This inspection took place on 14 March 2017 and was announced.

This service provides care 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 agreements; this inspection looked at their personal care arrangements. There were 71 people receiving personal care when we inspected. At the last inspection, in June 2015, the service was rated Good with requires improvement in our question ‘Is this service safe?’ At this inspection we found that the service improved to good in safe as the provider had the management of people’s medicines and remained good overall.

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 and associated Regulations about how the service is run.

People told us that they felt safe in their home and staff told us about how they kept people safe. People’s risks had been identified and plans showed the steps staff needed to take to ensure people were at low risk of harm or injury. People who had support with their medicines had them administered when needed, with staff who were trained and competent to do so.

Staff had received training to ensure their skills and knowledge reflected the needs of the people they cared for. Staff were supported with regular supervisions and the management team checked that staff were working as expected. Where people needed support with their meals they told us they were happy that staff gave them a choice or provided the assistance needed to enjoy their meal. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People told us they attended healthcare appointments as required and staff would help with telephone calls and reminders if needed.

People knew the staff and told us they were provided with a personalised service in their home. Care staff spent time chatting and getting to know people while providing care. People felt the care they had received met their needs and had been able to tell staff how they wanted their care on each call. People felt the staff were considerate and supported them in maintaining their dignity.

People’s views and decisions about their care had been recorded and were changed when needed. People knew how to make a complaint and information was provided to people who used the service should they wish to raise a complaint.

People, their family members and staff felt the management team were accessible and could speak with them to provide feedback about the service. The management team had kept their knowledge up to date. The provider ensured regular checks were completed to monitor the quality of the care that people received and to action where improvements were needed.

The inspection took place on 2 June and was announced. At our last inspection in May 2014 the service was complaint with the regulations we looked at.

The service provided domiciliary care to 71 people in their own homes and there was a registered manager in place. 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 kept people safe from the risk of harm. Staff knew how to recognise signs of abuse and who to raise concerns with. People had assessments which identified actions staff needed to take to protect people from risks associated with their specific conditions.

People were supported by the number of staff identified as necessary in their care plans to keep them safe. There were robust recruitment and induction processes to ensure new members of staff were suitable to support the people who used the service.

Staff supported people to administer their medication safely. Staff knew how to support people to take their medicines however they did not always record if people had taken their medication as prescribed. Care records did not always contain information about how staff were to support people to take “as required” medications.

Staff had the skills and knowledge to ensure people were supported in line with their care needs and best practice. Staff had regular supervisions in order to review and test their knowledge about how to meet people’s care needs.

The manager and staff we spoke with were knowledgeable of and acted in line with the requirements of the Mental Capacity Act 2005. Staff sought consent from people before providing personal care.

When necessary, people were supported to eat and drink and access other health care professionals in order to maintain their health.

People had positive relationships with the staff who supported them and spoke about them with affection. The provider sought out and respected people’s views about the care they received. Staff promoted and upheld people’s privacy and dignity.

The provider was responsive to people’s needs and changing views. People were supported by staff they said they liked and care was delivered in line with their wishes. People could raise concerns and the provider responded appropriately.

People were confident in how the service was led and the manager’s abilities. The provider had established processes for monitoring and improving the quality of the care people received. The provider had identified concerns with how people were supported to take their medication and had taken action to investigate and prevent similar incidences from reoccurring.

The inspection was undertaken by one inspector. We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We spoke with five people who used the service, relatives of two people who used the service, the care manager and six members of staff.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We spoke to five people who used the service and relatives of a further two people. All of these people confirmed that they felt safe when being supported by care staff.

People told us that care staff knew how to care for them. We spoke with care staff and looked at records. We saw that care was delivered in a way which kept people safe.

We saw and staff confirmed there were enough gloves and aprons for these to be available for staff when supporting people with their personal care. People told us that these were always used. We saw that staff had access to policies and procedures about preventing the spread of infection. One person told us, “They always wear gloves.”

The provider had a robust recruitment process to ensure that people were cared for by staff who had the training, experience and knowledge to support vulnerable people.

Is the service effective?

People’s health and care needs had been reviewed with them. There was appropriate information in care plans in people's homes about the support they needed and how they wanted to be supported. A person who used the service told us, “They [Care staff] are very good. I would be lost without them.”

Where necessary, risk assessments had been undertaken and were used to help staff provide appropriate, safe and consistent support to people who used the service. Care plans contained information and guidance about people’s specific conditions to enable care staff to meet the individual needs of the people who used the service.

People who used the service were asked to comment on the service provided, this included questions about the support they received.

Is the service caring?

All the people we spoke to confirmed that staff were kind to them. A person who used the service told us, “The staff are very friendly, they are always asking how you’re doing.”

When speaking with staff it was clear that they genuinely cared and knew about the people they were supporting. People’s preferences, interests, aspirations and diverse needs had been recorded and support had been provided in accordance with people’s wishes.

Is the service responsive?

People were supported to comment on the care they received at regular meetings. People told us that the provider made them feel comfortable to raise concerns. We saw that the provider responded appropriately to concerns so that the service could improve.

The provider had a complaints policy which showed people how to make a complaint if they were unhappy. The manager was aware of the provider’s policy and knew how to respond to concerns. We saw evidence that the provider had taken action when complaints were raised.

The service worked well with other agencies and services to make sure people received care in a coherent way. People were supported to attend doctors, dentists and other health appointments when needed. The provider supported people to seek the opinions of other health providers in order to gain further information about specific conditions. A community nurse told us, “The staff seem to know what they are doing. I have no concerns about how people are looked after here.”

Is the service well-led?

The provider regularly sought the views of the people who used the service. We saw evidence that they had introduced changes to how people were supported in response to comments received.

Staff told us they were clear about their roles and responsibilities. We saw that there were meetings with staff to discuss quality issues and this helped to ensure that people received a good quality service at all times.

There was evidence that the provider had ensured that learning from incidents or accidents took place and appropriate changes were introduced or implemented to keep the people safe from harm.

The service had a quality assurance system and records showed that identified problems and opportunities to change things for the better were addressed. These included spot checks to assess the quality of the care being delivered in people’s homes and reviewing people’s care records.

When we visited 72 people were receiving personal care. We spoke with six people who used the service and five staff who supporting them. We also looked at records and spoke to a person who commissions the service and a social worker who supports some of the people receiving care. A person who used the service told us, “They really meet all my needs.” A locum district nurse told us that the service “Has a very good reputation within the nursing team”.

People who used the service were involved in planning their care. They were supported to make choices about the care they received. Where decisions were made on a person’s behalf they were done so with their agreement and in their best interest.

Care was planned and designed to meet the individual health and welfare needs of the people who used the service. A person we spoke to expressed confidence that their care was planned, managed and delivered with dignity in the way that was promised.

We saw that the provider had made suitable arrangements to ensure that people who used the service were safeguarded against the risk of abuse.

We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. A member of staff told us, “I feel I can discuss anything with my team leader”.

The provider was able to protect people from unsafe care and treatment by regularly assessing and monitoring the quality of the service provided.

Seventy three people were receiving personal care at New Oscott Village at the time of our inspection. Whilst at the village we spoke with three people using the service, four relatives and staff supporting them.

People told us that they were happy with the quality of care received and that it made a difference to their lives. They told us that staff supported them in a sensitive and respectful manner. Comments included,: “Carers are so friendly. That’s why I love it here” and “The staff care for my mother without any fuss or complaint. They take away any embarrassment she may be feeling.”

During our inspection, we asked local authority staff involved in monitoring the service about the quality of care provided. At the time of writing this report, we had not received any information from them.

When we visited the service on 17 October 2011 we spoke to two of the people whose care we followed and to the family member of a third person. Each was happy about the quality of personal care they they received. The family member said they had four good carers who called four times each day to care for their relative and that they “cannot fault them”.

We spoke to three personal support assistants who provided regular care to the people whose care we followed. They were aware of peoples specific needs including dementia care needs. Each assistant was able to identify particular risks associated with the condition of a person they cared for and how they worked to reduce those risks.

We saw that one person was making use of the reminiscence activity provided in the village on the day that we visited. They told us that resident support assistants also helped them to regularly attend their church.

We saw that the provider had a thorough training and follow up training plan for workers. Support workers who did not have NVQ qualifications in care when they started work were required to begin training soon after their induction to the service.

We saw that people used the complaint system that was in place. We have asked the provider to improve this system by separating the housing complaints from the care complaints which, are the ones that we need to see.