Steeple View provides care and support to people living in an ‘extra care’ housing scheme. Extra care housing is purpose built or adapted single household accommodation in a shared site or building. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care provided by the service. Not everyone living at Steeple View received the regulated activity of personal care. On the day of our inspection 35 people were receiving this service.

Steeple View consists of 36 one and two-bedroom self-contained apartments over two floors. The service is situated in a quiet rural area on the edge of the town of Stowmarket in Suffolk. The service provides support to people to live in their accommodation, with their own tenancy agreements. The aim of the service is to

provide high quality care and support at all times to enable people to remain living as independently as possible within their own homes.

At the last inspection in January 2017, we found a breach of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. We were concerned the service was not consistently safe as the provider's recruitment procedures were ineffective. Pre-employment checks on new staff did not always identify gaps in employment and ensure references from the most recent employer had been provided. We asked the provider to take steps to improve and complete an action plan to show what they would do and by when to improve the key question of responsive. At this inspection we found improvements had been made. We viewed the staff recruitment records of six staff recruited since our last inspection. We found appropriate checks such as employment references had been undertaken prior to the staff member commencing employment.

People were provided with care and support according to their needs and any risks were identified and managed. People's care plans provided staff with the information they needed to support people and were personalised to reflect their preferences. Systems were in place to support people with their medicines where required. Staff understood the principles of mental capacity.

People were cared for by staff who received appropriate training and support from their line managers.

People's dignity, privacy and independence were respected and promoted. People were supported with their eating and drinking needs when needed. People were supported to access healthcare professionals when required and the service worked with a number of external agencies to ensure that people received joined up, consistent care.

People and their relatives had access to and were aware of the services complaints procedure. People were regularly asked for their views. There were effective systems in place to monitor and improve the quality of the service provided.

The service was well-led and people were satisfied with the care and support provided. There was a quality assurance system in place to ensure the service was routinely audited and checked.

This inspection took place on the 25 & 26 January 2017 and was unannounced.

Steeple View is a housing with care complex and is registered to provide personal care to people living within their own flats. The scheme has 36 flats. On the day of our inspection the manager told us there were 39 people receiving care.

There was 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.

At our last inspection in July 2016 this service had an overall rating of requires improvement. We had moderate concerns about the safe handling of people’s medicines and the lack of robust and effective audits. We asked the provider to send us an action plan describing how they would make improvements.

At this inspection we found improvements in the management of people’s medicines. The provider had taken steps to update their medicines management policy and procedural guidance for staff to reflect current national good practice guidelines. There were improved arrangements in place for the safe handling and administration of medicines, including controlled drugs. Effective systems were in place for the safe booking in, storage, administration, stock control and disposal of medicines.

People were well cared for, relaxed and comfortable with staff. Everyone who used the service was complimentary about the staff team and the quality of care they received. People were cared for by a motivated, caring, well trained staff team. Staff understood how to identify people at risk of abuse and aware of protocols for reporting any concerns they might have.

Staff had been provided with sufficient guidance and information within care records. Care and plans were personalised, regularly reviewed and accurately reflected people’s care and support needs including their likes and dislikes.

People’s likelihood of harm was reduced because risks to people’s health, welfare and safety had been assessed and risk assessments produced to guide staff in how to mitigate these risks and keep people safe from harm. However, we found that systems for the recruitment and selection of staff were not robust. We were not assured that the provider had taken appropriate steps to evidence that safety checks had been carried out on all staff employed prior to their starting employment at the service.

The culture of the service was open, inclusive, empowering and enabled people to live as full a life as possible according to their choices, wishes and preferences. The management team provided effective leadership to the service and enabled people to air their views through regular care reviews, meetings and surveys. Staff understood their roles and responsibilities and were well supported by the management team.

The provider carried out regular quality and safety monitoring of the service. Where shortfalls had been identified action plans had been produced which evidenced planning towards continuous improvement of the service.

We carried out an unannounced comprehensive inspection of this service on 30 September 2015. We found breaches of legal requirements in relation to the Health and Social Care Act 2008 (Regulated activities) 2014This was because the provider had failed to take action to assess and mitigate risks to the health welfare and safety of people. People’s medicines were not managed properly and safely. There were no effective systems in place to assess, monitor and improve the quality and safety of the service.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this focused unannounced inspection on the 7 July 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Steeple View’ on our website at www.cqc.org.uk

Steeple View is a housing with care complex and is registered to provide personal care to people living within their own flats. The scheme has 36 flats. On the day of our inspection the manager told us there were 36 people receiving a domiciliary care service.

There was 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.

At this focused inspection on 7 July 2016 we found the provider had made some improvements in meeting the shortfalls we identified. However, further work was needed to ensure the provider was meeting the requirements of the law.

The provider had taken action to set up a system to improve the process for ordering, receipt and maintaining records of medicines administration.

The manager had taken action to ensure that all staff received updated training in medicines management. However, the provider’s medicines management policy and procedural guidance for staff remained not fit for purpose. The provider had not taken the prompt action that they told us that they would take and the staff did not have the guidance that they needed. In addition care plans did not always contain the most current information, required for staff to be able to care for people consistently and safely.

The manager had implemented regular medicines management audits which were carried out by team leaders at the service. However, these audits largely consisted of checks to identify any gaps in staff signatures in medication administration records and not any audit of stock. We found that there were anomalies in the stock which had not been identified by audits.

Staffing levels had been calculated according to people’s dependency levels. Staff and the manager told us there were a number of current staff vacancies which resulted in a continued use of agency staff. Staff worked well as a team to cover extra shifts from within the team to ensure consistency of care for people. All of the people we spoke with told us that they did not notice any shortages of staff and there was sufficient staff available to meet their needs

The provider had developed safeguarding policies and procedures which provided staff with guidance in response to allegations of suspected abuse and steps for staff to take to protect people from the risk of harm.

During this inspection we identified a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 30 September 2015 and was unannounced.

Steeple View is a housing with care complex and is registered to provide personal care to people living within their own flats. The scheme has 36 flats. On the day of our inspection the manager told us there were 39 people receiving care.

There was 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 had been placed at risk as some aspects of medicines management were not safe. Risks to people‘s safety had not been properly identified, assessed and managed.

Recruitment procedures were robust and although there had been shortages of staff which had resulted in a high use of agency staff, new staff had recently been recruited and were due to start their employment shortly after our inspection.

Staff were provided with a variety of training which included training in recognising and responding to abuse. However, we found the provider did not respond when safeguarding concerns had been identified in taking action to report to relevant authorities in line with local safeguarding protocols. Steps had not been taken to analyse incidents with outcomes to mitigate further risks to people’s welfare and safety.

People were supported to maintain good health and have access to healthcare services. Where risks of malnutrition had been identified guidance for staff had been provided within people’s care plans.

People’s consent to care and treatment had been sought in line with legislation and guidance.

Staff demonstrated kindness and compassion towards people. People were treated with respect and their dignity was protected when staff supported them with personal care. People had been involved in the planning of their care and had been given information about the service. This meant they knew what to expect in terms of their care package and timings of support visits from care staff.

People found the management team approachable and available when needed. Staff experienced positive team working.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 30 September 2015 and was unannounced.

Steeple View is a housing with care complex and is registered to provide personal care to people living within their own flats. The scheme has 36 flats. On the day of our inspection the manager told us there were 39 people receiving care.

There was 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 had been placed at risk as some aspects of medicines management were not safe. Risks to people‘s safety had not been properly identified, assessed and managed.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with seven people who used the service, two relatives, the manager and two members of staff as part of this inspection. People who used the service told us, that they felt safe, the staff were kind, cheerful and helpful. Another person said, “The staff are like an adopted family.”

The service was well lead, as the emergency plan had worked well, when put into action because of the recent storm when the service lost power for ten hours. The staff increased visits to people to ensure they were warm, safe and had food and drinks until the power was restored.

We found that the service was meeting the personal, emotional and healthcare needs of people who used the service. Care plans were well documented and up to date and the service carefully sought the person’s consent about how they wished their care to be delivered. The service had a robust recruitment process and a complaints system was in place that people could use if the need arose.

People told us that they liked living at Steeple View and that staff were supportive and caring. People told us they could get help when they needed it. One person said "We are so happy we came to live here." We saw that care was agreed with people and provided according to their assessed needs. We found that staff were trained comprehensively in the skills required to provide safe care. The provider had effective systems to monitor the quality of the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.