The provider is registered to provide support and personal care to adults. People who used the service received their support and care in their own flats within the extra care complex. On the day 33 people required personal care and support from staff.

Our inspection was unannounced and took place on 05 June 2017.

At our last inspection in March 2015 the service was rated good in four of the five questions we ask: Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? The remaining question, ‘Is the service safe?’ was rated as ‘requires improvement’ as improvement was required in relation to medicine management. During this, our most recent inspection, we found that improvements had been made in that area.

A manager was registered with us as is required by law and was involved in our inspection. 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.

Faults on the emergency lighting had not been rectified which posed a potential risk to people and staff. Measures had been taken to reduce people’s individual risks and to promote their safety. Medicines were now managed more safely. Temperatures of the medicine fridge and stock cupboard were being monitored and records confirmed the medicines received into the service. We found that where medicines were prescribed on an ‘as required basis’ there were instructions for staff to confirm when the medicine should be given. The registered manager and staff had followed the provider’s procedures to ensure the risk of harm to people was reduced and that people received care and support in a safe way. Staff were available to meet people’s individual needs.

We found that staff were trained and competent to support the people who lived there effectively and safely. The registered manager was aware that some staff training was required and was in the process of addressing this. Induction training was available for new staff and staff had the support they needed to ensure they did their job safely. Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that the registered manager was meeting the requirements set out in the MCA and DoLS. DoLS applications had been made to the Court of Protection ensure that people received care in line with their best interests and were not unlawfully restricted. Staff supported people with their nutrition needs and their health care needs were met by a range of external health care professionals.

People’s dignity, privacy and independence were promoted by kind and caring staff. People were able to make decisions about their care and they and their families were involved in how their care was planned and delivered. Staff supported people to keep in contact with their family as this was important to them. People had access to advocacy services as required.

People’s needs were assessed and reviewed regularly. The provider ensured that people could secure religious input if they wanted to. Systems were in place for people and their relatives to raise their concerns or complaints. Provider feedback forms and a comments book were used to gain the views of people, relatives and external healthcare professionals.

The provider had a robust management structure that staff were familiar with. People and their relatives told us that the quality of service was good. Processes were used to monitor the quality of the service however this required some fine tuning to ensure that all areas of safety and support were included.

The provider is registered to provide support and personal care to adults. People who used the service received their support and care in their own flats within the extra care complex.

Our inspection was unannounced and took place on 4 March 2015. At our last inspection in June 2014 the provider was meeting all of the regulations that we assessed.

A manager was registered with us as is required by law. 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.

Medicines were not always managed safely. Temperatures of the medicine fridge and stock cupboard were not being monitored and records did not always confirm medicine received into the service. We found that where medicines were prescribed on an ‘as required basis’ there were no instructions for staff to confirm when the medicine should be given.

Staff followed the provider’s procedures to ensure the risk of harm to people was reduced and that people received care and support in a safe way.

People and their relatives told us that staff were available to meet their [or their family members] individual needs. We found that staff were trained and competent to support the people who lived there effectively and safely. Staff told us and records confirmed that they received induction training and the support they needed to ensure they did their job safely.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that the registered manager was meeting the requirements set out in the MCA and DoLS to ensure that people received care in line with their best interests and were not unlawfully restricted. They knew that regarding extra care services any DoLS referral would have to be made to and approved by the court of protection.

Staff supported people with their nutrition and health care needs. We found that people were able to make decisions about their care and they and their families were involved in how their care was planned and delivered. Systems were in place for people and their relatives to raise their concerns or complaints.

Staff supported people to keep in contact with their family as this was important to them.

Staff supported people to be as independent as possible. People were encouraged and supported to undertake daily tasks and attend to their own personal hygiene needs.

All people received assessment and treatment when needed from a range of health care professionals including their GP, specialist consultants and nurses which helped to promote their health and well-being.

All people we spoke with told us that the quality of service was good. This was confirmed by all of the relatives we spoke with. The management of the service was stable, with processes in place to monitor the quality of the service.

The care provision was extra care. This meant that people lived in their own flat within the extra care complex and the staff provided the care and support that they needed.

Our inspection was unannounced. On the day of our inspection 29 people received personal care packages from the service. Additional people received support that did not involve personal care provision for example, safe and well checks.

We spent time in the communal areas of the complex where we could observe staff interactions with people and met some of the people who used the service. During our inspection we spoke with 11 people who used the service, one relative, six staff, a visiting social care professional and the registered manager. Following our inspection, we spoke with four relatives by telephone. We also looked at comments made by relatives in recent review documentation. We did this so that we could get a picture of what it was like for the people who used the service and to find out their views on the service provided.

All of the people who used the service and their relatives we spoke with were very complimentary about the service and care provided. One person said, “I have lived here for over 10 years. I have seen a number of changes in that time but still think it is very good here”. Another person told us, “It is wonderful. We are very well looked after”. One relative told us, “The service is second to none”. Another relative said, “It is a brilliant place”. A visiting social care professional told us, “I come in here regularly and observe. I have only seen positive things”.

The summary is based on our observations during the inspection, discussions with people who used the service, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

We considered all the evidence we had gathered under the outcomes we inspected. This is a summary of what we found:

Is the service safe?

The provider had a rolling training programme that covered core areas such as safeguarding vulnerable adults which incorporated the Mental Capacity Act. Staff we spoke with had some knowledge about the need to uphold people’s rights. The registered manager told us that if they identified issues concerning possible harm or limitations being imposed on people they would speak with the relevant professionals in the local authority safeguarding team. This showed that systems were in place to prevent unnecessary restrictions being imposed on people. One relative told us, "I have no concerns at all, I am extremely happy with the standard of care". All people we asked told us they felt safe and that they had not seen anything of concern. One person said, “None of that abuse business happens here. We are safe”.

We found that some systems were in place to maintain safety and reduce risks. We saw that equipment had been secured to meet the individual independence and safety needs of people who used the service. We also saw certificates to confirm that the firefighting appliances were serviced regularly to ensure that they were safe to use and fit for purpose.

We found that systems were in place to manage day to day risks and to promote safety. This included the monitoring of falls. We found that where staff had identified concerns regarding risks associated with people’s health and welfare they had been referred to appropriate agencies.

Recruitment processes were in place which gave people who used the service assurance that only suitable staff had been employed.

We found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was safe.

Is the service effective?

All of the people we spoke with confirmed that they were happy with their care and support. They told us that the service provided met their needs. One person said, “I am very happy here”.

All staff we spoke with told us that they felt that the people who lived there were well cared for and were safe. One staff member said, “The service we provide is very good. All people are well cared for”.

We found that systems were in place to ensure that people could select food and drink which was nutritious and varied. We saw that the meals provided were well presented attractive and in sufficient quantity. One person said, “I enjoy the food”.

People had their needs assessed and staff knew how to support people in a caring and sensitive manner. The care records showed how they wanted to be supported and people told us they could choose how this support was provided.

Staff received on-going support from senior staff to ensure they carried out their role effectively. All staff we spoke with told us that they felt supported. One staff member said, “All seniors and the manager are very good. We all feel supported”.

Arrangements were in place to request heath, social and medical support to help keep people well.

We found that the provider had processes and systems in place to meet the requirements of the law to ensure that the service was effective.

Is the service caring?

We saw that care was provided with kindness and compassion. People told us that they could make choices about how they wanted to be supported, and that staff listened to what they had to say. All of the people we spoke with were extremely complimentary about the staff. They described them as being, “Compassionate”, “Kind” and “Caring”. One person who lived there said, “The staff are all so wonderful”.

We spent some time in communal areas observing interactions between staff and the people who lived there. We saw that staff showed people respect and promoted their dignity. We also saw that staff showed patience when supporting people.

The staff knew the care and support needs of people well enough to ensure individual personal care was provided.

We found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was caring.

Is the service responsive?

We found that meetings were held regularly so that the people who used the service had the opportunity to raise any issues. This showed that the provider was willing to listen to the views of the people who lived there to improve the overall service provision.

We found that the provider had taken note of the findings from our previous inspection and had taken action to address issues for example, sustaining the improvement of medication management systems.

The people who used the service were supported to take part in recreational activities within the complex and the community which were organised in line with their preferences.

When people became unwell the staff noticed this and secured appropriate medical input.

We found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was responsive.

Is the service well led?

There was a registered manager at the service who was aware of their legal responsibilities.

The staff were confident they could raise any concern about poor practice at the service and these would be addressed to ensure people were protected from harm.

Plans and systems were in place to ensure people knew how to act in the event of any emergency to keep people safe.

The staffing was organised to ensure people’s needs were met and support was available for any appointments and activities.

We found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was well led.

During our inspection of this service in August 2013 we found non-compliance with medication management. We identified that appropriate arrangements were not in place in relation to the recording of medication. When we looked at medication records to see if they had been completed correctly we found that a significant number had not. We found a high number of gaps on medication records where staff had not signed to confirm that they had given the person their medication. We carried out this inspection to find out if improvements had been made and found that overall they had.

At the time of our inspection 36 people were using this service. People who used the service had varying needs. Ten people only required minimal support and prompting whilst others required up to four plus calls a day to provide full care and support. During our inspection we met and spoke with eight people who used the service, six staff, two relatives and the manager.

All people we spoke with were complimentary about both the service that they received and the staff. No one made any negative comments or raised any issues of concern. One person told us "I think it is a wonderful place. It is my home. The staff are so good”. Another person said “The service is second to none. They look after us all. There is nothing that I need that I do not get”. One relative said, “They are extremely well looked after. If they were not, or I had any concerns they would not be here”. Staff told us that they enjoyed their work and that they felt people using the service were well looked after.

During the time we spent with people we saw that staff treated them with respect and dignity. All people we spoke with told us that choices were offered and their views had been taken into consideration.

People's needs had been assessed by a range of health professionals including specialist doctors and the optician. We saw that equipment needed to prevent risks and meet people’s needs was available. This meant that staff had enabled people to have their health care and safety needs monitored and met.

We found that medication management needed some improvement as there were gaps and shortfalls in evidencing that people had been given their medication as it had been prescribed by their doctor.

We found that adequate staff were provided to meet people’s needs and to keep them safe.

We found that some systems had been used to monitor how the service had been run and people had been encouraged to give their views about the service provided.

Our inspection was unannounced no one knew we would be visiting. There were 37 people living at this extra care scheme on the day of our inspection. We spoke with seven people and six staff to find out their views about the service provided.

People we spoke with told us positive things about the service that they received. One person told us "I have lived here for years. I really like it and am happy”. Another person said “It is a really nice place”.

Due to their health conditions or needs not all people were able to share their views about the care that they had received so we used other ways to find out people's experiences including observation.

We saw that staff had treated people with respect and dignity. People told us that choices had been offered and their views had been taken into consideration.

People's needs had been assessed by a range of health professionals including specialist doctors and the optician. This meant that people's health care needs had been monitored and met.

Although staff had received some training we found that training opportunities needed improvement so that all staff would have up to date knowledge to support the people who lived there.

We found that systems had been used to monitor how the home had been run. The manager was aware that improvement to those systems was needed.