This service is provided by SOS Homecare to people living at Oakmere which offers extra care housing where people have their own individual apartments. They provide personal care and support to 35 older people; people with learning disabilities; physical disabilities; people with mental health needs and complex needs. Staff are available on site over 24 hours, seven days a week. They also provide on call support from senior carers.

At the last inspection the service was rated good. At this inspection we found the service remained good.

People continued to be safe from the potential harm of abuse or ill-treatment as staff knew how to recognise and respond to such concerns. People were supported by enough staff to meet their needs. People were assisted with their medicines safely.

The provider followed safe recruitment procedures when employing new staff members.

Staff members had the training and skills to meet people’s individual needs. Staff members were supported by a management team in order to complete their job.

People had care and support plans that were personal to them and reflected their individual needs and preferences. Staff members knew the people they supported well.

People were supported to have choice and control over their lives. Staff were aware of current guidance which directed their practice and people’s individual rights were protected by the staff who supported them.

People received support that continued to be caring and kind. People had their privacy and dignity respected by those supporting them. People were supported by staff members when they felt upset or worried.

Staff members knew people’s support needs and assisted them in the manner they preferred. People and their relatives were encouraged to raise any concerns or complaints. The provider had systems in place to address any issues raised with them.

The management team were approachable and supportive. People receiving services from SOS Homecare felt involved and their suggestions were valued by the provider.

Staff members felt valued as employees and their opinions and ideas were listened to by the provider. The provider had systems in place to monitor the quality of service and where necessary made changes to drive improvements.

Further information is in the detailed findings below.

We considered our inspection findings to answer questions we always ask;

• 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?

People living at Oakmere told us that staff were always rushing and often late for their visits and in their opinion they felt the staffing levels were too low and they needed more staff. The staff team were short staffed as they had one staff member less than stated on the duty rota as a staff member did not arrive for duty on the day of our visit. This impacted on the workload and quality of care provided and correlated to the opinions of people who received support from the service. We noted two complaints during our inspection, one related to a drop in the standard of care provided and another related to the lack of choice provided in the gender of staff providing personal care.

Staff were confident they would be listened to by the provider and supported with reporting procedures to safeguard people living at Oakmere. However, some staff had not received updated training in safeguarding which put the management of maintaining people's safety at risk. The overview and management of risks was poorly managed and lacked any evidence of risk assessments to show effective actions to keep people safe. The service had not reported a number of incidents to the Care Quality Commission (CQC) which is a legal requirement to ensure transparency of the management of the service. Following our visit we have met with the provider and they have told us they do have risks assessments in place.

Is the service effective?

Seven people living at Oakmere and two relatives told us they were mostly happy with the care that had been provided to them and their relatives. However they did not want to express any more details about a small minority of staff who they felt were, "just ok."

Staff described the support they provided on a day to day basis and felt it was difficult when they were working with lower than usual numbers. They felt they tried their best to get all of the work done and wished they could bring in agency staff to help when their staffing levels were lower than usual.

Is the service caring?

People living at the service made general positive comments about the staff such as:

"The staff have been ok, they are caring"; "The care is fantastic" and "The staff are mostly very caring".

Relatives were positive about staff but they told us they were unhappy in having to repeatedly raise concerns about the standards of care offered by some staff and the lack of choice in the gender of staff providing personal care. There had been no effective review of their comments and concerns. The manager agreed to review their concerns following our inspection.

Is the service responsive?

Each person living at the service had a support plan in place to help to show how their needs were being met by the staff team. These records were regularly reviewed, however most care files still stored documentation relating to the previous provider. This meant that some people had out of date information about the service relating to the providers complaints procedure and information about SOS Homecare.

Is the service well-led?

Prior to our inspection we had received an anonymous complaint about the staffing levels, the lack of training and the administration of medications. We used this information to help us plan our inspection. We found that these areas needed reviewing by the provider to produce improved compliance and standards in the management of staffing; training and the management of medications.

Staff told us they felt well supported by the managers from SOS Home care. However, they believed improvements could be made in relation to: Managing staffing levels and training and facilities for staff to work in.

People living at Oakmere also shared their views about how they would like the service to be improved. They wanted staffing levels reviewed and a simpler way to raise issues and conversations about the service. They also wanted their comments about service users acting inappropriately while living at Oakmere be reviewed.

There was limited evidence of engagement with people living at the service and the provider. Both service users and relatives took the opportunity to express their opinions and suggestions for improvements to the service. Following our visit we met with the provider and they advised that they do regularly visit the service and that the manager held ‘surgeries’ and coffee mornings for people to attend.

A range of policies were in place and accessible by all staff. However, some policies were in need of review. These policies created risks to the staff team who needed updated information to ensure the safe management of the service.

The manager and provider quality checks at the service required development. Improvements were needed in the present arrangements for monitoring of the service, specifically with the management arrangements and engagement with people using the service; safeguarding; complaints; medications; training and supervisions; staffing levels and general incidents.

This inspection took place on 20 May 2015 and was unannounced.

This service is provided by SOS Homecare to people living at Oakmere which offers extra care housing where people have their own individual apartments. They provide personal care and support to approximately 21 older people; people with learning disabilities; physical disabilities; people with mental health needs and complex needs. Staff are provided on site over 24 hours, seven days a week. They also provide on call support from senior carers.

The care agency had a manager in post who had applied to be registered with CQC. 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 and associated Regulations about how the service is run.

At our last inspection in September 2014 we found that action was required from the registered provider to address issues relating to support of staff and medication management.

We also served warning notices on the provider with regard to assessing and monitoring the quality of the service.

Following this the provider sent us an action plan telling us about the improvements they intended to make.

We noted improvements to the service during this inspection and saw evidence to show the compliance actions and warning notices had been met.

The experiences of people who used the service were positive overall. People told us they felt the carers provided them with good quality, safe care. People were at the heart of the service, which was organised to suit their individual needs and aspirations.

We saw that people’s medicines were securely stored and safely managed. The provider had a policy to guide staff regarding the safe management of medicines. Staff were aware of the actions to take in the event of an error when giving medicines.

There were robust recruitment checks in place so that people were protected from being supported by unsuitable or unsafe staff.

We looked at the duty rotas and spoke to staff about the numbers of staff on duty. We found there were adequate numbers and skill mix of staff on duty to meet the needs of people living at Oakmere.

We saw records which showed that staff training had taken place and all staff were up to date with appropriate training including the Mental Capacity Act 2005 so that they could ensure that people were properly cared for. Staff were confident and knew how to make sure people who did not have the capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest.

Staff were encouraged to raise concerns and report incidents. Incidents were used as an opportunity to review what worked well for each person and what needed to be changed.

The agency had a complaints procedure in place. We saw that complaints were logged and investigated and any actions taken were recorded to show what improvements had been made to the service.

The provider had robust quality monitoring systems in place to monitor the quality of care. Continuous improvement plans were in place which identified any shortfalls and action plans, set deadlines and were regularly monitored and reviewed.