We undertook an announced inspection on 24 August 2017. We gave the provider 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their homes; we needed to be sure that someone would be available at the office.

Quinton Lodge provides housing with care. The unit consists of 31 flats. People live in their own home and staff provide personal care and support at pre-arranged times and in emergencies. Included in these flats were five short term tenancies. These provided people with an opportunity to regain skills after being in hospital, or in the community to assess if they were able to continue at home or needed to move somewhere with more support. At the time of our inspection 18 people were receiving support with personal care.

At the last inspection in December 2014, the service was rated Good. At this inspection we found the service remained Good.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 continued to receive care in ways which helped them to remain as safe as possible. Staff understood the risks to people’s safety, and were able to respond to them. Staff we spoke with recognised the different types of abuse people may be at risk of. There were systems in place to guide staff in reporting any concerns and support people to remain safe. There were regular staff available to ensure people’s needs were met. People were supported to receive their medicines by trained staff who knew the risks associated with them. The management team completed regular checks to ensure staff were competent in their role.

The care people received continued to be effective. Staff received training which matched the needs of people they supported. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff ensured people agreed to the support offered before assisting them. People were supported to eat and drink well when part of their identified needs. They were supported to stay well and access to health care services when they needed to.

People had developed caring relationships with staff and were encouraged to make their own choices and maintain their independence. People were treated with dignity and staff were respectful to people’s wishes. People and their relatives said staff and management team were compassionate and kind.

People and their relatives’ views and suggestions were listened to. People’s care plans reflected their preferences and people told us the service adapted to meet their needs. Systems were in place to promote and manage complaints.

Staff were involved in meetings, to share their views and concerns about the quality of the service. People and staff said the management team were accessible and would take action when needed.

People, their relatives and staff were encouraged to make any suggestions to improve the care provided and develop the service further. Regular checks were in place to monitor the quality of the service and improvements were driven through for the benefit of people who were supported by the service.

We undertook an announced inspection of Quinton Lodge on 15 December 2014. We told the provider two days before our visit that we would be coming.

Quinton Lodge provides housing with care. The unit consists of 31 flats. People live in their own home and staff provide personal care and support at pre-arranged times and in emergencies. At the time of our visit there were 25 people using the service. The unit had three short term tenancies. This provided people with an opportunity to regain skills after being in hospital and to assess if they were able to return home or needed to move somewhere with more support. There was one person using the short term facility on the day of our visit.

At the previous inspection on 14 November 2013 the provider was meeting the required standards.

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 who used the service said they felt safe living at Quinton Lodge. Staff understood their responsibilities around keeping people safe and there were systems and processes in place to protect people from the risk of harm. These included a risk management process, a thorough staff recruitment procedure and an effective procedure for managing people’s medications.

There were enough suitably trained staff to meet people’s individual care needs. Staff understood about consent and respected the decisions people made about their daily lives. People were supported to maintain their independence and were able to live their lives as they chose.

People were happy with the care they received and said they got on well with the staff that provided their support. Staff maintained people’s privacy and dignity when providing care and people said staff were respectful and caring. Care plans and assessments contained information that supported staff to meet people’s needs. Staff provided care to people in the way they preferred.

People felt listened to and were confident they could raise any concerns about their care or support. There were processes in place for people to express their views and opinions about the service.

People told us Quinton Lodge was well managed and they were happy with the service they received. There were systems in place to monitor the quality of the service. This was through feedback from people who used the service, staff meetings and a programme of checks and audits.

On the day of our visit there were 28 tenants at Quinton Lodge, which has 31 flats. A visiting professional told us “I can’t praise it enough, it’s very friendly here.”

We visited the service on a weekday and looked at records. We observed how people were being cared for and we talked with people who used the service. We spoke to people who lived there and observed some people having lunch. We spoke to staff and to the registered manager.

Staff had a good knowledge and understanding of the individual needs of people living at Quinton Lodge. All the interactions we observed were friendly, positive and informal.

We spoke to two relatives. One relative said “The staff are very very pleasant.” People told us that support staff were polite to them. One person told us “I like it here, they are nice here.”

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were cared for by staff who were supported to deliver care safely and to an appropriate standard. All the staff we spoke with said they felt supported in their work. One staff member said “I’ve recently been on some training, I’ve got some more coming up.”

On the day we visited Quinton Lodge there were 27 people using the service. People who used the service received varying levels of care and support. Some people received support with personal care while others only required a well being check.

We spoke with six people who used the service and two relatives who were visiting. People told us they were happy with the service provided by Quinton Lodge. Comments we received included “The care staff are absolutely superb.” “It’s a brilliant place, the staff are all very helpful.”

We looked at how people’s care was being managed. We found care records provided staff with the information they required to meet people’s needs. There was also a procedure to make sure care was delivered safely. We saw that staff recorded the things they had done and signed the times they arrived and left people’s homes.

Staff we spoke with knew how to recognise symptoms of abuse and what to do to keep people safe. We found staff supported people to maintain independence and make their own decisions.

There were processes in place to safely recruit staff and provide staff with the training and support to meet the care needs of people.

We looked at the way the service managed complaints. We found that complaints could be managed better so people can be sure their comments and complaints are listened to and acted on effectively.

People told us that that their care and support needs had been agreed with them when they moved into their flats. People told us that they were consulted and involved in decisions made about the care they receive. All the files we looked at contained an assessment of need completed by the social worker, and a care plan and needs assessment completed by the agency. We were told copies of care plans are kept in the tenants’ flat and that plans are updated regularly.

People said there is a team of consistent care staff who they know well. People we spoke with said staff are responsive to changing needs. One person said ‘The staff here are all lovely especially since I’ve not been well, they now come and help me get up in the mornings.’

Care staff we spoke with demonstrated a good understanding of client needs and gave examples of promoting independence and maintaining peoples’ privacy and dignity.

One member of staff told us, “We encourage x to do as much for herself as possible, she is able to wash herself but she likes someone there for safety”.

People we spoke with told us that staff are always polite and treat them with respect. We were told carers are helpful and friendly. We observed staff speaking to people in a respectful manner throughout our visit. A relative we spoke with said that all the staff are friendly and respectful to their relative. She told us, ‘My father is very content here. He says the staff are very attentive’.

People we spoke with said they had been given a tenants guide that told them about the services the agency offer. They said there was a file in their flats with this information in it. People said they are visited daily by a member of staff to make sure they are ok.

We looked at five support plans to see how the agency manage peoples care. We found not all identified risks had assessments completed. There was no pressure area management in one plan we looked at and no medication assessment in another.

One of the support plans had not been updated when the person’s needs had changed. This tenant is now unable to stand unaided and required several calls a day from unit staff. This person had a history of pressure sores, and the district nurses were visiting regularly. However, there was no information in the care plan about pressure area management. This is a potential risk. There should be documented information about how pressure areas are managed to ensure people remain safe and well. The manager agreed to take the appropriate action to update this person’s care plan to reflect their current care needs.

Serious concerns were identified with one tenant’s medication. This was not being given as prescribed. Action was taken by the manager while we were there to address the concerns and minimise the risk.

People we spoke with said they felt safe at Quinton Lodge. One person said “I like the fact staff are here if you need them. It’s very reassuring to know that.” Another person told us, “I look after myself but someone still comes in every day to make sure I’m OK.” Staff we spoke with said they had completed safeguarding training and knew what to do to keep people safe.

We found at the time of our visit there was sufficient staff available to meet the current needs of tenants’. People we spoke with said there was always staff available if you needed to talk to someone.

People told us they are asked for their opinions of the care provided. We were told there are regular tenants’ meetings and they are sent a questionnaire every year. One person told us “Its really good here, I’ve been at Quinton Lodge for 14 years, it’s a lovely place to live.”