Plymouth Court provides care and support to people living in specialist ‘extra care’ housing. The setting comprises of 52 purpose-built bungalows in a shared site. The accommodation is bought 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. At the time of the inspection three people were using the service.

We last inspected this service in April 2016 and found the provider was meeting all legal requirements and rated the service as ‘Good’. At this inspection we found the service was not always clear about some aspects of medicine management. Staff supervision discussions were not formally recorded. Quality assurance systems had not identified these shortfalls.

At this inspection we rated the service as ‘Requires Improvement’.

We have made a recommendation about the management of medicines and quality assurance systems.

The service had 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.

People received their medicines at the correct time. Medicine administration records were signed. Medicines were stored securely. Records were not accurate on how people were to be supported with their medicines. Written guidance for staff on where to apply prescribed creams was not in place.

The provider did have a policy and procedure in place for safe recruitment. No new staff had been employed since the last inspection.

Staff felt supported and had discussions with the registered manager in terms of practice and support but these were not formally recorded. The registered manager’s supervision sessions were not always recorded.

The provider ensured staffing levels met the needs of the people using the service. Staff were aware of safeguarding and knew how to raise concerns if they felt people were at risk of abuse or poor practice. Accidents and incidents were recorded and reviewed by the registered manager.

Staff received an annual appraisal. Staff received training appropriate to the needs of the service.

People were supported with their health needs and had access to healthcare professionals when necessary. Staff supported people with some meal preparation.

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 and relatives felt the service was caring. Staff provided support in a respectful manner ensuring people’s privacy and dignity was promoted. Where possible people were supported to be as independent as possible.

The provider had a complaints process in place which was accessible to people and relatives.

People, relatives and staff felt the registered manager was approachable. We observed the registered manager was visible in the service and found people interacted with them in an open and friendly manner. The provider worked closely with outside agencies and other stakeholders such as health care professionals.

The inspection was announced and took place on 11 April 2016.

The provider is registered with us to provide personal care and support for people who live in their own bungalows within Plymouth Court. At the time of our inspection 4 people received care and support from this service.

A registered manager was in post. 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.

People said that they felt safe at Plymouth Court and received support from staff who were kind, caring and respectful towards them. Staff understood how to protect people from abuse and were clear about the steps they would take if they suspected someone was unsafe.

People told us that the staff and management were approachable and if they had any concerns they would be listened to. People said that there were enough staff to meet their needs and they were supported to take their medicines when they needed them.

Staff said training helped them do their job and gave them the right skills to meet the needs of the people they supported. However we saw that some staff training was overdue for renewal to ensure staff were kept update with any new information.

People we spoke with were very positive about the care that they received. They told us staff were kind and caring and treated them with respect. Staff provided support that ensured people were treated with privacy and dignity. People were supported by staff to maintain their independence.

People told us that they were involved in the care and support that they received. People were given choice and their wishes respected by staff. Staff understood they could only care for and support people who consented to being cared for. People told us that staff were quick to respond when they were unwell and they were supported to access health professionals when needed.

People told us that staff helped them prepare meals or get meals from the onsite restaurant when needed. Staff ensured people were offered a choice of meals and drinks.

People and staff were confident of the actions they would take if they had concerns and that any concerns would be dealt with appropriately.

The management team ensured regular checks were completed to monitor the quality of the care that people received and action had been taken where areas were identified for improvement.

People were positive about the care and support they received and the service as a whole.

During this inspection we spoke with four people who used the service about their experiences of the support they had received. We also spoke with two relatives, two staff and the registered manager.

All the people we spoke with who used the service spoke positively about the care they received. One person told us: “You can’t fault the care”. All the people we spoke with told us that the care staff who supported them understood their care needs. People told us that their wishes were always listened to and we found that the provider made sure people consented to any care.

We found that the provider had taken the necessary actions to ensure that people who used the service were safeguarded against abuse.

We found that the provider had the necessary assurances and checks to make sure that staff employed had been able to carry out their job roles safely and effectively.

We saw that the provider had systems in place to monitor the quality of the service. We also saw that where required the provider took action to improve the service quality.

During this inspection we spoke with seven people who used the service about their experiences of the support they had received. We also spoke with four of the staff. All of the people we spoke with who used the service spoke positively about the care they received. One person told us that they were, "Very happy with the care". All of the people we spoke with told us that the staff who supported them understood their care needs, treated them with dignity and respect and had the knowledge

and skills to support them safely.

People using the service are supported to take their own medicines. There are systems in place to ensure that the correct medicines are being taken and that any problems or concerns are identified and actioned immediately.

Staff employed at the service had access to further training and told us that they felt supported by their peers and the registered manager. One staff member said that, "There is a regular system of training". Another said, "People are always on hand to offer support or supervision".

We saw that the provider had systems in place to monitor and assess the quality of services being provided. Feedback was regularly sought from the people using the service, families and staff. Regular internal audits made sure that any areas for improvement could be identified and actioned quickly.

Plymouth Court Limited is an extra care housing scheme of 52 privately owned bungalows where people had access to a 24 hour call system. At the time of our visit four people received a personal care package from Plymouth Court Limited. Each person that lives at Plymouth Court becomes a share holder in the company and there are three ‘owners meetings’ a year in which all aspects of the complex are discussed.

We spoke with four people who used the service. People told us that they felt it was a “wonderful service” and “at the start we talked about the care I needed and when I needed it”. They told us “the service was really really good” and “I could not fault them”. Other comments included “that’s my care plan which they update daily” and “they look after me and they make sure I call my GP or the district nurse if I do not feel well”.

We looked at three care plans. These contained information about the care and support that people required. People we spoke with told us they had been able to tell care workers about the care and support they required on each call, this information had been recorded in the daily notes, but not added to the care plan documents.

We met with the nominated individual and the registered manager following the inspection to talk about our findings and they told us about the changes they planned to make. These will form part of their action plan that will be submitted to CQC. They described to us the way the owners of the flats meet and all have a say in the running of Plymouth Court. This means that the quality of the service is constantly reviewed and any change needed can be discussed openly.