Marram Green is a very sheltered accommodation providing personal care to people living in their own flats, some of these people are living with dementia. When we inspected on 27 and 28 July 2017 there were 24 people using the service. This was an announced inspection. The provider was given 48 hours’ notice because the location provides a domiciliary care service.

This was the first rating inspection under the service’s new provider who registered with the Commission on the 10 August 2016.

There was no registered manager in post. The previous registered manager had resigned in September 2016. 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. Although the provider was / had been actively trying to recruit to the position, at the time of the inspection they had been unsuccessful in finding the right applicant. Management support was being provided by a registered manager from another of the provider’s sheltered housing complex and visiting leadership.

People told us, although the provider was trying to recruit to the post that the service had been without a registered manager for some time. We found although cover arrangements were in place, it was not the same as having a permanent manager to drive continuous improvement.

People told us they were provided with safe care and trusted the support workers coming into their home. If they had any concerns they felt comfortable to raise the issue with senior staff, and had confidence that their concern would be acted on.

There were systems in place which provided guidance for support workers on how to safeguard the people who used the service from the potential risk of abuse and avoidable harm. Support workers understood the various types of abuse that vulnerable people were at risk of and knew who to report any concerns to. Where safeguarding issues had arisen the service had learnt from these and taken action to reduce of it happening again. They understood their roles and responsibilities in keeping people safe, including following risk assessments which identified how the risks to people were minimised.

There were sufficient numbers of support workers who were trained and supported to meet the needs of the people who used the service. Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.

People and their relatives were complementary about the approachable and friendly staff. Staff had good relationships with people who used the service and their relatives. People were consulted on how they wanted to be supported. The interactions between staff and people were caring, respectful, supported people's dignity and carried out in a respectful manner.

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 received care which met their individual needs and were being consulted about the care they received and, where appropriate, relatives were involved in contributing to the care provided. Where required people were provided assistance with their dietary needs to support their health and welfare. Where support workers had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment.

Where people required assistance to take their medicines, they told us they received these safely and as prescribed. Further improvements were needed in the management of topical creams and promoting a person centred approach. We have made a recommendation to supp