This inspection took place on 18 January 2017. Minster court Limited is a domiciliary care service run by Minster Court (Bracebridge Health) limited which provides personal care and support to people who live in apartments in an independent living complex owned and run by Minster Court (Bracebridge Heath) limited. On the day of our inspection 23 people were using the domiciliary service.

The service had a registered manager in place 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 and associated Regulations about how the service is run.

People felt safe and staff understood their responsibilities with regard to protecting the people who used the service from abuse or harm. Risks to people’s health and safety were assessed and managed, and people were encouraged as far as possible to maintain their independence.

People’s needs were met and they were cared for by sufficient numbers of staff. They received their medicines as prescribed and the management of medicines was safe. Staff caring for people received sufficient and appropriate training to carry out their roles.

People were encouraged to make independent decisions and staff were aware of legislation and the principles of the Mental Capacity Act 2005 (MCA) to protect people who lacked capacity when decisions were made in their best interests.

When required people received the support they needed to have enough to eat and drink and referrals were made to health care professionals when needed.

People who used the service, or their representatives, were encouraged to contribute to the planning of their care and were treated in a caring and respectful manner by staff who delivered support in a relaxed and considerate way.

People who used the service, or their representatives, were encouraged to be involved in decisions and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.

This inspection took place on 8 December 2015 and was unannounced. Minster Court provides a personal care service to adults of all ages with a range of health care needs who live within the Minster Court complex. People live in privately owned flats where they can receive support with their personal care if they require it. When we undertook our inspection there were 12 people using the service.

At the time of our inspection 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 with the care they received from their carers. Staff had completed safeguarding training and had access to guidance. They were able to recognise if people were at risk and knew what action they should take within the organisation, however they were unsure how to report concerns outside of the organisation.

Where risks had been identified there were plans in some areas to manage them effectively. Risk assessments were not in place for falls. Staff understood risks to people and followed guidance. Staff were alert to changes in people’s health. They recorded incidents and reported them.

There was sufficient staff to provide people’s care. Recruitment checks ensured that people were protected from the risk of being cared for by unsuitable staff. People’s care was provided by staff who were sufficiently trained and supported.

Medicine records were not consistently completed. Staff undertook medicines training. Staff had received an induction when they started employment with the provider and completed further training relevant to people’s needs and were supported to undertake professional qualifications. Systems were in place to support staff and monitor their work.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA). Staff treated people with dignity and respect. Staff asked for consent before providing care to people.

Care plans were updated regularly. People’s needs in relation to nutrition and hydration were documented. Care plans were personalised and people were supported to maintain their choices. People were supported to access health professionals such as the GP and district nurse.

Staff felt supported and the manager ensured people had information and support to make complaints. Where complaints were made they were investigated and actions taken in response. People’s feedback on the service was sought through a range of methods. Staff were encouraged to speak with the office about any concerns they had about people’s care.

The provider had quality checks in place however these were not always effective and action plans were not in place to ensure issues were addressed. Staff were unclear about the whistleblowing policy.

The summary is based on our observations during the inspection, speaking with people who used the service, and the staff who supported them. We spoke with two staff members and two people who used the service. We also looked at five care records in detail and other documentation.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service caring?

We saw that staff were kind and attentive and encouraged people to be independent.

During our inspection we observed staff spoke with people on an individual basis and understood their particular needs.

We spoke with two people who used the service they told us, staff were respectful and always asked them what they wanted doing before carrying out a task.

Is the service responsive?

We saw that people's individual physical, mental and social care and support needs were assessed and met. We saw evidence that care plans had been discussed with people. This also included people's individual choices and preferences as to how they liked to have their care provided. For example, care plans detailed how people liked to have their meals.

We observed people's consent had been obtained on issues such as provision of care and support with medicines.

Where people's needs had increased or changed we observed care had been changed to meet those needs.

One person we spoke with told us that after a hospital admission they had received support from the provider to meet their needs in a timely and appropriate manner.

Staff we spoke with told us if people required additional support on an ad hoc or regular basis they were able to provide it.

Is the service safe?

Risk assessments regarding people's individual care needs, for example falls and mobility were carried out and measures were in place to minimise these risks.

The home had policies and procedures in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) in place. Mental Capacity Act (2005) and Deprivation of Liberty Safeguards are laws protecting people who are unable to make decisions for themselves.

When we spoke with the registered manager they gave us an example of when they had carried out an assessment of capacity to ensure a person received care in their best interest.

Staff were able to tell us what they would do if there was an accident or incident. They also said that there was always a manager about to ask for assistance if required.

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. Staff told us about situations when they required more support for people and they were able to obtain this, for example, if a person required more time for support due to illness

We observed care plans had been updated to reflect people's changing needs and where people had short term needs due to illness care plans were in place to ensure these were met.

Where people had specific physical issues such as diabetes we saw their care plans reflected this.

Is the service well led?

Staff said that they felt supported and trained to safely do their job. They told us they felt able to raise issues with the managers.

We saw staff had received supervision and had had opportunity to raise issues at their supervision such as additional training needs. Staff had not had appraisals in the last year. Appraisals are used to provide support to staff and identify ongoing training needs. They are usually held on a yearly basis. The registered manager told us that they were reviewing the format for supervision and appraisal and would be planning the appraisals for this year.

The manager told us they were in the process of revising the appraisal arrangements and setting these up with staff.

Quality assurance arrangements and checks were in place and people were listened to. For example a survey had been sent out to people in February 2014. There were also arrangements in place to enable people to speak with managers on a regular basis about the service provision.

The provider did not have a formal arrangement in place for observing and recording care practices. They told us they would address this issue.

Records were accurate and reflected the care people required. The provider had put in place arrangements to ensure records reflected the care people required and that people had agreed to this care.

As part of our inspection we spoke with the manager and two members of staff. We spoke with two people who used the service. We also looked at records.

When we looked at the daily logs we found they were completed on a daily basis and recorded the care people received.

People told us they were happy with the care and felt safe and well cared for. People said, “Couldn’t be better” and “Girls will do anything I want”. People told us they were, “Well looked after.

Staff were able to tell us about people's care. Overall we observed people were supported by skilled and experienced staff who understood their roles and responsibilities in order to provider safe care to people.

We spoke with staff about consent and found they understood the issues around consent. We saw evidence in the records consent had been obtained for some areas of care.

During our visit we looked at care plans and found they had information about people's likes and dislikes. We saw records included detailed information about the care people were to receive.

We saw evidence of liaison with other professionals according to the needs of people.

We observed the service was responsive to people's needs.

When we looked at the records we found there were gaps in the records and a lack of evidence of records being reviewed regularly. This meant there was a risk people received inappropriate care.

Overall we observed people were supported by skilled and experienced staff who understood their roles and responsibilities. However we found that staff had not received appropriate support and development.

We saw people were treated with dignity and respect and were supported to make decisions about their care.

When we spoke with people they told us they felt confident with the care they received and that staff knew how to meet their needs. We spoke with staff and they were able to tell us about how people liked to be cared for.

A person said the carers were, "Brilliant."

During our visit we heard staff talking to people who had queries in a sensitive way.

During our visit we looked at care plans and records and found a number of gaps in the care records.