An announced inspection visit took place on 26 July 2018 and we announced our return on 27 July 2018.

Margaret Court is registered to provide personal care to older people. Care and support was provided to people at prearranged times in a specialist ‘extra care’ housing service. Margaret Court consists of 44 apartments and six bungalows. People living at Margaret Court share on site facilities such as a lift, lounge, library, dining room, laundry and a garden.

Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. At Margaret Court, each person exclusively owns their own home and the building is designed to enable and facilitate the delivery of care and housing related support to people now, or in the future. The provider is based at Margaret Court and provides emergency support to everyone living there. Planned day to day personal care can be provided by staff based at this site or from other agencies who provide personal care and support packages. Not everyone living in extra care housing receives regulated personal care.

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 provided by Margaret Court.

At the time of this inspection visit, Margaret Court staff supported six people in six apartments. Therefore, for this inspection, we only looked at the care and support for those six people receiving personal care from this provider. All six people continued to be independent and did not have any complex care needs.

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.

At our last inspection we rated the service Good overall, however at this inspection we found some aspects of the management of the service required improving so the overall rating has changed to Requires Improvement. In ‘Well led’ we found a lack of evidence and embedded practices that had not identified some of the concerns we found that has resulted in one breach of the regulations. We found evidence in ‘Safe’ that had potential to place people at unnecessary risk. Where risks associated with people's health and wellbeing were known, there was no information to tell staff how to manage those risks. Some risks for particular health conditions were not included within care plans and staff’s practice of administering medicines was not in line with NICE guidance, which had potential for staff not to provide consistent support.

People were pleased and satisfied with the quality of care provided by a consistent, kind and caring staff team. People and relatives were complimentary of the service and staff and people said there were enough staff to provide them with the care and support they needed, at the times they preferred.

People were supported to remain as independent as possible so they could live their lives as they wanted. People made day to day choices about what they wanted to do for themselves and how they lived their lives. People were encouraged to maintain important relationships with family and people built friendships with others living at Margaret Court.

Care plans were not person centred and did not contain all of the information required for staff to provide consistent and safe care. For people assessed as being at risk, care records did not include important information for staff to help minimise risk. When people’s needs changed over time, there was no updated care plan or process to ensure staff delivered care in line with those changing needs which meant there was an inconsistent approach in how staff supported tho

We carried out an unannounced inspection at Margaret Court on 08 March 2016.

Margaret Court provides a home care agency service including personal care for up to 50 people who own their own homes within the complex. Margaret Court has three floors with 44 apartments. There are also six bungalows in the grounds. There are communal facilities available which include a lounge area, a dining room, a library and a garden. At the time of our visit there were two people receiving personal care from the Margaret Court staff. The amount of care and support varies from a few hours domestic support each week, to people receiving support up to 24 hours a day. Some people purchased care and support from Margaret Court and others purchased this care and support from other external home care agencies.

Margaret Court had a registered manager in place. 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 told us they felt safe. Staff were confident to report any concerns and were aware of their responsibilities to keep people safe from harm. Staff had been recruited following safe recruitment procedures. People were kept safe through risks being identified and well managed. People received support receiving their medicines as prescribed.

People received care and support from staff who had received training to meet their individual needs. Staff were given opportunities to meet regularly with their seniors to reflect on their practice and continually improve their performance. The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and staff promoted and respected peoples’ choices and decisions. People were supported to receive the healthcare services they required.

People received care and support from caring and kind staff and were treated with respect and dignity. Staff were compassionate towards people and assisted people to retain their independence and make their own decisions about their life style choices.

Peoples’ individual needs were at the centre of the service offered and provided. Staff responded to peoples’ changing needs. People were encouraged to express their views about the service and where suggestions for improvements were made, staff acted on these to improve the quality of services delivered.

The registered manager and senior team were well respected, were accessible and provided effective leadership. The vision and values of the service were clearly communicated to and understood by staff. Systems to monitor the quality of the service were in place and used to inform decisions in order to make improvements where required.

When we visited Margaret Court we spoke with three people who used the service and two relatives to obtain their views about the service. We spoke with the manager, the duty manager and two care staff. We also spoke with the cook following our visit.

People who lived at Margaret Court told us, “Could not find a better place.”

We saw staff were kind and attentive when speaking with people. We saw people were supported and encouraged to maintain their independence.

We looked at two people’s care records and saw their care plans reflected their personal needs.

We spoke with three staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Care staff had received training to enable them to look after people safely. We saw staff had a formal meeting with the manager.

We found the service had systems in place to monitor the quality of service provided at Margaret Court.

We spoke with two people who had been using the service, two relatives of people using the service and three staff at the housing complex. People told us that they felt able to express their views and felt confident when doing so. The provider may like to note that only one completed satisfaction survey had been completed for one person using the service which detailed feedback about their experiences. Comments from the people we spoke with identified that they had been happy with the care and support that had been received. One such comment was: ‘’It’s very agreeable living here.’’

We saw people's needs had been assessed, risks identified and personalised plans of care developed for each person. We saw evidence of involvement of allied professionals to ensure people's ongoing healthcare needs were met.

The staff confirmed staff recruitment processes were robust and as such ensured people were cared for by staff that had the appropriate skills and experience. We observed recruitment processes had been robust.