About the service: Levington Court 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 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. The service comprised of 58 flats. At the time of visit there were 54 people receiving support with personal care from the service.

What life is like for people using this service:

• People receiving support from Levington Court have their needs met by sufficient numbers of suitably trained staff. People told us the staff were friendly, kind and cared about them.

• The service provided opportunities for people to engage in meaningful activities where this was part of their care plan and reduce the risk of social isolation.

• Where required, people were provided with appropriate support to maintain good nutrition and hydration.

• People had been asked about their preferences in coming to the end of their life and this was documented.

• The service worked well with other organisations to ensure people had joined up care. External healthcare professionals made positive comments about the service provided to people.

• People told us they were asked for their consent and felt they had the independence they wished for.

• Where required, people were supported to make appointments with other healthcare professionals and attend appointments.

• People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

See more information in Detailed Findings below.

Rating at last inspection: At the last inspection on 12 and 13 May 2016 the service was rated Outstanding.

Why we inspected: This was a planned inspection following the service’s registration with the Commission.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

Levington Court is extra care sheltered scheme. The service provides personal care to people living in their own flats at the scheme and also to people living in the local community. To prevent unplanned admissions to hospital and care homes, the service provided a flexible community support service for people living with dementia. When we inspected on 12 and 13 May 2016 there were 62 people using the service.

This was an announced inspection. The provider was contacted on the morning of 12 May 2016 and given short notice of our intention to carry out the inspection. This was because the location is a community based service and we needed to be sure that someone would be present in the office.

The service was managed by 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.

The registered manager provided exceptionally strong, clear leadership and ensured an enabling and person centred culture was firmly embedded in the service. People, relatives, stakeholders and staff spoke very highly of the leadership, and held the registered manager in high regard. There was a clear commitment to put people at the heart of the service, by empowering and working in partnership with health and social care professionals.

People, relatives and care professionals were enthused about the very skilled and motivated staff. On–going recruitment ensured there were enough staff to provide a flexible service, which was ‘skill matched’ to meet the preferences and assessed needs of people they were supporting. People were involved in the recruitment process which focused on care workers being able to demonstrate the right values and character. Training and development was a high priority and linked to a comprehensive structured induction, regular supervision and resulted in an enabling and continual learning culture. Staff were knowledgeable and well trained to meet the changing needs of people. Staff felt supported and valued and spoke positively about the provider as an employer.

People received care and support which was very responsive to their physical and mental health needs, rights, wishes and preferences. People or their representatives, where appropriate, participated in the planning of their care. Care plans provided detailed information about people so staff knew about the whole person, and exactly how they wanted to be supported. This ensured that people were supported as individuals and encouraged to maintain their independence in ways that were important to them. Where care workers had identified concerns in people’s wellbeing appropriate prompt action was taken to contact other health and social care professionals to support people’s wellbeing.

People who used and worked for the service felt able to express their views and to influence service delivery. The service was committed to person centred care and this approach underpinned everything they did. There was an excellent rapport between care workers and people using the service. Staff expressed a genuine interest in people, especially people living with dementia. High importance and time was spent learning about them as individuals and this was used to improve the quality of their current and future life.

There were robust and effective quality assurance systems which led to service improvements and continual development. The registered manager had good oversight of the service and was committed to gaining feedback from people, whether positive or negative. They were innovative in the ways they did this and used research and best practice, trying different approaches and communication systems to meet people’s range of needs and abilities.

People told us they felt safe and tr

During our inspection we focused on the work that had been undertaken to address compliance.

We did not speak with anyone using the service about this standard when we carried out our follow up inspection. However, we did meet three people who used the service when they visited a communal lounge. They were playing cards at the time and we saw that staff interacted in a friendly and positive way that enhanced the people’s wellbeing.

Discussions with staff and records we were shown, confirmed that there were effective systems in place to ensure that all the contracted staff received appropriate supervision and appraisal. Where it was identified that relief staff had not been included in the list to receive feedback on their work through supervision and appraisal, the registered manager addressed it straight away. They did this by adding the names of the relief staff, to the list of staff that would be receiving one to one supervision and written appraisal of their work. This meant that there were systems in place to ensure all staff were given an opportunity, at regular interviews, to talk through any practice issues and receive support on an individual basis from their line manager.

We spoke with five members of staff who all confirmed that they received the level of support they required to provide a responsive and effective service to the people who used the service.

We visited three people who used the service, and spoke with three members of staff and two social care professionals who support people who use the service.

People told us that they were happy with the service provided and would recommend it to others. They told us that staff had never missed a visit. One person told us, “I’m more than happy with the support I get here.” Another person described the staff as, “Excellent.”

People told us that their visits were undertaken by the same core group of staff who they had got to know. They told us that staff respected their privacy and dignity and spoke to them in a respectable manner. One person told us that, “Staff are always polite.”

We were told staff supported people to retain their independence by enabling them to do what they could for themselves. They said staff ensured that they never ran out of their medication and supported them to take it.

Staff we spoke with were positive about the management of the service. They told us that they had access to a range of training to undertake their role. One social care professional felt that staff had a very good knowledge base and were, “All very experienced people."

People we spoke with told us that they were very happy with care they received at Levington Court. We were told that staff are “lovely”, “their manner is very “polite” and they “would do anything for you”. One person told us that they found their experience at Levington Court “A1” (meaning excellent) and that they felt all staff were approachable by stating “you can tell staff anything and they will always help”.

We met seven people who used the service, and one person’s relatives. All were positive about the quality of the domiciliary care service they received.

People told us that they felt the service was well led, that their views were listened to and acted on. One person said, “I can’t fault them.” Another person told us that the staff, “Are all very nice.”

People told us that staff were caring, and responded to their changing needs. People told us that staff fully involved them in decisions about their care and staff supported them to retain their independence.

We found the service's flexible dementia service enabled people to be supported in their own home during periods of distress or illness. This had enabled the service to work jointly with other social and health care professionals to ensure people’s safety and wellbeing whilst their needs could be fully assessed in an environment they felt comfortable in.

People who lived in Levington Court told us they felt safe in the knowledge that, although they lived in their own home, if they fell or became ill they could summon staff quickly. One person said, “I’ve got the assurance that they (staff) are here 24/7 and I have a lot of falls, only got to press my buzzer they are here in seconds…gives me confidence.”

We found issues around staff not being given regular one to one support to enable them to discuss work related issues which could have an impact on their practice and wellbeing.