Our inspection was unannounced and took place on 10 October 2016.

At our last inspection of 26 October 2015 although there was no actual breach of regulations, we found that some improvements were needed regarding medicine management and safeguarding. At this inspection we found that improvements had been made in those areas. However, we found that the updating of some care records, staff supervision sessions and some refresher training and the implementation of feedback forms was still to be addressed.

The provider is registered to provide support and personal care to adults. The service is registered to and managed by Sandwell Council. People who used the service received their support and care in their own flats within the extra care complex. At the time of our inspection 33 people received personal care and support a further two people were in hospital.

A manager was registered with us as is required by law and was present on the day. 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 provider had processes in place that they and staff followed to prevent people experiencing any mistreatment or abuse. Risk assessments were undertaken and staff knew of the actions they needed to take to keep people safe and minimise any potential risk of accident and injury. Staffing ensured that people received a consistent service from staff who they were familiar with, knew of people’s individual circumstances and could meet their needs. Improvements had been made regarding medicine management so that people were supported to take their medicines as they had been prescribed by their doctor.

Staff received induction training and the support they needed when they started work that ensured that they did their job safely and provided support in the way that people preferred. Staff told us that they had received some training that was required to meet people’s needs and to keep them safe. However, training records showed that some staff refresher training was required and the registered manager told us that they were working to address this. People were enabled to make decisions about their care and they and their families were involved in how their care was planned and delivered. Staff understood that people have the right to refuse care and that they should not be unlawfully restricted. Staff supported people to have drinks and meals that they enjoyed.

People were cared for and supported by, staff who were kind and caring. Staff supported people to be as independent as possible. People were encouraged and supported to undertake daily tasks. .

The service was responsive to people’s needs. Complaints processes were in place for people and their relatives to access if they were dissatisfied with any aspect of the service provision.

People, relatives and staff had confidence in the management team and the service. People we spoke with told us that the quality of service was good and that the management were approachable and helpful.

Our inspection was unannounced and took place on 26 October 2015.

The provider is registered to provide support and personal care to adults. The service is registered to and managed by Sandwell Council. People who used the service received their support and care in their own flats within the extra care complex. At the time of our inspection 38 people received personal care and support.

A manager was registered with us as is required by law. 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 were not consistently managed safely as they were not always given to people as they had been prescribed by their doctor.

Although staff knew of the provider’s procedures to decrease the risk of harm to people we had not been informed of a recent incident as is required by law.

People and their relatives felt that processes in place prevented people from the risk of accidents and injuries.

People and their relatives felt that there were enough staff available to meet their [or their family members] individual needs.

Staff felt that the induction training they received and the support they had on a day to day basis ensured they did their job safely and in the way that people preferred.

Staff supervision sessions were not always carried out often and staff training records were not available, the registered manager was to address this.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They knew that regarding extra care services any DoLS referral would have to be made to and approved by the court of protection.

Staff supported people with their nutrition and personal care needs. We found that people were able to make decisions about their care and they and their families were involved in how their care was planned and delivered.

Staff supported people to keep in contact with their family as this was important to them.

Staff supported people to be as independent as possible. People were encouraged and supported to undertake daily tasks and attend to their own personal hygiene needs.

People received assessment and treatment when needed from a range of health care professionals which helped to promote their health and well-being.

Complaints processes were in place for people and their relatives to access if they were dissatisfied with any aspect of the service provision.

All people we spoke with told us that the quality of service was good. This was confirmed by relatives we spoke with. However, due to a lack of support from senior care staff due to vacancies managerial systems that included the updating of records and the quality monitoring of the service had not taken place.

The care provision was extra care. This meant that people lived in their own flat within the extra care complex and the staff provided the care and support that they needed. The complex had some communal facilities which included gardens, living and dining areas. People could choose if they accessed the communal areas or if they preferred, they could spend their time in their flat.

Our inspection was unannounced. On the day of our inspection 35 people received personal care packages from the service. This included four people who required rehabilitative care and support. This provision was available for a short duration as ultimately people could return back to their homes within the community or transfer to alternative care facility. Additional people received support that did not involve personal care provision for example, house cleaning and shopping.

With their permission, we visited one person in their own flat within the complex. We spent time in the communal areas of the complex where we could observe staff interactions with people and met some of the people who used the service. We spoke with ten people, two relatives, six staff and the registered manager. We also looked at comments made by relatives in recent review documentation. We did this so that we could get a picture of what it was like for the people who used the service and to find out their views on the service provided.

All of the people who used the service and their relatives we spoke with were positive about the overall services provided. One person said, “I would rather be here than anywhere else”. Another person told us, “They are very good. They do what they should to look after us”. A comment made by a relative at a recent review for a person who used the service stated, “I know they are in good hands”.

The summary is based on our observations during the inspection, discussions with people who lived at the home, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

We considered all the evidence we had gathered under the outcomes we inspected. This is a summary of what we found;

Is the service safe?

All people we asked told us they felt safe and told us that they had not seen anything of concern. One person said, “I feel safe here. The staff are very kind”.

Staff demonstrated they had an awareness and knowledge of the Mental Capacity Act 2005 which meant they could support people to make choices and decisions where they no longer had capacity.

We found that some systems were in place to maintain safety and reduce risks. We saw that equipment had been secured to meet the individual independence and safety needs of people who used the service. We also saw certificates to confirm that the firefighting appliances were serviced regularly to ensure that they were safe to use and fit for purpose.

We observed that systems for the management of day to day risks and safety were in place. This included the monitoring of skin deterioration. We found that where staff had identified concerns regarding risks associated with people’s health and welfare they had been referred to appropriate agencies

We found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was safe.

Is the service effective?

All of the people we spoke with confirmed that they were happy with the service provided. They told us that the service provided met their needs. One person said, “I am happy here. I like it”.

All staff we spoke with told us that they felt that the people who used the service were well cared for and were safe. One staff member said, “We provide good care and the people are happy”.

We found that systems were in place to ensure that people could select food and drink which was nutritious and varied. We saw that the meals provided were well presented attractive and in sufficient quantity. One person said, “The food is very good”.

People had their needs assessed and staff knew how to support people in a caring and sensitive manner. The care records showed how they wanted to be supported and people told us they could choose how this support was provided.

Staff received on-going support from senior staff to ensure they carried out their role effectively.

Arrangements were in place to request heath, social and medical support to help keep people well.

We found that the provider had processes and systems in place to meet the requirements of the law in relation to ensure that the service was effective.

Is the service caring?

All of the people we spoke with were complimentary about the staff. They described them as being, “Wonderful”, and “Kind”. One person who used the service said, “The staff are friendly and kind”.

We spent some time in communal areas observing interactions between staff and the people who used the service. We saw that staff showed people respect and promoted their dignity. We also saw that staff showed patience when supporting people.

We saw that care was provided with kindness and compassion. People told us that they could make choices about how they wanted to be supported, and that staff listened to what they had to say.

The staff knew the care and support needs of people well enough to ensure individual personal care was provided.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensure that the service was caring.

Is the service responsive?

We found that meetings were held regularly so that the people who used the service had the opportunity to raise any issues. This showed that the provider was willing to listen to the views people had to improve the overall service provision.

We found that the provider had taken note of the findings from our previous inspection and had taken action to address issues to improve, for example, medication management systems.

The people who used the service were supported to take part in recreational activities within the complex and the community which were organised in line with their preferences.

When people became unwell the staff noticed this and secured appropriate medical input.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensure that the service was responsive.

Is the service well led?

There was a registered manager at the service who was aware of their legal responsibilities.

The staff were confident they could raise any concern about poor practice at the service and these would be addressed to ensure people were protected from harm.

Plans and systems were in place to ensure people knew how to act in the event of any emergency to keep people safe.

The staffing was organised to ensure people’s needs were met and support was available for any appointments and activities.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensure that the service was well led.

During our inspection of this service in September 2013 we found non-compliance with medication management. We identified that appropriate arrangements were not in place in relation to the recording of medication. When we looked at medication records to see if they had been completed correctly we found that a significant number had not. We found a high number of gaps on medication records where staff had not signed to confirm that they had given the person their medication. We carried out this inspection to find out if improvements had been made and found at least 17 staff signature gaps on medication records which confirmed on-going non-compliance.

There were 37 people living at this extra care facility on the day of our inspection. No one knew we would be visiting. We spoke with 14 people who lived there, four relatives, four staff and one external support worker.

All people we spoke with told us positive things about the care provided. One person said, “It is excellent here”. Another person said, “I have lived here for a long time and I am very happy”. One relative said, “It is so much better than the place they were in before. I do not worry now I know they are looked after very well”. Another relative told us, “It is very good here. I am very pleased with the service provided”.

During the time we spent observing we saw that staff treated people with respect and dignity. All of the people we spoke with told us that choices were offered and their views had been taken into consideration.

People's needs had been assessed by a range of health professionals including specialist doctors and the optician. We saw that equipment needed to prevent risks and meet people’s needs was available. This meant that staff had enabled people to have their health care and safety needs monitored and met.

We found that medication management needed some improvement as there were gaps and shortfalls in evidencing that people had been given their medication as it had been prescribed by their doctor.

We found that adequate staff were provided to meet people’s needs and to keep them safe.

We found that some systems had been used to monitor how the service had been run and people had been encouraged to give their views about the service provided.

There were 38 people living at this extra care facility on the day of our inspection. No one knew we would be visiting. We spoke with seven people who lived there, one relative, six staff and two external health care workers.

All people we spoke with told us positive things about the care provided. One person told us "overall I think it is good here". Another person said “They look after us". A third person said "The staff are good". One relative said “They are looked after". An external health care worker told us "Overall the care provided is good".

We saw that staff were polite to people and showed them respect. People's needs had been assessed by external health professionals including the dietician and speech and language therapists. This meant that people's health care needs had been monitored and met.

Staff gave us a good account of what they would do if they were concerned about anything or witnessed abuse.

Recruitment processes ensured that staff employed were suitable to work with the people living at the home which protected them from harm.

Records and staff both confirmed that systems had been used to monitor how the home had been run.