Housing and Care 21- Rokeby Gardens is an extra care service that contains 52 self-contained flats. The service is registered with the Care Quality Commission (CQC) to provide personal care to people living in these flats. At the time of the inspection there were 18 people using the service who required support with their personal care needs. People who required this care had a range of support needs, including older people living with dementia and people with disabilities.

We previously inspected the service in August 2016 and found breaches of the regulations in relation to quality assurance and the lack of person-centred care planning. The overall rating for the service was, "requires improvement." We asked the provider to tell us how and when they would make the required improvements. These actions have now been completed.

There was a manager in place who was in the process of being registered with CQC. Registered managers 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 continued to provide safe care to people living in their own homes. Staff understood their responsibilities for safeguarding people from harm and followed the provider's policies to provide people's prescribed medicines safely. There were enough suitably skilled staff to meet people's needs. Staff had been recruited using safe recruitment practices.

The manager promoted a caring culture that was reflected in the comments made by people and the attitude of staff. Staff felt valued and well supported. The manager had good oversight of the service. Staff received training to ensure they had the skills and knowledge to meet people's needs and had access to development opportunities.

Staff had regular supervision and they had been trained to meet people's individual needs. They understood their roles and responsibilities to seek people's consent prior to care and support being provided. The requirements of the Mental Capacity Act 2005 (MCA) had been met.

People were supported by caring, friendly and respectful staff. They were supported to make choices about how they lived their lives. Where required, people had been supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access other health services. People's needs had been assessed and they had care plans that took account of their individual needs, preferences, and choices. People and their relatives had been involved in planning and reviewing people's care plans.

The provider had an effective system to handle complaints and concerns. They encouraged feedback from people who used the service, their relatives, other professionals and staff. They also acted on the comments received to continually improve the quality of the service.

There were effective quality assurance systems in place to help ensure any areas for improvement were identified and action taken to continuously improve the quality of the service provided. People told us they were regularly asked for their views about the quality of the service they received.

The inspection took place on 2 AND 3 August 2016 and was announced.

Housing and Care 21 - Rokeby Gardens is a domiciliary care service providing personal care to people in their own homes.

Although under one CQC registration the service runs two services independent of each other, each with a manager, both of which are in the process of registration. One delivers personal care to people in their own homes in the Doncaster area, whilst the other delivers personal care to people resident at the 52 bed Rokeby Gardens extra care scheme. At the time of our inspection there were 112 people using the service.

There were two managers in post in the process of registration. 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.

During this inspection we found the registered provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to governance and care planning. The provider did not fulfil the statutory requirement to send the Care Quality Commission (CQC) notifications of certain incidents. Quality assurance procedures at the service were not always sufficient to help them to assess, monitor and improve the quality of care being provided.

People felt involved in their care planning. Care records reflected people's preferences and other important details relevant to their care needs. However, this needed to be more consistent across the service.

Communication between care workers and the management team were effective in ensuring risks to people were understood.

Feedback received from people was very positive. Staff respected people's privacy and dignity and interacted with people in a caring, respectful and professional manner.

Staff were trained in subjects relevant to the people they were caring for, and there was an induction plan for new staff which ensured they were confident to perform their role.

Systems were in place which safeguarded people from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe and took action when needed.

The service was flexible in meeting people's needs. Staffing levels ensured people received their care at the times they requested.

People received their medicines in a timely manner, but documentation was not always completed correctly. This was however identified during audits.

The managers and area managers were committed to achieving a service which provided high quality care to people. They accepted our findings and the need to improve documentation.

People told us they knew how to complain, and that they communicated regularly with the management team.

Training records we looked at showed staff were up-to-date with their training programme. Staff received supervisions and appraisals as part of their on-going support. People were supported by staff to have access to food and drink of their choice.

We spoke with 19 people who used the service or their relatives. Most people spoke positively about the standard of care they received. People told us staff respected their privacy and dignity and provided care in a compassionate way. We asked whether they would recommend the service to their family of friends. The majority of people said they would and rated the service as good, very good or excellent. A few people said the provider could improve continuity of care and communication, particularly at weekends.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People we spoke with said they felt safe with staff and were able to raise concerns with the agency if required.

There were enough qualified, skilled and experienced staff to meet people's needs. The manager told us the staffing levels were based on the needs of people who used the service. People we spoke with said on the whole staff attended on time and stayed for their allocated time. They told us, "Staff are very reliable and this helps me" and "The staff generally arrive on time but let me know if they are going to be late."

There were suitable arrangements in place to ensure staff received appropriate professional development. Staff had completed relevant training to enable them to deliver care to people safely and to an appropriate standard. People we spoke with said the staff were well trained and capable to meet people's needs.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

During our inspection we contacted six people by telephone to discuss the service they received from the agency. Where people were unable to speak to us we spoke with their representatives. People who used the service told us they were satisfied with the standard of care provided. Most people said they received care from the same staff group and staff were reliable and efficient.

Before people received care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People told us they were involved in their care and felt that staff respected their opinions and decisions in this process.

People were provided with a choice of suitable and nutritious food and drink. The care plans we looked at reflected the choice of food and drink made by people who used the service. People we spoke with confirmed they had access to drinks and snacks between mealtimes.

There were effective systems in place to reduce the risk and spread of infection. People we spoke with confirmed staff always wore protective clothing and washed their hands.

There were enough qualified, skilled and experienced staff to meet people’s needs. One person told us, "I'm happy with the service staff know what to do."

People were made aware of the complaints system. Information about how to report a complaint was included in the service user guide. People we spoke with confirmed they could raise any concerns with the office and these would be acted on.

As part of our inspection we contacted people by telephone to discuss the service they received from the agency. Where people were unable to speak to us over the telephone we spoke with their representatives.

Most of the people we spoke with were positive about the care and support they received. They told us they were happy with the service and staff were caring. We received comments such as: "I'm thrilled with the service, the staff are caring and polite" and "It's absolutely fine, I am happy with the service."

People we spoke with confirmed staff stayed for their allocated time. They told us most staff informed them if they were going to be late or the office would contact them if there were any changes to their regular carers. One person told us: "I call the office if I have a problem and it gets sorted out" and "I receive a weekly rota which tells me who my care staff are."

The relatives we spoke with told us the service had improved. One relative told us: "If staff are going to be late they call us and make up the time." Another relative said: "My wife has regular care staff if these change I am told in advance."

As part of our inspection we contacted people by telephone to discuss the service they received from the agency. Where people were unable to speak to us over the telephone we spoke with their relatives.

Some of the people we spoke with were happy with the standard of care they received and liked the staff that looked after them. The comments included: "I need two people to hoist me, the carers come four times a day and they never rush me", “Carers respect my wishes, they are very nice” and “Staff are kind and polite.”

People using the service confirmed that they felt safe when receiving care. One person said, “I feel very safe.” Another person told us: “Staff are very nice; they are very good with me.”

The relatives we spoke with told us the care was generally good however they felt some carers were better than others. One person told us: "Some do lots of things but others don't."

We also received some mixed comments about staff not arriving or staying at the agreed times. One person told us: "Some don't stay; they are just in and out." A relative said: "We don't get told if there are any changes, I've not had a rota for two weeks."