This inspection took place on 15 and 16 March 2017 and was announced. At the last inspection on 8, 9 and 10 December 2015 no legal requirements were issued but some areas needed improvement. These included needing to review and make sure there were enough of the right staff on duty, at the right times, to meet people’s needs and to manage the service effectively. There needed to be an improvement in people’s support/care plans so staff were fully aware of people’s individual needs and preferences.

During this inspection improvements in these areas had been achieved by the interim manager in post. The service however, was still without a permanent and registered manager which had been the case since December 2015. 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. This issue was discussed during this inspection. Following our visit to Middleton House it was confirmed that a new manager was due to start soon and they planned to apply for registration with the CQC. This plan of action will be monitored by the CQC.

Sanctuary Home Care Ltd – Gloucester provide a domiciliary care service to people who live at Middleton House. Middleton House comprises of 49 one and two bedroom apartments for rent or shared ownership. As well as private apartments there are communal areas which people can use and enjoy. These include lounges, a restaurant, hair salon and additional toilet and bathing facilities. Care staff were based at Middleton House and carried out care visits to people who lived there.

The service is safe. People were protected against risks that may affect them. There were arrangements in place to manage known risks and quickly identify potential risks. There had been improvements made to staff numbers and the availability of staff. The service was now able to carry out all planned care visits for the agreed allotted time. Staff were also able to manage additional situations and tasks without this having an impact on people’s planned care visits. For example, visits by and liaising with care and health professionals, additional requests for support (extra care calls), emergencies and maintaining necessary care records. There were robust recruitment processes in place to protect people from those who may not be suitable to care for them. People were protected from potential acts of abuse and discrimination. Staff received training which enabled them to carry out their tasks safely and in line with necessary legislation and people’s human rights. Staff told us they would like some additional training relating to particular illnesses and conditions. The provider subsequently provided us with a comprehensive list of training which all staff received. They also confirmed that staff were able to request additional training, in the illnesses/conditions they had mentioned, through the provider's learning and development team. People’s medicines were managed safely and they received these as they required them.

People received effective care which was provided in a caring and compassionate way. People’s individual choices, preferences and wishes were listened to and supported by the staff. People were treated with dignity and respect irrespective of their diverse needs and beliefs. Staff showed a genuine desire to make people comfortable and to offer reassurance when needed. Staff supported people to live independently but were aware of when additional support was needed. Staff provided necessary support to ensure people ate and drank sufficiently and they helped them access support from health professionals when needed. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and therefore people were supported to make independent deci

The inspection took place on 8, 9 and 10 December 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that managers were present.

This was the service’s first inspection since it was registered with the Care Quality Commission (CQC) in March 2014. This service took place in Middleton House where people own or rent their own accommodation which consists of 49 two or one bedroomed flats. People can purchase different types of support and we inspected the domiciliary care service. This service manages all aspects of a person’s care needs, for example, personal hygiene, nutritional support, support with medicines and organising help with other health care related needs. Visits from the care staff are planned and varied from one to four visits a day. The provider also offered what they called “extra care” at Middleton House. This meant people could call for support in-between their scheduled care visits for an additional charge. Examples of this so far had been people feeling unwell or needing to use the toilet before their next care visit.

In June 2015 a manager was registered with the CQC, but they stopped managing the service on 19 November 2015. 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 therefore put temporary management arrangements in place until a new and permanent manager could be recruited.

People receiving care told us they were very happy with the service provided. They told us they felt safe, trusted the staff and their needs were responded to well. People received their care visits more or less when they expected to. Some visits had been late and the reasons for this were being addressed. People told us this had not, so far, had a negative impact on them. The care people wanted to receive was planned with them and they gave their consent before any care or treatment was delivered. Where people were not able to do this, due to a lack of mental capacity, the principles of the Mental Capacity Act 2005 were adhered to and people received their care lawfully. Some improvement to the recording of this process was needed and senior managers had already identified this. People received the support they required in order to take their medicines. Some improvements were needed to how the medicines system was monitored but again, this had been identified by senior managers who were improving this. People told us their dignity and privacy was maintained and staff were caring and compassionate.

Staff told us they felt supported by the senior managers and they had received appropriate training to be able to meet people's needs. It had already been identified that some staff would need additional training and guidance to be able to meet some new responsibilities which were planned for their role. Robust recruitment checks ensured people were protected from those who may not be suitable. The use of agency staff had reduced over the last 4 months but where there was still a need for this, senior managers tried to get the same agency staff back so as to avoid too much change for people.

There were arrangements in place to ensure people's areas of dissatisfaction and complaint were managed effectively. The provider’s quality monitoring arrangements were effective and had identified shortfalls in some of the service's systems and processes and these were being proactively addressed.