Creative Support – Bedfordshire Service provides personal care and support to people who live in extra care housing schemes across three locations; Redhouse Court in Houghton Regis, Lavender Court in Ampthill and St Georges Court in Leighton Buzzard. At the time of our inspection they were providing a service to 53 people.

This inspection took place on 4, 5 and 6 October 2016, and was announced. At the last inspection in October 2015, we asked the provider to take action to make improvements to the number of staff on duty and the completion of mandatory training for members of care staff. This action had been completed.

The service has a registered manager in post that was present throughout our inspection. 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 Care Act 2008 and associated Regulations about how the service is run.

People told us that they felt safe and were supported by consistent, reliable staff. Staff understood their responsibilities with regards to safeguarding people and they had received relevant training. There were systems in place to safeguard people from the risk of possible harm.

Accidents and incidents were reported promptly, analysed by senior staff and action taken to reduce reoccurrence. Personalised risk assessments that gave guidance to staff on how individual risks to people could be minimised were completed and updated regularly.

The service had robust recruitment procedures in place. There were sufficient staff on duty to meet the care and support needs of people and an effective system to manage the rotas and schedule people’s care visits in each of the schemes.

There were effective systems in place for the management of medicines. People were supported to take their medicines as prescribed, where assessed as required.

Staff were skilled and competent in their roles and were supported by way of spot checks, supervisions and appraisals. These were consistently completed for all staff and used to improve and give feedback on performance.

People were complimentary about the catering services provided at the schemes and the support they received at mealtimes. People were supported to maintain their health and well-being and accessed the services of health professionals.

Staff were kind, caring and friendly. They provided care in a respectful manner and maintained people’s dignity. People were involved in making decisions about their care and their consent was sought. Positive relationships existed between people and staff.

People’s needs had been assessed and they had been involved in planning their care and deciding in which way their care was provided. Each person had a detailed care plan which was reflective of their needs and had been reviewed at regular intervals. Staff were knowledgeable about the people that they were supporting and provided personalised care.

People, their relatives and staff knew who to raise concerns to. The provider had an robust process for handling complaints and concerns. These were recorded, investigated, responded to and included actions to prevent recurrence.

There were effective quality assurance processes. Feedback on the service provided was encouraged and action plans had been developed to address any issues raised within audit processes and surveys, with a view to continuously improve the service.

There was positive leadership at the service and people, staff and relatives spoke highly of the registered manager. Staff felt valued, motivated and were committed to providing quality care.

The inspection took place on 21, 22, 28 and 30 October 2015. We gave the provider 48 hours notice of our visit so that they could arrange for people to be available to talk with us about the service. When we last inspected the service in August 2013 we found that the provider was meeting their legal requirements in all the areas that we looked at.

Creative Support Ltd- Bedfordshire Service provides personal care and support to people who live in extra care housing schemes across three locations: St George’s court in Leighton Buzzard, Redhouse Court in Houghton Regis and Lavender Court in Ampthill. They also provide support to six people within a supported living service. At the time of our visit there were 56 people receiving personal care.

Although it is required to have one, the service did not have a registered manager in post at the time of 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. The previous registered manager had left the service in July 2015 and a new manager was due to start at the service imminently.

We found that there was not always enough trained and competent staff on duty to reduce the risk of harm to people using the service although the service ensured staff were suitable to work in the service through appropriate recruitment practices. However, staff carried out procedures for which they had not been trained. People did not always receive their calls on time and staff were not always able to spend the correct amount of time with people. Staff were negative about the amount of pressure they were required to work under and did not always receive appropriate levels of supervision, performance management or management support.

Staff received an induction to the service and were trained to care for people, however some staff hadn’t received a full induction before starting. Staff were trained and knowledgeable in the requirements of the Mental Capacity Act 2005. Staff that worked in the service were kind and caring. Care staff were knowledgeable about people that used the service and understood their needs and preferences.

People using the service had care plans which were person-centered, detailed their likes, preferences and needs and were reviewed regularly. People were encouraged to access healthy, nutritious and varied meals. Detailed assessments of risks to people had been completed.

People had opportunities to provide feedback on the service and the views of people, families and professionals were regularly sought through questionnaires and residents meetings. Complaints received by the service were resolved quickly and satisfactorily. Some people did not know who the manager was and weren’t sure who to complain to.

The service undertook effective regular internal audits and kept up to date with best practice.

During this inspection we found that there had been breaches of Regulations 12 and 18 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.