Applegrove (Domicillary Care) provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing and this inspection looked at people’s personal care and support service. At the time of the inspection, 12 people were being supported by the service.

At the last inspection, the service was rated Good. At this inspection on 8 November 2017, we found the service remains Good.

People were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or avoidable harm. There was sufficient numbers of staff to support people safely. Staff took appropriate precautions to ensure people were protected from the risk of acquired infections. People’s medicines were managed safely, and there was evidence of learning from incidents.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences, and choices. Staff had regular supervision and they had been trained to meet people’s individual needs effectively. The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. Where required, people had been supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access healthcare services.

People were supported by caring, friendly and respectful staff. They were supported to have maximum choice and control of their lives, and the policies and systems in the service supported this practice.

Staff regularly reviewed the care provided to people with their input to ensure that this continued to meet their individual needs, in a person centred way. The provider had an effective system to handle complaints and concerns. Where people were able to remain in their own homes, staff ensured that they remained comfortable, dignified and pain-free at the end of their lives.

The service was well managed and the provider’s quality monitoring processes had been used effectively to drive continuous improvements. The registered manager provided stable leadership and effective support to the staff. They worked well with staff to promote a caring and inclusive culture within the service. Collaborative working with people, their relatives and other professionals resulted in positive care outcomes for people using the service.

Further information is in the detailed findings below.

We carried out an announced inspection on 9 September 2015. The service provides care and support to people living in their own homes, within an extra care housing scheme and the care staff are based in the building. At the time of the inspection, 19 people were being supported by the service, some of whom may be living with chronic health conditions, physical disabilities and dementia.

The service had 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised. There were systems in place to safeguard people from risk of possible harm.

The provider had effective recruitment processes in place and there were sufficient numbers of staff to support people safely.

Staff understood their roles and responsibilities to seek people’s consent prior to care being provided.

Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff. They were supported to access other health and social care services when required.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to improve the quality of the service.

The provider’s quality monitoring processes had been used effectively to drive continuous improvements.

During our inspection of Applegrove (Domiciliary Care) on 31 October 2013, we spoke with people who use the service about their experiences. All of the people we spoke with said they were very satisfied with their care and with the service. They said care workers attended all of their scheduled appointments and delivered the care and support they were supposed to. They told us they had the opportunity to feedback to the service about their care and experiences and had no complaints to raise at the time of our inspection. Those who had raised concerns in the past said the service had responded quickly and appropriately. One person summarised the views of the people we spoke with saying: "It's a good service with good, reliable staff who all know exactly what they're doing. I have no complaints whatsoever."

We saw that each person received an assessment of their care needs, including any risks associated with their care provision. In all the cases we looked at, we found that the care provided matched with the care required and was what people had agreed to. We saw that people's care was provided by a sufficient number of suitably qualified staff.

We saw the service had effective systems to regularly assess and monitor the quality of service that people received. These included customer consultation visits, care documentation audits and surveys. There was an effective complaints system available and comments and complaints people made were responded to appropriately.

The people we spoke with told us they had their privacy and dignity respected and were encouraged to be independent. They said they were able to make choices and decisions about their care and had their preferences respected. They said they were given useful and relevant information relating to their care by the service.

The people we spoke with said they had received an assessment of their needs when they started using the service and that staff displayed a good understanding of their needs and how to meet them.

The people we spoke with told us they felt safe being cared for by staff from Applegrove. They said the staff were respectful and professional and appeared qualified and experienced to carry out their roles. They said they felt the standard of care provided was very good.

The people we spoke with told us they were able to raise concerns or comments with the service and any concerns they had were dealt with satisfactorily. They could recall being provided with questionnaires requesting their feedback on the service but were unable to recall completing them.

One person summarised the general feeling of the people we spoke with by saying: “Everything seems to run smoothly. I like the care workers who are respectful and able to do everything I need them to”.