Housing & Care 21- Bridlington Branch is an extra care housing service, which also has a domiciliary care service registered with CQC to provide personal care. The service provides domiciliary care to 27 older people, two of whom lived in the local community. 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. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care [and support] service.

At our last inspection in September 2015, we rated the service good overall with the caring domain rated outstanding. At this inspection we found the evidence continued to support the rating of good and the outstanding rating of caring. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The feedback from people who used the service, relatives and professionals was overwhelmingly positive. We observed extremely positive interactions between staff and people who lived at the service. Staff promoted people's privacy and dignity with sensitivity. There were systems in place to ensure people were involved with all aspects of their care and support.

Staff treated people with respect whilst being friendly, caring and compassionate. People, their relatives and professionals all commented on what they described as wonderful, kind and caring staff.

There were safeguarding procedures in place which staff were knowledgeable about and they knew what action they should take if abuse was suspected.

Recruitment checks were robust. They had been carried out to assist the registered manager in making recruitment decisions and to ensure that people were kept as safe as possible. There were sufficient numbers of staff deployed to meet people’s needs. Records confirmed that training had been completed to ensure staff were suitably skilled. Staff were supported though an appraisal and supervision system.

People's nutritional needs were met and they were supported to access healthcare services when required.

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.

Care plans were in place, which detailed people’s individual care and support needs. These included social and spiritual needs through a programme of activities as part of the extra care housing.

There was a complaints procedure in place, which was followed by the service when dealing with issues raised by people.

Audits and checks were carried out to monitor all aspects of the service and action plans were developed to highlight any areas, which required improvement. Staff said they enjoyed working with people at the service.

Further information is in the detailed findings below.

The inspection of Housing & Care 21 – Bridlington Branch was on 17 September 2015 and was announced. At the previous inspection on 7 January 2014 the regulations we assessed were all being met by the service.

The organisation Housing & Care 21 has three service ‘arms’ or businesses, which provide separate services for people that require support of a particular sort. These are (1) a sheltered housing scheme, (2) an extra care scheme and (3) domiciliary care services.

Housing & Care 21 – Bridlington Branch operates a domiciliary care agency from Applegarth Court complex in Bridlington. Office hours are between 9:00 am and 5:00 pm. It provides care and social support services to older people who may also have a memory related condition. The office is located in Applegarth Court which is also the location of 22 self-contained flats, which are owned by the extra care scheme of Housing & Care 21. Some of the people that live here also receive a service from the domiciliary care services provided by that particular ‘arm’ of Housing and Care 21. There are some people that use the service who live in the community: Middleton Court, which is owned by the sheltered housing scheme ‘arm’ of Housing & Care 21. There are some people that receive the service who live in privately rented or owned accommodation. The service was providing care and support to 32 people at the time of our inspection.

The registered provider is required to have a registered manager in post and on the day of the 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.

We found that people that used the service were protected from the risks of harm or abuse and that the right action would be taken in the event anyone made an allegation or declaration of abuse. Staff were competent in handling safeguarding issues and there were systems in place to manage them well.

We found that people were protected from harm potentially caused by unsafe premises, as there were environmental risk assessments in place for each individual. Staff understood the concept of and their responsibilities towards whistle blowing and there were appropriate accident and incident reporting and recording systems in place.

There were sufficient numbers of qualified and trained staff employed to safely meet people’s needs. Safe recruitment systems were followed to ensure staff were right for the job. There were suitable systems in pace to assist staff supporting people with their finances and staff showed accountability to ensure people were protected from abuse.

We found that medication management systems were safe and staff practices followed safe infection control procedures to ensure people were protected from the risks of harm.

We found that staff were skilled and knowledgeable in their roles as they had completed qualifications in social care and undertook relevant training in courses that equipped them to carry out their roles effectively. We found that staff were well supported by the management team and there were suitable induction, training and supervision systems operated to ensure staff were well supported.

We found that staff were aware of the processes and legislation they were required to follow in order to uphold people’s rights when they lacked capacity and staff knew when issues needed to be put forward and addressed using this legislation and these methods.

People were effectively supported with their nutritional and health care needs by staff that were trained and skilled in working in these areas.

We found that everywhere we went to speak with people connected to the service that people spoke very highly of the care, support and kindness people that used the service received. The care and support provided by staff was very much a reflection of the leadership approach and expectations from the management team.

We saw from the way staff assisted people that they regarded them as individuals with differing needs and that staff conducted their relationships with people on friendly but professional terms.

The service provided care and support to people that was ‘over and above’ people’s expectations, particularly in the areas of staff approach, building relationships, ensuring privacy and dignity and providing end of life care, which was a reflection of how caring the management team and staff were.

We found that the service was efficient in responding to and meeting people’s needs, because the systems in place to assess, review and carry out care and support were thorough and consistently applied.

People were supported to undertake many individual social activities of their personal choosing and had an extensive network of social contacts they could be involved with and events they could take part in.

There were systems in place to manage complaints efficiently and the service cooperated well with other organisations and health care bodies to ensure it was responsive to people’s needs at all times.

We found that the staff at Housing & Care 21 were proud to work for the organisation, were part of a caring, open and transparent culture and followed the organisations mission statement. There was a strong management team that led the service well by setting good examples in practice and understanding.

The management team operated an effective quality monitoring and assurance system to ensure people received the best possible care and support.  The service worked well in cooperation with other health and care organisations and bodies.

We saw that care and treatment provided by Housing 21 was planned and delivered in a way that was intended to ensure peoples' safety and welfare. The service was 'caring' and 'responsive to peoples' needs'. People told us they thought the standard of care was 'excellent'. They said, "Oh I am looked after very well, the girls are very helpful", "The staff are good girls...they visit to help me with just one task but they never refuse to do anything else I might ask of them" and "The staff spoil me. No matter what I ask it is never too much trouble for them. I have never known such a lovely bunch of lasses".

We found that peoples' health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in cooperation with others and documentation was seen in peoples' care files to evidence this. The service was effective.

There were effective systems in place to reduce the risk and spread of infection. Staff were trained and guided in good infection control systems and techniques, so people were effectively protected from the risk of harm from infection. The service was safe.

We found that people were encouraged to maintain their independence where medication handling was concerned, but that the support, in whatever form, was available to them and was provided where they required it. This meant that the service was responsive to peoples' needs and therefore people received their medication safely when they needed it and so their optimum health was maintained.

We found that appropriate security and 'fitness' checks were undertaken before staff began work and there were effective recruitment and selection processes in place to ensure staff were the right staff to support vulnerable people.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people received and improvements in the service were made where necessary. The service was well led.

We found that people that used the service were satisfied with the help, care and social support they received after giving their formal consent.

One person said, “Yes I have signed my support plan and I agreed to the care that staff give me. Staff help me with personal care and everything. They ensure my dignity.” Another said, “Staff provide me with some wonderful social support. I am happy with everything.” Case file documentation confirmed that people had their needs met in the way they wanted.

We saw that the agency had a system for handling situations of a safeguarding nature and that staff were trained in dealing with and passing on information to the appropriate authorities. We saw that there was a complaint system and procedure that was also well managed. We found that staff had been safely recruited, were supervised and received good opportunities to be trained to carry out their roles.

We found that the agency was providing a well managed service, which meant that people understood the care and support available to them. People were able to amend their support where necessary and had their needs met at all times.