We carried out this inspection on 11 July 2017. The inspection was announced which meant the provider knew we were coming. At the last inspection on 27 May, 7 and 8 June 2016, the service was rated requires improvement. We made a recommendation for the provider to review care practice in line with the Mental Capacity Act 2005.

The provider provides an on-site domiciliary care and support service to people who are tenants within Keelboat Lodge extra care scheme. The scheme can accommodate up to 71 people, at the time of our inspection there were 44 people receiving a care service.

The service did not have a registered manager. A new manager had been appointed and had recently taken up their post. The intention was that this manager would apply to become the registered manager for Keelboat Lodge. 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.

Medicines audits had not been effective in identifying and investigating medicines errors. This had also been identified during a recent check on the service by the provider’s internal quality department. We have made a recommendation about this.

People told us they were happy with their care. They also said staff were kind and caring.

The provider had effective risk management processes. Where potential risk had been identified a risk assessment had been completed and control measures identified to keep people safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

A new assessment and support plan format had been implemented. This was person centred and based around people’s needs and preferences. Support plans were individual to each person and had been reviewed to keep them up to date.

The provider had dealt with previous safeguarding concerns appropriately including making a referral to the local authority safeguarding team.

The provider had effective recruitment processes to follow when assessing the suitability of new staff. This included requesting and receiving references and checks with the disclosure and barring service (DBS).

We found the provider had good systems to monitor incidents and accidents and ensure the correct action had been taken.

Personal evacuation procedures had been written to help ensure people received appropriate support in emergency situations.

Staff were well supported and received relevant training. Training, supervisions and appraisals were up to date for all staff.

People only gave us positive feedback and said they knew how to complain. Previous complaints had been dealt with in line with the provider’s complaint procedure.

People were consulted to gather their views and feedback about the care provided at the service. Good feedback had been received during the most recent consultation in February 2017.

This inspection took place on 27 May 2016, 7 June 2016 and 8 June 2016. This was the first inspection of the service since it was registered with the care quality commission on 29 April 2015.

Keelboat Lodge provides an on-site domiciliary care and support service to people who are tenants within Keelboat Lodge extra care scheme. The scheme can accommodate up to 71 people, at the time of our inspection there were 58 people receiving 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.

Some risk assessments were general and did not record the specific measures required to keep people safe.

Most people’s medicines administration records (MARs) were accurate. However, one person was not receiving there prescribed medicines at the time they were due. The provider was taking action to change the person’s calls to change this situation. Regular medicines audits were carried out.

Recruitment practices did not reflect the provider’s policy as the registered manager told us new care workers could start employment following appropriate DBS checks and receipt of one reference. Confirmation of acceptable recruitment checks was not available in staff files.

People told us they received good care from kind and considerate care workers. One person commented, “Excellent, they are perfect, they give you a hand. It is the best move I have made. They do a good job. I’ll not be moving again.” Another person told us, “It is good, I would recommend it to anyone. I can’t find fault with it.” A third person said, “It is the best move I have ever made. I can get outside now.” They also confirmed care workers treated them with dignity and respect.

People and care workers told us the service was a safe place to live. One person told us, “It is very safe in here.”

Care workers understood their role in safeguarding and whistle blowing, including how to report concerns. Care workers told us they did not have any concerns but would report things if required. One care worker commented, “The manager would get it sorted straightaway. We would be encouraged [to raise concerns].” Safeguarding concerns had been referred to the local authority safeguarding team in line with the provider’s agreed procedure.

People and care workers said there were a sufficient number of care workers on duty. People confirmed care workers responded quickly to their requests for help and stayed for the full length of their agreed call.

There were emergency procedures and personal evacuation plans to help keep people safe in an emergency. Incidents and accidents were logged and action taken to help prevent further falls.

Care workers were well supported and received the training they needed for their caring role. One care worker told us they were “very supported”.

Although care workers had not completed specific training on the Mental Capacity Act (MCA), they still demonstrated a good understanding of MCA. Where best interest decisions had made been on behalf of people, care records did not contain a record of a capacity assessment and who had been involved in making the decisions. We have made a recommendation about this.

People were supported with their nutritional needs in line with their assessed needs. We observed people were supported to visit the restaurant at their request.

Care records showed people had input from a range of health professionals, such as GPs and community nurses.

People’s needs had been assessed to gather information about their support needs and how they wanted their support providing. This information was used as the basis for developing people’s support plans. Support plans had been reviewed, although