Creative Support – Stockport Extra Care Services provide care and support to people living in their own homes based within seven extra care housing schemes. The seven schemes were run as four projects/schemes dependent on their location. The four locations were Edgeley, Marple, Reddish and Heald Green areas of Stockport. The registered office for the service is located at Spey House in Reddish. At the time of our inspection the service was providing support to 130 people across the seven schemes.

This inspection took place on 12, 13 and 14 September 2017 and was announced.

At our comprehensive inspection of the service carried out in July 2016 we identified five breaches of three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in relation to; safe management of medicines; taking actions to mitigate potential risks; ensuring the competence of staff; record keeping and effective systems to monitor the safety and quality of the service. We also made one recommendation, which was in relation to ensuring all members of staff receive regular supervision. The provider was informed of the actions required in order for the service to become compliant with the identified breaches of regulations.

We last inspected the service on 13 and 14 September 2016 when an unannounced focused inspection took place. At that inspection, the team inspected the service against three of the five questions we ask about services: is the service safe, effective and well-led. Although improvements had been made in some areas, and were underway in others, we found continued breaches of these regulations. Again, the provider was informed of the actions required in order for the service to become compliant with the relevant regulations. The provider sent the Care Quality Commission an action plan informing of how they intended to become compliant with the breaches of regulations identified.

During this inspection of the service we found that all previous breaches of Regulations had been satisfactorily addressed.

At the time of our inspection the registered manager of the service had recently resigned. The Care Quality Commission had received the appropriate documentation from the registered manager with details of their resignation. A new manager had been identified and, at the time of the inspection, was waiting the return of relevant documentation from the Disclosure and Barring Service (DBS) prior to sending their application for registration to the Care Quality Commission. 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.

Within the registered managers resignation documentation it was stated that they had concerns about their lack of support from line management and issues relating to their management of the staff team. During the inspection we spoke in depth with the service director about the concerns raised and evidence was supplied to demonstrate the support offered and provided to the registered manager during their employment with the service.

People told us that Stockport Extra Care provided them with safe and appropriate care to meet their identified needs.

We saw that all staff had been trained in keeping people safe and when we spoke with staff they told us they knew what to do should they witness or suspect poor practice or that abuse of any kind had occurred.

At the time of the inspection we found medicines to be safely managed with regular management overview of staff practice taking place.

People were supported to access health and social care professionals when required.

Staff were receiving training appropriate to the jobs they are employed to do.

People we spoke with were confident about raising co

We carried out an unannounced comprehensive inspection of this service on 13 and 18 July 2016. After that inspection we received concerns in relation to the safe management of medicines at the service, including an error that had put a person at serious risk. As a result, we undertook a focused inspection to look into those concerns, and to follow-up on actions taken to meet the legal requirements relating to the breaches identified at our last inspection. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Creative Support – Stockport Extra Care on our website at www.cqc.org.uk

This focussed inspection took place on 13 and 14 September 2016 and was unannounced. At our last comprehensive inspection of Creative Support – Stockport Extra Care we identified five breaches of three of the regulations. The breaches were in relation to; the safe management of medicines; taking actions to mitigate potential risks; ensuring the competence of staff; record keeping and effective systems to monitor the safety and quality of the service. At this inspection, although improvements had been made in some areas, and were underway in others, we found continued breaches of all these regulations. You can see what action we have told the provider to take at the end of this report. We are currently considering our options in relation to enforcement and will update this section once any action has been concluded.

Creative Support – Stockport Extra Care Services (Stockport Extra Care) provided care and support to people living in their own homes based within seven extra care housing schemes. The seven schemes were run as four projects/schemes dependent on their location. The four locations were Edgeley, Marple, Reddish and Heald Green areas of Stockport. The registered office for the service is located at Spey House in Reddish. At the time of our inspection the service was providing support to between 125 and 140 people across the schemes, although not all people received assistance with personal care.

At the time of our inspection there was a registered manager employed by 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.

Following our last inspection we had identified that the provider was sending though a high volume of notifications relating to medicines errors, including errors that presented a risk of harm to people using the service. The provider had made some improvements following our last inspection to the processes relating to the auditing and administering medicines. For example, a new more frequent ‘spot-check’ was being carried out on people’s medicines, staff had received medicines supervisions and competency assessments, and the service had made efforts to ensure all people’s medicines were recorded on pharmacy printed administration records. Despite these steps, we identified on-going issues in relation to the recording and administration of medicines, including two serious medicines errors that had not been identified by the provider or registered manager. We requested the provider to refer these concerns to the local authority safeguarding team.

We found on-gong issues with the way the service identified and reduced risk to people using the service. Since our last inspection, actions had been taken to identify people at risk of pressure sores and we saw appropriate steps had been taken to reduce potential risks. However, one person who was supported using a hoist did not have a moving and handling risk assessment in their file for staff to review, and one person did not have a current risk assessment. This would incr

This inspection took place on 13 and 18 July 2016 and was announced.

We last inspected the service on 21 July 2014 when we found the service to be meeting the requirements of the regulations inspected.

Creative Support – Stockport Extra Care Services (Stockport Extra Care) provides care and support to people living in their own homes based within seven extra care housing schemes. The seven schemes were based in the Edgeley, Marple, Reddish and Heald Green areas of Stockport. The registered office for the service is located at Spey House in Reddish. At the time of our inspection the service was providing support to 132 people across the seven schemes.

At the time of our inspection there was a registered manager in post. 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.

At this inspection, we identified five breaches of three of the regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; the safe management of medicines; taking actions to mitigate potential risks; ensuring the competence of staff; record keeping and effective systems to monitor the safety and quality of the service. You can see what action we told the provider to take at the back of this report. We made one recommendation, which was in relation to ensuring all members of staff receive regular supervision.

There was a reliance on the use of agency staff to ensure the service was able to meet all calls. We found there had been a high number of recent medicines errors by agency staff and there was a lack of evidence to demonstrate the provider’s process for inducting agency staff had been followed. Whilst people told us they were more recently being supported by the same staff on a consistent basis, they also told us they preferred to receive support from regular staff. We saw evidence the provider was actively trying to recruit permanent staff to the service.

People expressed satisfaction with the service they received from Stockport Extra Care and talked positively about the extra care model of care. People told us they felt staff respected their privacy and promoted their independence, for example, by allowing them time to complete tasks for themselves. People told us the permanent care staff knew them and their routines well.

People who had made a complaint told us the Registered Manager had dealt with their concerns to their satisfaction. We viewed records of complaints, which demonstrated complaints had been investigated, appropriate actions taken and a response provided to the person making the complaint. Everyone we spoke with told us they would feel confident to raise a complaint.

We found medicines were not managed in a safe way. Records were not always current or accurate, and there had been a large number of medicines errors occurring in the service. Medicines audits had not been effective at consistently identifying issues or ensuring actions were taken to improve the safe management of medicines. The provider had also identified concerns in relation to medicines and shortly before our visit had requested assistance from their quality assurance team.

We found there was not always evidence that appropriate actions had been taken to ensure potential risks were mitigated following incidents. For example, a risk assessment had not been reviewed following a person sustaining a fall, and another person’s risk assessment had not been reviewed following an incident involving a piece of equipment. The provider took action during our visit to rectify these issues and to improve procedures in place.

We saw staff received training in a variety of areas including safeguarding, moving and handling and demen

At the time of our visit to the service, Creative Support – Stockport Extra Care Services was providing a range of support to 114 older people based across seven various sized housing schemes throughout Stockport.

The inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive and is the service well led?

This summary is based on a visit to the office base of the service which is located at Spey House, Criterion Street, Reddish. There we met and spoke with the registered manager of the service. We also looked at some records. We also spoke with three people using the service at Spey House and six members of the staff team.

The full report contains the evidence to support this summary.

Is the service safe?

The people using the service who we asked said that they felt safe living at the scheme and with the care staff who supported them. Their comments included, “I can honestly say I feel safe with any of the staff when they are with me in my flat”. Another person said, “I like my flat and I’ve always felt safe living here. The staff are very kind and I don’t worry about any of them when they are with me”.

Risks to the safety of people who used the service were identified and addressed. Staff had clear guidance to help maintain and support people’s safety.

Is the service effective?

The manager told us that every person who received a service had their needs assessed before the service started. This enabled the service to identify anyone whose needs they could not effectively meet. The assessment process also enabled an effective person centred support plan to be developed.

All staff who we asked confirmed that there was always a written support plan available in the home of the person using the service. They told us that people using the service were involved in discussions about their support plan. They also told us people could influence the way in which their care and support was provided.

The service had effective quality monitoring systems in place. These would help to identify if the service needed to amend any of its practices or policies and procedures.

Is the service caring?

People who used the service were very positive about the attitude of the staff who visited them. Their comments included: “The girls [care staff] are very good and very obliging when they come to me, I don’t think they’ve ever missed coming although they do sometimes come a bit late, say by ten or twenty minutes”. Another person using the service told us “All the one’s [care staff] that come to me are absolutely lovely and have a really nice way with them”.

Is the service responsive?

A complaints log was available and a record was kept of all complaints, concerns, safeguarding referrals and investigations. All the complaints received had been responded to and action taken to prevent any further occurrences.

We saw evidence of completed copies of recent incident reports. From looking at these reports it became evident that two different Incident Report forms were in use which was causing some inconsistency in the information that was being collated. Information was not being fully completed with some questions being left blank. The provider should consider ways of making sure that the latest version of the Incident Report form is the only one available for use and is fully completed in all instances.

There was a range of quality monitoring systems in place. However at the time of this inspection the registered service had only been operating from this location since February 2014 and was therefore still developing the system. We did see evidence that quality monitoring checks had been conducted at the service by the Quality Monitoring team from Creative Support.

Is the service well led?

There were clear lines of accountability within the service.

The service had a manager that was registered with the Care Quality Commission.

There were a variety of systems in place to enable the manager to monitor quality and identify risk. This helped ensure that people continued to receive a safe and effective service.

The manager was described by staff as approachable and supportive.