The inspection took place on 21, 22 and 23 August 2018 and was announced. This was the first inspection since Cecil Gardens was registered with the Care Quality Commission (CQC) in July 2017. We gave the provider, Hales Group Limited, 12 hours’ notice of our inspection. This was because the location provided a domiciliary care service and we needed to be sure the registered manager and staff would be available to support the inspection process.

Cecil Gardens 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. The CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

There are 95 individual flats in Cecil Gardens. Not everyone living there receives a regulated activity. The CQC only inspects the service being received by people provided with ‘personal care’, for example, help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of the inspection, 71 people were receiving the regulated activity of personal care from Hales Group Limited. There were also 63 people who lived in the surrounding area who also received calls for personal care from Hales Group Limited. Most were older people who had a range of needs, which included physical difficulties and those people who were living with dementia. However, there were other people who had mental health needs and a small number of people who had a learning disability.

The service had a registered manager in post, although a new person had been appointed as a 'care manager' and was in the process of applying for registration with CQC. The registered manager was to ‘de-register’ for this location once the process of registration with the care manager was completed. 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 Act 2008 and associated regulations about how the service is run.

During this inspection, we identified shortfalls in relation to medicines management, gaps in recording and quality monitoring of the service. These issues were breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) 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.

We found people had not always received their medicines as prescribed. There had been some administration errors and also recording omissions, which made it difficult to check if people had actually received them. Staff received additional training and competency checks. The recording errors had persisted although were reducing. This meant people remained at risk of harm as the provider could not be assured people were receiving their medicines in line with the prescribing instructions.

There was a quality monitoring system and audits had identified some shortfalls. However, the system had not identified other recording issues. These included mental capacity documentation, missing dates and signatures on important assessments, the lack of an important care plan update following a significant change in one person’s needs, no monitoring charts for pressure relief for a person at risk and some elements of risk identification. The quality monitoring had not identified a lack of time in-between care calls within Cecil Gardens.

Staff knew how to protect people from the risk of abuse and had completed training. They knew who to contact if they had concerns. Risk assessmen