William Wood House provides care and support to people living in specialist ‘extra care’ housing. Extra care housing consists of single household accommodation in a shared site or building. The accommodation is the occupant’s own home and is provided under a separate agreement. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. The service does not provide nursing care. At the time of our inspection there were 30 people using the service. They lived in separate flats with shared areas including gardens and a large lounge and dining room.

The inspection took place on 12 and 14 September 2017 and was unannounced.

There was a registered manager in post. 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 manager was passionate and committed in their role. They worked well with their new area manager and they had put a detailed action plan in place which was improving the quality of support being provided, and addressing concerns in an open and effective manner. They prioritised risk well and continued to address poor practice despite the on-going staffing challenges.

The manager had focused on improving the safe administration of medicines over the last six months. Staff had been retrained, medicine care plans revised and other systems improved. However, during our inspection we became aware of a medicine error during which staff had not responded effectively and in a timely manner when a person’s medicines had run out. This example highlighted areas where the improvements put in place by the manager had not yet become firmly established.

The manager was also facing concerns around staffing levels. Where no staff were available, they had prioritised direct care to ensure people’s needs were met and were often providing care themselves. At our inspection we were told a new additional team leader role had been created and there was on-going recruitment to ensure the manager had a full staff team and could focus on running the service. Despite the pressure on staffing levels, recruitment processes remained robust. There was some reliance on agency staff, however systems to improve the induction for these staff had been revised to help them understand better the aims of the service and people’s needs.

Risk was well assessed and measures put in place to support people to stay safe. Staff knew what to do if they had concerns regarding people’s safety. People were supported to communicate their preferences and to remain as independent as possible. Staff had developed positive relationships with people and treated them with dignity.

Staff were experienced and confident in their role. They were well trained and supported, though the recent staffing pressures had led to a dip in morale. The needs of people at the service were becoming more complex, especially in the area of dementia. The manager was working well with professionals to support staff to develop skills and to adapt the support people received to ensure it continued to meet their changed needs.

Staff enabled people to access outside health and social care agencies where necessary and worked well with other professionals to promote people’s wellbeing. People choose what they ate and drank in line with their preferences.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005. While most people at the service had capacity to make choices about their care support, the manager knew of the need to consider any legal requirements where people’s capacity was becoming more variable. Staff respected people’s right to make their own decisions about their life

We spoke with seven people using the service, two visiting relatives and a social worker who was on site. They all confirmed that the care provided by the service was good. One relative said, “I want you to know how happy we have been with the quality of care given to my relative. We could not be happier and it has given us great peace of mind.” Someone using the service told us, “Staff are lovely and they take time to have a chat. There is always something organised everyday so I don’t feel as bored and lonely. I love baking sessions and the art.”

We found that staff had received comprehensive and updated training which meant that they demonstrated a good understanding of the principles of effective care and support. Staff we spoke with knew how to store and administer medication safely, although we did find an error in medication recording during our inspection.

There were effective recruitment and selection processes in place to ensure that people were receiving safe care from staff with relevant qualifications and track records.

We spoke with four people who told us that they were happy with the support provided by the agency. One person told us that they considered the staff both kind and caring. Another person told us that the staff were always reliable and regular.

Two people told us that the agency had consulted them with regard to the care and support they had received through an annual questionnaire.

One person told us they did not mind who provided their support as "Everyone is kind and gentle."

William Wood House is very sheltered accommodation providing personal care to people living in their own flats. When we inspected on 25 and 26 June 2015 there were 26 people using the service. This was an announced inspection. The provider was given 24 hours’ notice because the location provides a domiciliary care service.

There was no registered manager in post. 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. A new manager had been appointed, and had started on the 1 June 2015. At the time our inspection they were in the process of applying to be registered.

There were systems in place which provided guidance for care workers on how to safeguard the people who used the service from the potential risk of abuse. Care workers understood the various types of abuse and knew who to report any concerns to.

There were procedures and processes in place to ensure the safety of the people who used the service. These included risk assessments which identified how the risks to people were minimised.

Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

There were sufficient numbers of care workers who were trained and supported to meet the needs of the people who used the service. Care workers had good relationships with people who used the service.

Where people required assistance with their dietary needs there were systems in place to provide this support safely. Where care workers had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment.

People or their representatives, where appropriate, were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions.

A complaints procedure was in place to ensure people’s concerns and complaints were listened to, and addressed in a timely manner and used to improve the service.

Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were being addressed. As a result, it would lead to continued improvements in the quality of the service being provided.