The last inspection of this service was carried out in July 2015. At that time the provider was failing to meet the legal requirement about medicines management and personalised care based on individual need. We found that staff training and appraisals were not up to date. The provider sent us an action plan showing how they intended to address these matters. During this inspection we found the provider had made improvements in all these areas which are recorded throughout the report.

This inspection was carried out on 3 and 8 November 2016 and was announced. We gave the registered provider 24 hours’ notice as it was an extra care service and we wanted to make sure the people would be in. We contacted people who received a service and their relatives on 16 and 18 November 2016 to gather their views.

Dovecote Meadow is registered to provide personal care to people living in their own apartments at an extra care housing complex. There are 175 apartments within the scheme and at the time of the inspection there were 86 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 found 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 such as Percutaneous Endoscopic Gastrostomy (PEG) feeds. PEG is a way of introducing food, fluids and medicines directly into the stomach by passing a thin tube through the skin.

People's care plans were detailed, personalised, and reflected their current 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.

This inspection took place on 13 July 2015 and was announced. The provider was given 24 hours’ notice because the location provides a domiciliary care service. A second day of inspection took place on 14 July 2015 and was announced. As the service was first registered on 11 August 2014 this was the first inspection.

The service provides care and support to people living independently in 175 apartments at Dovecote Meadow. When we inspected care was being provided to 83 people.

The care service at Dovecote Meadow is provided by Housing and Care 21. People either owned their flats or had a rental agreement with Housing and Care 21. Lunchtime meals were available in an onsite restaurant managed by an external catering company.

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.

People felt safe receiving support from the service. Staff had been trained in safeguarding and whistleblowing and were able to demonstrate a working knowledge of both. The service promoted equality and diversity, and people were protected from discrimination.

The registered provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medication was not always administered safely and as prescribed. The service had a medicines management policy but this was not always followed. Audits and spot checks by the service were effective at detecting medicines errors, but there was no evidence that action was being taken to address the causes. It was not always possible to tell from Medicine Administration Records (MARs) precisely what medication had been administered and when. We also did not find evidence that personal risk assessments had been carried out.

An emergency plan was in place to provide continuity of care in case of an emergency. This included details of key contacts and emergency accommodation. People told us that they felt safe living at the service.

There were sufficient staff to provide care which met people’s needs, though there was no system in place for assessing staffing levels. Recruitment procedures were followed to ensure that only suitable people were employed.

Staff were provided with regular training, and told us they felt confident to request further support should they need it. Spot checks were undertaken of their performance. There was evidence that staff received feedback from management, but it was not always clear how supervisions and appraisals were organised.

The principles of the Mental Capacity Act 2005 (MCA 2005) were followed and staff understood the concept of consent. One person had some restrictions on their movement in place. We found that the principles of the MCA 2005 had been followed.

People told us that they were happy with the care that was provided and that it met their needs, and were complimentary about staff. Where appropriate people were supported to have a healthy diet and sufficient food and drink.

People’s care plans contained some detail of their needs. However, risks to people were not always appropriately addressed. In places the plans were generic and were not relevant to the person.

Staff felt supported by the registered manager. They described an open and inclusive culture where they were able to raise any issues or concerns that they had. The management team monitored the quality and safety of the service, but it was not always clear how this fed into service improvement.