The inspection took place on 9 and 10 June 2016 and was announced. We gave the service 48 hours’ notice of the inspection because it is small and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.

Broad Meadow is registered to provide personal care services to older adults in their own homes as part of an extra care scheme. On the day of the inspection, 50 people were receiving support. 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.

People felt safe within the service. We found that care staff knew how to keep people safe and what action would be required where people were at risk of harm. People were able to receive their medicines as it was prescribed.

Care staff had the skills and knowledge to meet people’s needs. Care staff were knowledgeable about the legislation relating to mental capacity and people’s human rights. Care was only provided with people’s consent and their human rights were protected.

The provider ensured people were involved in how their needs were assessed and how they were supported. Where reviews were carried out people were involved in the process and any decisions made. People’s dignity, privacy and independence was respected.

People received support how they wanted and were able to raise any concerns they had as part of a complaints process.

The provider had systems in place to ensure the quality of the service was checked and monitored regularly and audits were carried out.

People were able to share their views on the support they received by way of completing questionnaires or meeting regularly with management.

When we inspected the service there were 75 people receiving personal care support in their own homes. We spoke with eight people living there, the senior carer and three carers on the day of our inspection. One person told us, “I like living in my own home and the carers give me the help I need, I am very happy”.

Carers understood the importance of obtaining consent from people before they commenced care tasks. One person said, "We sign our consent for the tasks we need help with and things like carers entering our flats. It was all explained to us”.

People's support plans showed how their health and personal care needs were met. People confirmed that they had the agreed support from carers and they were usually on time.

People were happy with their arrangements for meals. Carers were clear how to recognise when people did not eat or drink enough.

The arrangements for supporting people with their medicines had improved and people confirmed they had medication when they needed it.

Carers were supported in their care role. One carer told us, "We have regular supervision and meetings and we have a handset so we can call for support when we need it”.

We inspected the service to check on improvements the provider had made following our last inspection on 11 July 2012. We spoke with four people, the manager and a senior carer.

Broad Meadow provides personal care to people living in their own homes. We did not speak directly to people in their flats but spoke with four people in the communal areas of the scheme. One person told us, “I am very happy here”, another person told us, “It can be difficult to get repairs sorted which does depress me”.

We also saw people had commented about their experiences in their care reviews, for example, "I am satisfied with the support I receive” and "I am very happy here".

We found improvements in the assessment and planning of people's care was evident.

The deployment of staff had improved so that people's needs were met and people were safer. Improvements in respect of checking staff competencies had been progressed this ensured people had care delivered to them at the times they needed and in the way they wanted.

This review included a pharmacist inspector who inspected the arrangements for the management of people's medications on 2 January 2013. We found some improvements in the management of people’s medication, but further improvements were still needed to ensure people had their medication as it was prescribed.

We saw that the arrangements for monitoring the quality of the service had improved and included feedback from people about their experiences.

We visited Broad Meadow on 11 July 2012 because we were made aware of concerns in relation to the delivery of care. We reviewed all the information we hold about this provider, checked the provider's records, observed how people were being cared for, looked at records of people who use services, talked to staff and talked to people who use services.

The visit was unannounced, which meant the provider and the staff did not know we were visiting. For part of our visit we were accompanied by an expert by experience. An expert by experience is some one who uses services, or has had experience of services. Our expert by experience spoke with people using services, and wrote a report about what they found.

We spoke to people who live and receive personal care from Broad Meadow care staff. People told us that they were happy with the care they received. People told us that staff were respectful and provided assistance when they needed it. We also saw that people had been surveyed about their experiences and some of their comments were as follows: “They (staff) are better than excellent”.

“They are friendly and helpful”.

“I am very happy here”.

“When called by pendant one minute means fifteen (minutes)”.

We observed that interaction between staff and people using the service was seen to be caring and compassionate and that people had said they felt that they were treated with dignity and respect. We heard from some people about delays in staff responding to their requests for support.

We looked at care plans for four people that used the agency, and spoke with a number of people and staff. We found that there were inaccuracies in the information within care plans and risk assessments and the support people needed was not clear. We looked at the risk assessments in people's care records. We found that where these had been completed they were contradictory. In two care records we saw little information of how people's health should be monitored where there was increased risk such as with their medication.

We heard from Dudley social services that they had received concerns about the levels of support people were receiving. The main concerns raised centred on medication errors, care plans not being followed in relation to specific health care needs, concerns about the thoroughness of night time checks, and a fall not being correctly followed up. We were informed that safeguarding investigations had commenced.

We found that people did not always get the support and care that they needed. We found that the staff did not always record the full time of care given and that there was no tool used to calculate the actual care hours needed. We also saw that there was no analysis of actual care hours delivered even though these were in excess of what people had been assessed as needing. This meant that the provider could not be sure if all of the people were receiving their full allocation of care hours. From the records we did see, this appeared to be compromised because some people needed higher levels of care which meant staff were being stretched.

For part of our visit we were accompanied by a pharmacist inspector who inspected the arrangements for the management of people’s medications. Their findings are reflected in outcome 9.

We found there was not a system for auditing staff practice, or checking visit sheets, to ensure that staff are providing the care that people need and have requested. This means that there is no ongoing review of people's needs and the care they receive.