knew how to complain if they were unhappy. One person said they would, “Tell Linda [registered manager] if I am unhappy.” Another person said, “If I was not happy I would speak to Linda [registered manager] or [senior support worker’s name].” None of the people we spoke with raised any concerns about the support they received. We saw previous complaints received had been investigated. People had opportunities to give their views about the service through regular ‘tenants’ meetings.’

The home had a registered manager. We found the provider had not made all of the required statutory notifications to the Care Quality Commission. This matter is being dealt with outside of the inspection process.

People and staff said the registered manager was approachable. One person said, “She’s great, she sees to things”, and, “Lovely, top of the pops.” Another person said, “She is fantastic, she is a good girl.” Another person said, “Definitely approachable, She will sit and talk to you.”

There were regular staff meetings where staff were able to give their views about the service.

The provider had made progress with their action plan they sent us following our last inspection. Monthly medicines audit had been implemented which had been successful in identifying issues relating to the quality of medicines management.

The registered manager undertook other quality checks and audits. However, these checks were ad hoc and had not been consolidated into a structured quality assurance programme. We have made a recommendation about quality assurance.

The local authority’s commissioning team was undertaking regular visits to check on the quality of the service. We saw 14 out of 18 people had given positive feedback about the service through completing questionnaires. They had also suggested activities they would like to take part in including a tea dance, a pamper session and a darts and dominoes evening.