We undertook an announced inspection of Housing and Care 21 – Greenrod Place on 10 and 11 April 2017. We told the provider two days before our visit that we would be coming because the location is an extra care service and we needed the provider to be available to assist with the inspection. The service provides purpose built flats in a community setting, with flexible care and support services available on-site to enable people to live as independently as possible.

Housing and Care 21 – Greenrod Place provide support for people in their own homes within an extra care housing complex. The scheme provides 31 one-bedroom and seven two-bedroom flats to rent and five two bedroom flats to buy through shared ownership. People received support with their personal care, support with medicines, food shopping and cleaning. People can also be visited by care workers from other external providers. At the time of the inspection 40 people were receiving support with personal care.

At the time of the inspection 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.

At the last inspection on 26, 27 and 30 October 2015 we identified issues in relation to risk assessments and care plans. During this inspection we saw improvements had been made.

A range of risk assessments were in place in the person’s care folder in relation to the care being provided. The provider had introduced risk assessments in response to specific issues.

The care plans were now reviewed regularly and provided detailed, focused information on how each person wanted their care provided. People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care. Care plans identified the person’s cultural and religious needs.

People told us they felt safe when they received support and the provider had policies and procedures in place to deal with any concerns that were raised about the care provided.

The provider had an effective recruitment process in place.

There was a policy and procedure in place for the administration of medicines.

The provider had policies, procedures and training in relation to the Mental Capacity Act 2005 and care workers were aware of the importance of supporting people to make choices.

Care workers had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service. Also care workers had regular supervision with their manager and received an annual appraisal.

The provider had a complaints process in place and people knew what to do if they wished to raise any concerns.

The provider had systems in place to monitor the quality of the care provided and these provided appropriate information to identify issues with the quality of the service.

We carried out and inspection on the 30 and 31 January 2013 where we found the service was failing to involve people in their care, did not effectively plan and deliver people's care and did not notify the relevant authorities of incidents that happened in the service to ensure people were protected from the risks of abuse. We asked the provider to send us an action plan detailing how improvements would be made. The provider told us that improvements relating to people’s care and welfare and safety and well-being would be achieved by 30 April 2013.

During this visit, we found improvements had been made. We spoke with eight people who use the service and people spoke positively about it. One person told us “the staff are so good here, they do everything they can to help." Another person told us “we have plenty of activities, the manager has arranged a lot for us, and its brilliant we have a communal restaurant it means we can meet up with other people and socialise."

We looked at the care records of four people and found these contained information about people's personal preferences such as the preferred gender of care staff to support them. We found there were also personal profiles about people detailing family relationships and who was involved in their care. People told us they had been involved in the writing of their care plan. One person told us “the manager and care staff sat and asked me lots of questions about what I wanted."

We found people's care had been planned effectively to ensure their safety and welfare. Each person had a care needs assessment and a detailed care plan which informed care staff how to meet people's needs. We found care records were updated on a monthly basis or where there had been a change in the person's needs. This meant that steps had been taken to prevent people from the risk of receiving inappropriate or unsafe care.

We looked at incident records and found where allegations of abuse had been made the provider had taken appropriate action to protect people by carrying out investigations and informing relevant authorities such as the local authority, police and CQC. We also found that the service had only employed people who were suitable to work in the service. This meant the provider had taken steps to protect people from the risks of abuse.

People who use the service and professionals who have an involvement with it told us that the previous management regime did not consult people about how the service is run or give them sufficient opportunities to express their views. However people said that there has been a marked improvement in this area since a new management team was put in place by the provider early in 2011.

People who use the service said that the management team communicated much better with them now than in the past and that they now have opportunities to give their views about how the service is run. This view was supported by the local authority, who told us that people who live there are now much more involved in shaping the service. The local authority also said that the management team had demonstrated a positive approach to working with them to address any concerns they had and to improve the service provided to the people who live there.

People who use the service gave positive feedback about the care and support they receive from staff, saying that care workers were professional, polite and caring. People told us that staff supported them to get medical treatment if they needed it. People also said that the package of care was reviewed and amended if their needs changed.

Several people who use the service told us that they wanted more opportunities to take part in activities and some people told us that they would like support to enable them to go out more. People said they had had the opportunity to tell the provider about their wish for more activities and that they felt the management team had listened to their views.

People who use the service told us that their flats were suitable for their needs. Those with mobility problems told us that their flats were accessible and that they were supported to obtain any equipment they needed to support their mobility.

People told us that they enjoyed the flexibility of having privacy when they want it and being able to use the communal facilities when they wished to. People also said that they valued the security of having a flat within an environment that is staffed at all times. People told us that the communal rooms of the home were kept clean and tidy but some people said they were not happy with the cleaning service in their flats.

We undertook an announced inspection of Housing and Care 21 – Greenrod Place on 26, 27 and 30 October 2015. We told the provider two days before our visit that we would be coming because the location is an extra care service and we needed the provider to be available to assist with the inspection. The service provides purpose built flats in a community setting, with flexible care and support services available on-site to enable people to live as independently as possible.

Housing and Care 21 – Greenrod Place provide support for people in their own homes within an extra care housing complex. The scheme provides 31 one-bedroom and seven two-bedroom flats to rent and five two bedroom flats to buy through shared ownership. People received support with their personal care, support with medicines, food shopping and cleaning. People can also be visited by care workers from other external providers. At the time of the inspection 38 people were receiving support with personal care.

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. The registered manager for Greenrod Place was responsible for two different services. There was a senior member of staff who was due to take on the full time registered manager role at the service but they had recently left the post without making an application to the CQC to be registered. The operations manager explained that an experienced registered manager who currently worked for the provider would start at the service at the end of November 2015.

The provider had generic risk assessments in place but they had not identified possible risks in relation to specific issues for people using the service and provide care workers with guidance on how to reduce these risks.

It was not clearly indicated on the support plans when they were last reviewed and if any changes to the support the person required had been made. This meant that care workers could not clearly identify if the information provided in the support plan represented the current care needs of the person.

People using the service and care workers felt the service was well-led and effective following the recent changes in senior management but the service improvement implemented by the operations manager had not been in place long enough to demonstrate sustained improvements.

People using the service and staff gave mixed feedback relating to staffing numbers with some people feeling there was not enough staff with other people happy with the staffing levels they experienced.

People using the service felt safe when they received care and support. The provider had processes in place to respond to any safeguarding concerns. There was a procedure in place to record and investigate any incidents and accidents.

The provider had an effective recruitment process in place. There was a policy and procedure in place for the administration of medicines.

The provider had a policy and training in relation to the Mental Capacity Act 2005 and care workers were aware of the importance of supporting people to make choices.

Care workers had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service. Also care workers had regular supervision with their manager. People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care.

Support plans identified the person’s cultural and religious needs. The plans also identified the person’s preference in relation to the language spoken by the care worker.

The support plans identified how the person wished for their care to be provided and care workers completed a record of each visit recording what support was provided.