This inspection took place on 13 September 2018 and was unannounced. This meant the staff and provider did not know we would be visiting.

This service is a domiciliary care agency. It provides personal care to older people living in their own flats within the Bramble Hollow complex.

Not everyone living at Bramble Hollow received 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. On the day of our inspection there were 27 people receiving personal care at the service.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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 last inspected the service in May 2016 and rated the service as ‘Good’. At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Accidents and incidents were appropriately recorded, risk assessments were in place and appropriate health and safety checks were carried out.

Appropriate arrangements were in place for the safe administration and storage of medicines.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

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 were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at the service. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

People’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

People were supported with their end of life care needs.

People were protected from social isolation and the service had good links with the local community.

The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the management team. People who used the service, family members and staff were regularly consulted about the quality of the service.

This inspection took place on 5 May 2016 and was announced. We gave the registered provider 48 hours’ notice as it was an extra care service and we wanted to make sure people would be in.

The service was last inspected on 17 March 2014 and met the regulations we inspected against at that time.

Bramble Hollow is registered to provide personal care to people living in their own flats at an extra care housing complex. There are 49 flats within the scheme and at the time of the inspection there were 21 people in receipt of 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.

Staff had a good understanding of safeguarding and were confident in their role of safeguarding people. Any safeguarding concerns were investigated with the outcomes fed back and practices changed if necessary in order to prevent reoccurrences.

People had risk assessments in place and associated care plans were clearly linked and updated in line with risk assessment reviews.

Staffing requirements were assessed in line with people’s support needs. From staffing rotas we saw staffing levels were consistent and staffing cover was provided by existing staff. Staff were recruited in a safe and consistent manner with all necessary checks carried out.

Staff had up to date training and competency assessments were carried out in relation to specific areas, including the management of medicines. Regular direct observations of staff practices were also carried out as part of the supervision process. Staff received annual appraisals.

Medicines were managed effectively with people receiving their medicines appropriately. All records were complete and up to date with regular medicine audits being carried out.

People were supported to access services from a range of health care professionals when required. These included GPs, specialist nurses, district nurses, occupational therapists and opticians.

People were supported to meet their nutritional needs, including where people had special dietary needs and specific support due to risk of choking.

People's care plans were detailed, personalised, up to date and reflected their needs. Staff used them as a guide to deliver support to people in line with their choices and personal preferences.

People told us they knew how to raise concerns and would feel comfortable in doing so. They confirmed they had no complaints about the care they received and they were happy with everything.

Staff told us they felt supported in their roles by the registered manager. They told us the registered manager operated an open door policy and was approachable. Staff also told us they received reassurance, help and advice from the registered manager, care team leader and senior care staff when needed.

A range of regular audits were carried out that related to the service the home provided, as well as the premises and environment.

During our previous visit we identified that people were not always protected from the risks of unsafe or inappropriate care because accurate records were not always maintained. During this visit we saw that records about care, treatment and support were clear, factual, accurate and up to date.

We spoke with eight people who used the care service at Bramble Hollow, as well as two visiting relatives and two health care professionals. People told us that they felt involved in consenting to their own care packages.

People had positive comments to make about the care they received. One person said, “They come on time and do what they need to do for me.”

Some people felt it would be better if there was more consistency in which care staff visited them to provide their support. All the people we spoke with commented positively on the attitude of care staff. Their comments included, “my carer is excellent”, “they’re very friendly” and “the staff are canny”.

The provider had a good system for managing the training needs of care staff. This meant staff received all the required training before they started work and there was refresher training provided when this was needed.

The provider had a clear system for checking the quality and safety of the service, and this included asking people for their views. However we saw care records were not always kept up to date when someone’s needs had changed, so some records did not accurately show people’s new needs.

We carried out this inspection visit to check what progress the service had made to the improvements we suggested in August 2012 about care and medication records. We did not talk with people who used the service as part of this inspection.

During this visit we spoke with six people who received care and a relative. People told us they had information about the service and were involved in making decisions about their care. One person said, “I felt I was given plenty of information and I was encouraged to come and have a look around before I made any decisions about my care.“

People felt living at the scheme meant they got staff support to help them to remain as independent as possible. One person said, “They help me with what I need – I wouldn’t be able to manage without them.”

The people we spoke with made many positive comments about the support they received from care staff. One person told us, “I need some help because I’m not able to walk. They visit me four times a day. They visit at the times that I need help with meals and medication.”

People said they felt “safe” at the scheme. One person said, “It makes me feel safe to live here. We’ve all got call alarms with us so we can call for help in an emergency.”

People told us about recent staff changes which had meant all care staff were new to them. Several people said it was difficult to get to know the staff’s names because they were all new.

One person said, “It’s had a few teething problems since Housing 21 took over the care service.” Another person said, “I would like to give them a chance because they’ve only been doing the care for a couple of months.”

People and their relatives felt confident about making any comments or raising concerns. People told us they felt able to raise any issues with the manager and that they would be resolved.