This inspection was announced and took place on 7 March 2017.

At our last inspection of 24 and 25 February 2016 although there was no actual breach of regulations, we found that some improvements were needed regarding recruitment processes and ensuring enough staff were available to meet the needs people who used the service. At this inspection we found that improvements had been made in those areas.

The provider is registered to provide support and personal care to adults. The service is registered and managed by Housing and Care 21. People who used the service received their support and care in their own flats within the extra care complex. At the time of our inspection 49 people were receiving personal care and support.

There was 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 service had processes in place that they were followed to prevent people experiencing any mistreatment or abuse. Risk assessments were undertaken and staff knew what actions they needed to take to keep people safe and minimise any potential risk of accident and injury. Adequate staffing levels ensured that people received a consistent service from staff who they were familiar with, knew of people’s individual circumstances and could meet their needs. Appropriate systems were in place regarding medicines management so that people were supported to take their medicines as they had been prescribed by their doctor.

Staff received induction training and the support they needed when they started work that ensured that they did their job safely and provided support in the way that people preferred. Staff told us that they had received training that was required to meet peoples’ needs and to keep them safe.

People were enabled to make decisions about their care and they and their families were involved in how their care was planned and delivered. Staff understood that people have the right to refuse care and that they should not be unlawfully restricted. Staff supported people to have drinks and meals that they enjoyed.

People were cared for and supported by, staff who were kind and caring. Staff supported people to be as independent as possible. People were encouraged and supported to undertake daily tasks.

The service was responsive to people’s needs. Complaints processes were in place for people and their relatives to access if they were not satisfied with any aspect of the service provision.

People, relatives and staff had confidence in the management team and the service.

People we spoke with told us that the quality of service was good and that the management were approachable and helpful. The provider had quality assurance processes in place to improve the service.

Hillside Court is part of Housing 21 extra care housing scheme. On the day of our inspection the agency was providing care and support to people living in their own flats in Hillside Court and in the Lincoln Gardens site. People who used the service told us they were very happy living at Lincoln Gardens. For example one person told us “it’s very nice here”. People felt they received care that met their needs.

We found that care plans had been updated and risk assessments were in place and regularly reviewed. This meant care was planned and delivered to meet people’s needs.

Staff told us that they attended training about medication and they were now working as a team to “get it right”.

Systems were in place to identify, assess and manage the risks to health, safety and welfare of people who used the service. This meant people received a service that was properly checked and monitored.

We visited Hillside Court and Lincoln Gardens to look at records, talk to the registered manager and observe and assess the quality of care and support being delivered by the service.

Hillside Court is part of Housing 21 Extra care housing scheme. On the day of our inspection the agency was providing care and support to 49 people living in their own flats in Hillside Court and 38 people in the Lincoln Garden site.

We were informed by the registered manager that 45 staff members were employed at both sites.

We looked at the care files of eight people at both Hillside and Lincoln Gardens and throughout the day we spoke with 10 of the people who used services there.

We spoke with 11 staff employed by the care agency and we checked the training and supervision records for all staff.

People told us the staff treated them with respect and supported them to maintain their privacy and independence. They also told us they were supported to make choices and that staff gave them care and support in a way they preferred. People were involved in the planning and reviewing of their care and support plans.

People told us they were happy with the care and support they were getting. One person told us, "I love it here, it is wonderful." They all told us staff always gave the care and support they needed during each visit and didn't leave until all the tasks were done. We saw there were care and support plans in place which met the needs of the person they were written for. However we found that they were not all being consistently reviewed and updated.

We spoke with 10 people and they all told us they felt safe in the service. One person said, “I feel very safe here although I have not had anybody disturb me but we had a policeman come to our tenants meeting to reassure us. If I did not feel safe I will feel confident to report the issue to the manager”.

Staff were trained and supported to care for people safely and appropriately. People we spoke with were happy with the way staff cared for and supported them. None of the people we spoke with had any complaints about the service. One person said, "I am quite happy. The staff seem quite competent." We saw that where concerns had been raised, these had been acted on and dealt with appropriately.

We found evidence that prescribed medicines were not given to people safely.

We found evidence that the provider did not have adequate systems in place to review the quality of their service in one of the sites.

We spoke with five people receiving a service, two members of staff and the manager during our visit. We also spoke with two people living in Lincoln, one member of staff and two relatives and one social care professional over the phone.

People told us they liked living in Hillside court and Lincoln gardens. They told us that the staff were supportive and friendly. People said they had a choice of how to spend their day and that the agency provided them with various options of activities. One person said “ I do my knitting in my flat and send the finished ones to hospitals. I am very content and happy”.

People told us that they could choose who supported them with their care. People said they had tenancy agreements and this had been discussed with them and where relevant their families. People told us that they had monthly meetings about their care and the services provided for them.

People told us that a copy of their care file was kept at their home and they were involved in decisions about their care. They said their views on the service were listened to and acted upon. They said they were aware of the complaints procedure but had no complaints.

People told us they felt safe and well supported by the staff working in the home.

One person said “overall I am happy here. It is the best place I can be. I am very fortunate to come here”

In total we spoke to 13 people who use the personal care service provided at both Hillside Court and Lincoln Gardens. Hillside Court is located in St George, Bristol and Lincoln Gardens is located in Lawrence Hill., Bristol.

We spoke to eight people who live at Hillside Court and we also spoke to five people over the telephone that live at Lincoln Gardens. We spoke to seven members of staff including the registered manager.

We asked people what the staff were like, people told us “The staff are very helpful and kind, nothing is too much trouble”, “Staff help me every day and they are very kind”, another person told us “The staff are always polite, they never rush me, they are patient”. Another person said; “Staff know exactly how I like to be supported and help me to maintain my independence”.

People confirmed to us that staff arrive on time and stay for their allocated time. One person told us “I am very happy here but I would like some help to get up earlier in the mornings, I have requested this but it has not happened yet, I am in bed by 10pm and don’t get up until 09:30 am, that’s nearly 12 hours”.

We asked people if they knew how to raise concerns, people told us “The staff are very approachable, I would talk to them if I had any worries”, another person said “The manager is in the office and I know that she would help me if I needed any advice”.

This inspection took place on 24 and 25 February 2016 and was announced. We gave the service 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be available at the office.

At the last inspection of the service in 11 September 2013 we found the service was meeting the regulations we looked at.

Housing 21 and Care – Hillside Court provides personal care for tenants living at Hillside Court. At the time of our inspection there were 49 people receiving services at Hillside Court.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

We found that staffing numbers were not always sufficient to ensure people’s care and support needs could be met in a timely manner. Accidents had not been analysed for patterns and trends to minimise occurrences. We also found that staff recruitment process was not consistently robust to make sure staff had all the necessary checks before they started work.

People told us they felt safe at Hillside Court and staff were respectful, kind and helpful towards them. People felt staff were well trained to support them and their care needs were met. People were supported by a consistent group of staff who had the necessary skills and knowledge to provide the care and support they required.

Where people were at risk of ill health due to not eating or drinking enough, staff monitored people closely and reported any concerns to the manager. We saw professional advice was sought where concerns about people’s nutritional health were identified. People also had access to a ‘community matron’ who visited the service each week. The service sought advice from the nurse in supporting people to maintain good health and people’s weight was checked if required.

The manager ensured risk assessments were carried out for people at risk of ill health due to their health conditions. This included nutritional risk assessments and these were regularly reviewed to identify any changes in the support people may need. People had an opportunity to say what social activities and entertainment they would like by attending resident meetings where these were discussed.

The registered manager and staff understood the principles of the Mental Capacity Act 2005 (MCA), and supported people in line with these principles. This included staff seeking consent from people before delivering care.

Care plans and risk assessments contained relevant information for staff to help them provide the personalised care people required. People were given opportunities to share their views and opinions about the quality of the service they received. People knew how to complain and information about making a complaint was available for people.

The provider and the registered manager were committed to providing quality care to people. People who used the service felt they were listened to and found staff approachable and responsive. There were processes to monitor the quality of the service provided and understand the experiences of people. This was through regular communication with people and staff, checks on records, staff and resident meetings and a programme of checks and audits.

We identified that the provider was not meeting regulatory requirements and was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.