About the service:

Housing & Care 21 – Roman Ridge is a domiciliary care service which provides personal care to people living in their own homes within the Roman Ridge extra care housing scheme. The service is based in an office on the ground floor of the housing scheme. At the time of this inspection the service was supporting approximately 40 people with personal care.

People’s experience of using this service:

People told us they felt safe. They said staff turned up when they were meant to and provided them with the support they expected to receive during each visit. People said staff were well trained and knew what they were doing. Staff told us they were happy with the training they received. They thought it supported them to deliver effective care to people.

People’s medicines were mostly managed safely, however we have made a recommendation about the provider’s medicines management policy.

People were involved in planning and reviewing their care. They told us they felt in control of the care and support they received. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s care records were person-centred and provided staff with clear guidance about the support people needed. Risks to people were assessed and kept under review, to help keep people safe.

Staff were kind and caring. People told us staff treated them with dignity and respect and supported them effectively. Staff supported people to maintain their independence. Staff knew people well and knew how they preferred to be cared for.

Staff supported people to maintain their health by liaising with community health professionals when necessary. People received appropriate support from staff to maintain a balanced diet.

The provider’s staff recruitment procedures had been amended shortly prior to this inspection. We were satisfied the amended procedures would be safe, but the registered manager needed to complete additional checks on staff already employed by the service. They agreed to do this.

The service was not providing end of life care at the time of this inspection, however we have made a recommendation about staff training in the provision of end of life care.

People using the service and their relatives told us they thought the service was well-run. The registered manager and senior staff completed a range of checks on the quality of the service to make sure it was operating effectively. Where they identified improvements could be made, they were discussed with staff during supervision meetings and staff meetings.

People knew how to make a complaint if they had any concerns about the care and support they received. People were provided with information about how to complain if they needed to.

More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated good (published 14 November 2016).

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Housing and Care 21 is a domiciliary care service which provides personal care to people living in their own homes within the Roman Ridge extra care housing scheme. The service is based in an office on the ground floor of the housing scheme and provides care for up to 37 people.

The inspection took place on 13 October 2016 and was announced. At the last inspection in May 2014, the registered provider was compliant with the regulations we assessed.

There was 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 2008 and associated Regulations about how the service is run.

The registered manager was not available on the day of inspection. We were supported by an acting manager who has applied to become the registered manager.

The service had developed systems to review the quality of service provision which highlighted areas that required further action. However, we were unable to find action plans with clear timescales to address shortfalls that had been identified at registered provider level through surveys of the staff on how the service could be improved. We have made a recommendation about this.

We found staff were recruited in a safe way; all checks were in place before they started work and they received a comprehensive induction. Staff received training in how to safeguard people from the risk of harm and abuse. They knew what to do if they had concerns and there were policies and procedures in place to guide them when reporting issues of potential abuse.

Safe systems were in place for the administration, storage and recording of people’s medicines.

The registered manager ensured staff had a clear understanding of people’s support needs, whilst recognising their individual qualities and attributes. Staff were positive about the support they received from their manager.

Records showed people had assessments of their needs and support plans were produced: these showed people and their relatives had been consulted and involved in this process. We observed people received care that was person centred and care plans provided staff with information about how to support people in line with their personal wishes and preferences.

Staff supported people with their nutritional and health needs. Staff liaised with health care professionals on people’s behalf if they required support in accessing their GP or other professionals involved in their care.

Risk assessments were completed to guide staff in how to minimise risks and potential harm. Staff took steps to minimise risks to people’s health and wellbeing without taking away people’s rights to make decisions.

Staff had received training in legislation such as the mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support, and what to do if people lacked capacity to agree to it.

There was a complaints procedure in place that was available in a suitable format, enabling people who used the service to access this information if needed.

People told us staff treated them with respect and were kind and caring. Staff demonstrated they understood how to promote people’s independence whilst respecting their privacy and dignity.

An adult social care inspector carried out this inspection. As part of this inspection we spoke with four people who received support with their personal care from the Housing 21 - Roman Ridge service. We also spoke with the manager, a senior care worker and two care workers. We also reviewed records relating to the management of the service.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found-

Is the service safe?

We spoke with four people in their flats, who told us staff respected their privacy and treated them with dignity and respect. People’s comments included: “the care workers are smashing, they are lovely and kind, they do give me dignity”, “they [care workers] don’t talk over your head, they talk to me”.

All the people spoken with told us they felt “safe” and had no worries or concerns. Their comments included: “I feel safe and I feel cared for” and “I feel safe and absolutely love living at Roman Ridge”.

Staff spoken with were clear about what their roles and responsibilities were and the action they would take if they saw or suspected any abuse. We saw the service had a process in place to respond to and to record safeguarding concerns. We found the service had a copy of the local protocols and followed them to safeguard people from harm.

Relevant checks were undertaken to ensure staff employed to work at the service were suitable.

We found the arrangements in place to safeguard people from financial abuse could be more robust.

Is the service effective?

People spoken with told us they were involved in the assessment of their care needs and we saw evidence on people’s records that they had signed their care plan documentation where they were able. People told us they were happy with the care they had received and felt their needs had been met.

We looked at four people’s care records. We saw people’s care plans contained a range of information including the following: personal hygiene, medical conditions, and moving and handling. We looked at people’s ‘pen portraits’, the level of detail of people’s personal preferences and life history varied amongst the records. We also saw there were generic risk assessments and measures to reduce risk included in people’s records which did not apply to them. We spoke with the manager who told us the provider was currently reviewing the care planning documentation in place.

Is the service caring?

We observed staff giving care and assistance to people in the communal areas. They were respectful and treated people in a caring and supportive way.

People spoken with were satisfied with the quality of care they had received and made positive comments about the staff. Their comments included: “[care worker] is brilliant and very caring”, “I say to myself you are a lucky lass, the staff are good to you”, “the staff always check if I am comfortable”, “the staff are very good, all the staff are great” and “the staff are kind and caring, they come at breakfast , dinner and tea time, they are as good as gold, I think they are wonderful” and “there isn’t one [care worker] I would grumble about”.

Is the service responsive?

A copy of the service’s complaints procedure was included in the care records in people’s home. People told us if they had any concerns they would raise these with the manager or a family member.

We found people had access to a pull cord in different areas of their flats to alert staff if they should need assistance. Many of the people we spoke with also wore a pendant to call for assistance. People spoken with told us staff responded to their calls. Their comments included: “I don’t have to wait long, they [care workers] are very good” and “it depends how many staff are on and if they are helping somebody else, plus there is only one staff member on at night”.

Two staff spoken with told us the most challenging part of the role was working on their own at night. They told us they could ring a senior care worker or the manager for advice but they had been advised to contact emergency services if there was an incident. We found there wasn’t an on call rota in place so staff. This meant there was not a nominated member of staff to call for support at night.

Is the service well-led?

Quality monitoring systems were in place to make sure that managers and staff learned from audit checks. As a result the quality of the service was continuously improving.

The service held regular staff meetings to review the performance of the service. This helped to ensure that people received a good quality service at all times.

Staff had received training to meet the needs of people they supported. We saw evidence that regular spot checks of staff performance had been completed.

The service had completed an annual service user questionnaire at the end of 2013. The outcome or the action taken had not been shared with people using the service. This meant that people could not see whether there were any common themes and the action taken to resolve any issues.

All the people we spoke with told us that they were treated with respect. They also told us that their opinions were sought so that they were involved in decisions and that they had choice. Their comments included: “the staff listen to me”; “I can go to bed when I want to” and “I am treated with dignity and respect”.

People made positive comments about the staff and were satisfied with the quality of care that they had received. Their comments included: “I am very happy with everything and I am always asked what I want", "they (staff) are wonderful” and “the seniors care workers are really very good”.

We spoke with two relatives who were very satisfied with the quality of care their family member had received. Their comments included: “they (staff) are all very nice and wonderful, I am fully involved in the care planning” and “they are pretty good”.

All the people we spoke with told us that they “felt safe” and that they had no worries or concerns. All the staff spoken with were clear about what their roles and responsibilities were and the action they would take if they saw or suspected any abuse.

Staff spoken with told us that they were supported. Staff were provided with relevant training to maintain and update their skills and knowledge.

We found that a clear recording process was in place to log and record informal and formal complaints.