The inspection took place on 24 September 2018 and was announced.

Housing and Care 21 – Rohan Gardens is registered to provide personal care 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 or purchased on a shared ownership scheme, 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; this inspection only looked at people's personal care service.

Housing and Care 21 – Rohan Gardens also provide an on-call emergency service to everyone living in the building under a separate arrangement which people pay for as part of the service charge for the shared premises.

Rohan Gardens has 42 apartments. People living at Rohan Gardens share on-site facilities such as lifts, lounge, restaurant, laundry and a garden. People who need support with personal care are free to choose Rohan Gardens or any other domiciliary care service as their provider. At the time of this inspection, Rohan Gardens supported 24 people with personal care.

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.

We last conducted a comprehensive inspection of the service in August 2016, where the service was rated as ‘Good’ overall, however effective was rated as ‘Requires Improvement’, because the provider had not met the legal requirements of the Mental Capacity Act 2005. We conducted a focussed inspection in October 2017, to review improvements made by the provider in that area and we rated the service as ‘Good’ because satisfactory improvements had been made. At this inspection we found the evidence continued to support the rating of ‘Good’. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from the risks of abuse because staff received training in safeguarding people and understood their responsibility to report any concerns to senior staff. Most risks to people's health and wellbeing were managed, however some risks had not been fully assessed.

The manager made sure there were enough suitably skilled, qualified and experienced staff to support people safely and effectively. The provider checked staff were suitable for their role before they started working for the service.

Staff worked within the principles of the MCA and supported people to have maximum choice and control of their lives. People were supported to eat and drink enough to maintain a balanced diet that met their needs and preferences. People were supported to maintain their health.

People felt well cared for. Staff understood people’s needs and interests and supported them to enjoy their lives according to their preferences. Staff respected people’s right to privacy and supported people to maintain their independence.

The provider and the registered manager demonstrated they valued care staff and promoted their learning and development. Staff enjoyed their work and were motivated to provide people with a good standard of care.

People were involved in planning how they were cared for and supported. Care was planned to meet people’s individual needs and preferences and care plans were regularly reviewed. People knew how to complain and had the opportunity to share their views and opinions about the service they received.

People were happy with the quality and leadership of the service. The registered manager was committed to ensuring people received good quality care and shared good practice with staff. Th

Housing and Care 21 - Rohan Gardens, is an extra care housing complex which provides personal care and support to people in their own homes.

This inspection took place on 04 October 2017 and was unannounced.

We had previously carried out an unannounced comprehensive inspection of this service in August 2016. At that inspection we found the provider was in breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We gave the provider a rating of 'requires improvement' in 'effective' as a result. This was because, where people lacked capacity to make decisions, this was not always clearly assessed or recorded. Applications to protect people who were being deprived of their liberty had not been made to the local authority as required. Following our visit, the provider sent us information telling us how they planned to ensure they met the legal requirements.

We undertook this focused inspection to check the provider had followed their plan and to confirm that they now met legal requirements. We found the provider had made the required improvements and was no longer in breach of the regulation. This report only covers our findings in relation to those requirements and to the key question of how effective the service was. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Housing and Care 21 - Rohan Gardens, on our website at www.cqc.org.uk.

The service is required to have 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 and associated Regulations about how the service is run. At the time of this inspection the service had a registered manager in post.

People were supported by staff who were well trained and knowledgeable, and knew about people's needs and how they preferred them to be met. Staff had access to essential and specialist training on an ongoing basis, and had regular opportunities to meet individually so they could develop.

The registered manager and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005. People were asked for their consent before staff supported them.

Staff supported people to eat a healthy and regular diet so they could manage their own health conditions. Staff supported people to attend health appointments, and ensured people had access to urgent medical attention where required.

We undertook an announced inspection visit to Rohan Gardens on 16 August 2016. We told the provider 48 hours before our visit, we would be coming. This was so people could give consent for us to visit them in their own flats to talk with them.

Rohan Gardens provides housing with care. People live in their own flats and received personal care and support from staff at pre-arranged times throughout the day, and in emergencies. Rohan Gardens consists of 42 flats and at the time of our visit, 24 people at Rohan Gardens received personal care.

The service had a registered manager, however they had been on extended planned leave since May 2016. The service was being managed by a deputy manager who was in the process of making an application to be registered with us. 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 using the service and there were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care and for managing people’s medicines safely. Staff knew what actions to take to keep people safe and had a good understanding of what constituted abuse. The suitability of care staff was checked during recruitment procedures to make sure, as far as possible, they were safe to work with people who used the service.

The deputy manager and staff had limited knowledge of their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records did not always ensure people received consistent support when they were involved in making more complex decisions, such as decisions around finances or where they wanted to live. Staff gained people’s consent before they provided personal care and supported people to retain as much independence as possible.

There were enough staff to deliver the care and support people required. Staff received training and supervision to support them in meeting people’s needs effectively and to help develop their own learning.

People received care from a team of staff they were familiar with, who stayed long enough to complete the care calls people required. People told us staff were kind and respectful and knew how they wanted to receive their care.

Support plans and risk assessments contained relevant information to help staff provide the personalised care people required, although some required further information to ensure staff continued to provide consistent care. People knew how to complain and information about making a complaint was available for people. People told us they felt they could raise concerns or complaints if they needed to because the management and staff were always available and approachable.

Staff had opportunities to raise any concerns or issues with the managers, knowing they would be listened to and acted on.

Management provided good leadership and who care staff found approachable and responsive. There were systems to monitor and review the quality of service people received and to understand the experiences of people who used the service.

We found a breach 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.

When we visited Rohan Gardens we spoke with the service team manager (who had started four weeks ago in his role and is referred to as the manager in this report), the care team leader, a senior health care assistant and one person who used the service. Following our visit we gathered evidence of people's experiences by telephoning three more people who used the service. We also spoke by telephone with two health care assistants. Speaking with these people helped answer our five questions; Is the service safe, effective, caring, responsive and is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We found people’s care records had been recently reviewed by a senior member of staff. We saw people’s care records reflected most of their care needs.

We saw people had risk assessments in place that made sure most risks to their health and wellbeing were managed. However we found some people who were at risk of developing pressure areas to their skin had not been assessed. We found there was some information in people’s care plans which gave instructions to staff about how to check people’s skin integrity.

We found staff understood the importance of safeguarding vulnerable adults and knew how to report a concern. People we spoke with told us they felt safe using the service.

We found information relating to some incidents was not reported straight away to senior staff.

We looked at staff records and found the provider’s recruitment practice was safe and thorough.

Is the service effective?

People told us the care they received met their needs. When talking about the care staff, one person told us, “They’re great.” Another person told us, “They ask if there’s anything I need.”

Staff we spoke with had a good understanding of the needs of the people they supported and what they told us was reflected in people’s support plans.

Is the service caring?

We spoke with four people who used the service. They gave us mixed views about how the staff treated them. Some people were satisfied with the service and told us staff were “very friendly and polite”. Other people told us staff had not treated them with respect. They told us they had raised these issues with the care team leader and improvements had been made to the service they received.

Is the service responsive?

We found people had been asked for their views about their care in a recent customer survey. We found some issues had been raised by people about the quality of care they received. The care team leader explained how these issues had been addressed on an individual basis with people.

We saw incidents, accidents and complaints had been logged. We found the service had taken action, but some of the actions had not been fully documented.

People told us care staff noticed when their needs changed and took action.

Is the service well led?

We found the service had an internal quality assurance system in place. The provider visited the service at intervals and checked a variety of issues. There was an action plan in place which identified improvements required to be undertaken by the manager. We saw the manager had engaged with the plan and was working towards completing it.

People who used the service told us they were able to speak with the manager and the care team leader and felt able to raise any issues or concerns they had. We found issues were responded to by senior staff in a timely way.