We carried out an announced inspection at Housing and Care 21 – Lea Court on the 26 July 2018. At the last inspection on 26 January 2017 we found that there were breaches in Regulations. Improvements were needed to ensure that there were effective systems in place to monitor and manage the service and the provider had not consistently notified us of incidents that had occurred at the service. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good. At this inspection we found that improvements had been made in some areas. However, further improvements were still required.

This service provides care and support to people living in specialist ‘extra care’ housing. 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.

People using the service lived in their own private flats in a large purpose-built building within the town of Madeley. The service is connected to a separately run community hub that has a café and food area and a hall where activities take place that people living within Lea Court are welcome to use.

Not everyone using Housing and Care 21 – Lea Court receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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.

Improvements were needed to ensure that the systems in place to monitor the quality of the service provided were completed as required to identify concerns within the service. Records did not always contain accurate and up to date information.

We have made a recommendation about assessing and planning people’s diverse needs and advance care planning for people's end of life needs.

People were supported to eat and drink sufficient amounts and nutritional risks were assessed and monitored. People’s health was monitored and health professionals input was sought and followed where required.

Medicines were managed safely to ensure people were supported with their medicines as required.

Staff were aware of their responsibilities to protect people from the risk of harm. Staff knew people’s risks and supported them to remain as independent as possible whilst protecting their safety.

There were enough safely recruited staff available to meet people’s needs in a timely way and infection control measures were in place to protect people from the potential risk of cross infection.

People were supported to make decisions about their care in line with the Mental Capacity Act 2005, which ensured people were supported in their best interests.

People were supported by caring and compassionate staff. People’s choices were promoted and respected by staff in a way that promoted people’s individual communication needs. People’s dignity was maintained and their right to privacy was upheld.

People were involved in the planning of their care and people received care from a consistent staff group in a way that met their individual needs and preferences.

People and relatives knew how to complain and the provider had a complaints procedure in place.

Feedback had been gained from people and relativ

We inspected this service on 26 January 2017. This was an announced inspection as we needed to ensure the registered manager and staff were available when we visited the office. At our previous inspection in February 2014, we found that the provider was meeting the required standards we inspected them against.

The service is registered to provide personal care to people in their own homes. At the time of our inspection 15 people were using the 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 and associated Regulations about how the service is run.

At this inspection, we identified two Regulatory Breaches. You can see what action we told the provider to take at the back of the full version of the report.

Effective systems were not in place to consistently assess, monitor and improve the quality of care.

Medicines were not always administered in a safe manner. Risks to people’s health, safety and wellbeing were not always assessed and planned for to ensure people received care that was consistently safe.

Effective systems were not in place to ensure the requirements of the Mental Capacity Act 2005 were followed. People’s consent to care was not regularly reviewed to ensure it was still valid.

People’s care records did not always contain accurate and up to date information for the staff to follow. This placed people at risk of unsuitable and inconsistent care.

Effective systems were not in place to ensure people’s feedback was acted upon to ensure their concerns were acted upon and their care preferences were met.

The registered manager did not always notify us of reportable incidents at the service as required by law.

There were enough staff available to provide people with prompt care and staff were recruited in a manner that protected people from abuse.

Staff knew how to identify and report potential abuse and they received training to enable them to carry out their role of delivering care.

People were supported to eat and drink in accordance with their care preferences.

People were supported to access health and medical support when required.

People’s privacy and dignity was promoted and staff treated people with kindness and respect.

Formal complaints were managed in accordance with the provider’s complaints policy.

Lea Court is a purpose built extra care housing service. The extra care housing service means that people live in their own flats in a housing complex and can have care and support provided within their own homes. Not all the people who live there have personal care services provided. Lea Court consists of 63 two bedroomed self-contained flats. At the time of this inspection 28 older people were receiving personal care and support from the service.

Most people told us they were happy with the care support they received and that privacy and respect was observed by the staff.

We found that people were involved in most decisions about the care and support they received. We spoke with staff and saw they understood people’s care and support needs. We observed staff were kind and thoughtful towards people and treated them with respect.

We saw that staff had the skills and knowledge to support the people at Lea Court. For example staff asked people what they wanted them to do when supporting them and one person said “If there is anything you want they will bring it to you.”

People spoke about the range of activities available at the scheme. A new committee had been established and feedback received from people who lived at Lea Court had been positive about this.

We found the communal areas of the scheme were clean, hygienic and well maintained.

Records showed that the Care Quality Commission had been notified, when appropriate and, as required by law of the incidents at the scheme that could affect the health, safety and welfare of people who used the service.

Lea Court had a manager who was registered with the Care Quality Commission. However, they are due to leave the service shortly. The post had been advertised and interviews were due to take place within the next couple of weeks. The current manager stated that they would remain at the service until a new manager is appointed.

We found that the service requires improvement in the continuity of the staff to people who used the service. This is because several people told us that there was a high turnover of staff and that this was disruptive to the support they received. One relative said it was particularly a problem for people who were living with dementia. People also commented that at times there was not enough shadowing by a carer with whom they were familiar before handing over to a new one.

We looked at the care records for three people who used the service. We found there was information about the support people those required and it was written in a person centred way. This meant that it identified the needs and preferences of each individual and staff could plan care and support around them. We saw that these records had been reviewed during the last month (March 2014).

We saw the employment records for four staff members. These showed that good recruitment practices were in place and that pre-employment checks had been completed. These included obtaining references from previous employers and undertaking a check to ensure staff were fit to work with vulnerable people.

In this report the name of a registered manager, Mrs Rachel Linares appears, who was not in post at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. Their name will be removed from the register when we have been notified by the provider.

People who used the service and their friends and relatives told us that they were happy with the care at Lea Court. One person who used the service said, “They look after us well.” One relative told us, “Everything is honkey dory here and we’re happy with the staff and the facility.” A staff member we spoke with told us, “It’s really customer focused. We don’t just look at the care provision, but what we can do for the person to achieve their goals and aspirations.” We saw staff delivering care in a professional and friendly manner which ensured people’s safety and welfare.

We observed that people were receiving the care they required to meet their individual needs. We observed staff seeking consent before engaging in required activities with people who used the service. A staff member we spoke with told us, “I won’t do anything until the person I’m with has acknowledged me.” We saw records that people who used the service had given consent to the care they received. This meant that the provider ensured that consent was obtained before care was provided.

People were cared for in a clean and tidy environment. The provider had a recruitment system in place to ensure their staff members were suitable to work with vulnerable adults. There were systems to deal with complaints and we saw that these systems had been used effectively.

The registered manager Rachel Linares was now the only manager of this service as Elaine Barber had left. Rachel also told us that she was managing two services for the provider and divided her time up between the two. The staff who worked for the service said they all felt supported by the manager and care manager.

People who used the service were happy with the care and support provided to them. One person told said, "Oh I think it's wonderful here. I am very happy with all the staff who look after me." Another person said, "The girls are always on time. They never let me down."

People received care and support that was developed with them, designed for them and delivered in a person centred way. This meant that care was centred on people as individuals and considered their personal choices and preferences throughout all aspects of their care. People thought that they were treated with dignity and respect by the staff who worked there.

People were supported to maintain social activities of their choosing and there was a good community spirit where people felt involved and included.

People were cared for by a competent staff team who had been trained to meet their needs.

There was an effective quality monitoring system in place where people were asked about their views and suggestions. People felt that they could talk to the staff and managers at any time.

People using the service at Housing 21 – Lea Court confirmed that they were treated with respect and their dignity was maintained. People using the service informed us that the standard of care provided by the staff was very good. People also told us that they generally received the same staff to provide their care, as it was a small staff team. We received the following comments about the support received: “We couldn’t be better looked after. The staff are wonderful and call regularly. They have never missed a call to see us. We couldn’t be without them” and “We love living here. We were unsure at first about coming to live here but it’s the best thing we have ever done. We feel very safe and happy”.

Systems were in place to offer protection to the people who use the service from abuse and people spoken with confirmed that they felt safe and had no concerns regarding the agency. Comments received included: “We have no complaints, we couldn’t ask for anything better”; “We can ask for the big managers at any time although we don’t really see them. The team leader is always on duty” and “We are very happy with the support. We have a file which contains contact details and complaints advice”.

People had mixed comments about whether they received reviews about their care package. Some people told us that they thought their care plans and package provided were reviewed regularly however other people were unsure but felt they could contact the staff whenever they needed to. Some people reported that they would like managers to be involved in reviews about their care packages.