The inspection was carried out on 30 August 2017 and was announced.

The Hawthorns is a housing with care scheme made up of 41 separate apartments all on one site. The accommodation has a communal lounge area, dining room and extensive garden for the use of the people living at the scheme. The property is designed to enable and facilitate the delivery of personal care and support to people, now or when they need it in the future. The service operates a 24hour on call system with staff on duty throughout the day and night. If they prefer, people can choose to commission care from other agencies in the area. At the time of our visit the service was providing the regulated activity of personal care to 13 people. The frequency of visits and duration across the service varied dependent on people’s individual needs and circumstances.

There was registered manager who had been registered at the service since February 2016. A registered manager is a person who has registered with the CQC 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 25, 26 July and 2 August 2016 we found breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. We gave the service an overall rating of ‘requires improvement’. These breaches related to the provider's failure to ensure that people were treated with dignity and respect at all times. The provider had not ensured that processes were in place to assess, monitor and mitigate the risks relating to people who used the service. The provider did not ensure that an accurate and complete record was held for each person. We asked the provider to make improvements and to send us an action plan of how they intended to address the shortfalls in care.

At this inspection, we found that provider had made significant improvements since our last inspection and was no longer in breach of the regulations.

People were supported to keep themselves safe from harm and abuse. Staff knew how to recognise the signs of abuse and who to report concerns to. The provider had completed recruitment checks to ensure that potential new employees were suitable and safe to work with people who used the service. There were enough staff to meet people’s needs in a timely manner.

Staff were aware of the risks associated with people’s needs and knew how to minimise the risk of harm without restricting people’s independence and choice. Staff knew what action to take in the event of accidents or incidents and there were procedures in place to reduce the risk of reoccurrence.

People were supported to take their medicine when they needed it to promote good health. Staff monitored people’s health and supported them to access health care as necessary.

People were confident that staff had the skills and knowledge to meet their individual needs. Staff had access to training relevant to their role and to meet people’s specific needs.

Staff sought people’s consent before supporting them. Staff explained things to people in ways they could understand to enable them to make their own decisions.

People were supported to eat and drink enough to maintain their health and wellbeing.

People were supported by staff who were kind and caring. People were involved in decisions about their own care and felt listened to. Staff treated people with dignity and respect.

People were supported by staff who knew their needs and preferences well. People received care and support that was personal to them. People received a flexible service that was responsive to changes in their needs and circumstances.

People had not had cause to complain but felt confident to raise concerns with staff or the registered manager should the need arise.

People and their relatives knew the registered manager well and fo

An announced inspection took place on the 25, 26 July and 2 August 2016.

We gave short notice as this was a personal care service and we wanted to be sure that someone from the service could meet with us. We also asked the registered manager to seek, in advance, consent from people who used the service to speak with us.

The service was last inspected on 21 August 2014 and at the time it met the requirements of the outcomes inspected.

The Hawthorn’s Care Housing is adapted single household accommodation that is occupied under a tenancy agreement which gives exclusive possession of a home with its own front door to the people that live there. The accommodation also has a communal lounge area and dining room for the use of the tenants. The property is designed to enable and facilitate the delivery of personal care and support to people, now or when they need it in the future. A personal care service can be provided by the staff based at the site and staff can deliver care in an emergency. People can choose to commission care from other agencies in the area.

There was registered manager who had been registered at the service since February 2016. A registered manager is a person who has registered with the CQC 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.

We found that the registered provider was not meeting some legal requirements and we identified 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.

People said they received the right level of support from staff and described them as “reliable” “caring” and “marvellous”. This inspection found that people did not always have their wishes respected by staff in matters relating to their wishes and preferences.

Staff knew people well and showed an interest in their lives. People were supported to meet their physical, emotional, spiritual and social needs. However, records kept by the service did not always clearly identity the risks, needs, preferences and wishes associated with each individual. This meant that staff less familiar with a person may not deliver the support required.

Choices were offered by staff and the consent of people sought before providing support. Some people lacked the mental capacity to make some decisions. Staff were aware of what was required to ensure that their rights were protected and made decisions in their best interest. We made a recommendation that the registered provider ensure this is better demonstrated within records to comply fully with the Mental Capacity Act.

People were provided with information about the service and their opinion was sought as to how it could be further improved. People felt able to raise concerns as they felt the registered manager and the staff were approachable.

Living at The Hawthorn’s combined with the support received made people feel safe and secure. There were safeguarding policies and procedures in place which staff were knowledgeable about. We saw that staff were confident to highlight concerns and swift action was taken by the registered manager ensure that people were safe and cared for.

Safe recruitment procedures were in place and were followed. Staff had the relevant pre- employment checks including those from the Disclosure and Barring Service. Staff had been given regular supervision, appraisal and support in their role. Their training needs had been identified in order to improve their knowledge and competence. This meant that people could be assured that staff were employed with the right character and skills to provide their support.

There were systems in place to record and monitor accidents, incidents, staff practice and any health and safety concerns. Ac

At our previous inspection in June 2014 we found that medicines were not stored safely and medicines records were not accurate.

We carried out this inspection to make sure that the provider had made the necessary improvements to ensure that medicines were managed safely.

We found that the service was safe because the provider had now implemented appropriate arrangements to manage medicines.

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?

Staff had received training in topics relating to health and safety. Risks to people's health, safety and wellbeing had been identified and acted upon to ensure people received safe care and support. The manager set the staff rotas, taking people’s care needs into account when making decisions about the numbers of staff required. This helped to ensure that people’s needs were always met.

People said that they were given their medicines correctly and on time, but we found that medicines were not stored safely and medicines records were not acccurate. Failing to maintain accurate records means that people are at risk of being given their medicines incorrectly and places them at unnecessary risk of harm.

Is the service effective?

Staff had all the information they needed to meet people’s needs and they ensured people received the right care and support. Staff were respectful and polite towards people who used the service and they consulted people about their care. People’s preferences and choices were understood and respected.

Is the service caring?

People told us they had been provided with written information about the service, including charges, and were able to discuss what support the service could offer before making a choice to use the service. People's religious and lifestyle choices were understood and respected. People who used the service and their relatives told us that staff were kind, polite and caring towards them. One person had commented in a customer satisfaction survey:- "I am very happy with everything and the staff are excellent".

Is the service responsive?

People told us they had been involved in the planning of their care and support, that they knew about their care plans and they understood and had agreed to them. People were given opportunities to put forward their views and opinions about the service and the way it was run. Any ideas people had for improvement were listened to and acted upon. The people we spoke with said they were satisfied with the service. Comments included: "I'm very happy with the care" and "It's brilliant. I don't have to worry because I know they look after Mum".

Is the service well-led?

People were happy with the care and support they received and they felt able to approach the manager and staff with any concerns they had and were confident that they would be listened to. Surveys were carried out regularly to monitor the quality of the service.

We spoke to three people who received personal care and two relatives. All said the person receiving the service had been able to visit a couple of times before moving in and had signed a tenancy agreement for the property and a contract for personal care. They said they had agreed the amount and type of personal care that would be provided and the hourly rate before moving in.

All the people we spoke with said the care was good. Comments included: "I'm very happy with the care"; "The care is excellent"; "I'm 99% satisfied"; "The staff are very kind and helpful".

People told us they felt safe and expressed confidence that if they had a problem they would be able to discuss it with the manager and that it would be taken seriously.

There were systems in place to seek the views of the people who used the service. The manager held tenants' meetings monthly and two drop in sessions every week. Surveys were carried out on a regular basis and people who used the service were informed of the outcomes of the surveys and action that would be taken as a result. There were also forms available in reception for people to submit comments or complaints.