An announced inspection visit took place on 10 October 2018.

Tiddington 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. Tiddington Court consists of 30 apartments and 12 bungalows. People living at Tiddington Court share on site facilities such as a passenger lift, lounge, dining room and the use of an onsite restaurant.

Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. At Tiddington 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 Tiddington 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 Tiddington Court.

At the time of this inspection visit, Tiddington Court staff supported six people. 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 and found the service continued to be Good. However, in well led, we found this had changed to requires improvement because there were limited and effective quality assurance checks recorded that assured the provider, people received good care outcomes.

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. There was flexibility in the rota to enable people to change their times if needed and any emergency calls, could be responded to.

People said the service was well managed and changes in management since our last inspection had positive results on the care provision. Staff echoed people’s comments. Staff were complimentary of the management and said the changes had meant people and staff were more settled and enjoyed living and working at Tiddington Court.

The provider promoted independent living and 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 Tiddington Court.

Care plans needed more specific information for staff to provide consistent and individualised care. For people assessed as being at risk, care records did not include sufficient information for staff to help minimise those risks, although we saw, this did not have a negative impact on people who received care.

Staff knew how to keep people safe from the risk of abuse. Staff and the management team understood what actions they needed to take if they had any concerns for people's wellbeing or safety. People told us t

We carried out an unannounced inspection at Tiddington Court on 09 March 2016.

Tiddington Court provides a home care agency service which can include personal care delivery, depending on individual needs. The provider manages Tiddington Court which provides home ownership for up to 42 people in their own apartment or bungalow. 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. At the time of our visit four people purchased care and support from Tiddington Court staff and others purchased their care and support from other external home care agencies.

Tiddington Court had a manager who was not yet registered. 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. There were systems to ensure peoples’ safety was managed effectively. Staff were aware of the actions to take to report their concerns. There were sufficient staff to ensure peoples’ needs were met and people were supported to manage their medicines safely.

People received care and support from staff who were trained and well supported. Staff knew people well and understood, and met, their needs. Peoples’ rights to make decisions about their care were respected. The manager and staff had a good understanding of the Mental Capacity Act 2005.

People told us the staff were kind, caring and respectful. People were involved in decisions about their care on a day to day basis.

There were opportunities for people to pursue their interests and access the local community. Peoples’ care records were detailed and provided staff with sufficient guidance to ensure their needs were met consistently. People had access to information on how to make a complaint and were confident their concerns would be acted on.

People were encouraged to provide feedback on the service in various ways. The provider had an effective system for assuring quality. There were however inconsistencies in recording in staff files.

When we visited Tiddington Court we spoke with six people who used the service to obtain their views about the service. We also spoke with the manager, the duty manager, two care staff and the cook.

People who lived at Tiddington Court told us, “Wonderful community.”

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 found the court worked well with other providers, for example outside care agencies. This ensured safe care was delivered to people.

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

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

We visited Tiddington Court on 7 January 2013. The inspection was unannounced so that the provider, staff and the people who lived at the service did not know we were visiting.

We last inspected the service on 13 August 2012 and we found the provider had not provided care staff with relevant training in the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLs).

A system to safeguard people’s money was not in place and whilst we were inspecting the service a safeguarding referral was made. We also found that the provider did not have a system in place to monitor the quality of service provision. For example, regular medication audits and a system to monitor complaints.

We were told by the provider that training would be delivered and systems would be in place by 19 December 2012.

We saw training had been delivered in MCA and DoLs. The provider had undertaken an investigation into the safeguarding allegation with the local authority and the provider had taken appropriate action.

We saw systems were in place to record and monitor complaints and regular audits had taken place to ensure medication had been correctly administered to people who used the service.

The provider had undertaken regular meetings with care staff to enable them to raise any concerns and to support them with their training needs.

People at Tiddington Court own their own bungalows or apartments and some people received care and support from the staff employed at the Court. People also had the option to receive personal care from an outside agency of their choice.

We carried out an inspection at Tiddington Court on 13 August 2012. The visit was unannounced so that no one living or working in the assisted living service knew we were coming.

When we visited we spoke with four people living at Tiddington Court, one relative, the manager, five care staff members and the cook.

People who lived at Tiddington Court told us they had received information about the care and support that could be provided, when they first arrived at the service. People told us they were involved in their care planning.

We saw that staff from the service had assessed people’s needs and care plans had been devised to describe how people liked to be supported. Risks to people’s health and well being had been identified in their care records. These had been recently reviewed to identify any change in needs of individuals and were signed by the person receiving the service and the duty manager.

People who use the service told us that the care staff understood what help and support they needed each day. One relative told us how care staff came in each morning to help their mother get up, get washed and they received their meals in their apartment.

People living at Tiddington Court told us they were spoken to with their preferred name and were treated with respect.

We received positive comments about the staff that were providing support to people. These included “staff are very good” and “staff are very nice and no one has never said they will not help me”.

Processes were in place for staff to raise safeguarding concerns. However, details were not available to visitors of how to raise a complaint or report safeguarding concerns.

During our inspection we were alerted to a safeguarding concern and this has been referred to the relevant authorities for further investigation.

We saw staff had received training, but they had not received training in the Mental Capacity Act or Deprivation of Liberties. Regular individual meetings between the manager and staff were taking place but the frequency of these varied between staff members. This meant that staff were not given the opportunity to raise any concerns or discuss their development needs timely.

People who lived at Tiddington Court told us they felt comfortable in raising any concerns with staff or the manager if required. However, we found that systems to regularly assess and monitor the quality of the service were not in place, for example complaints and incidents. We were told by the manager that although they checked medication administration on a monthly basis, these checks were not recorded.

People at Tiddington Court own their own apartments or bungalows and some people receive care and support from the staff employed at the Court.

We saw that people living in the apartments had been provided with information about the care and support that could be provided. People had discussed their individual needs with the agency to ensure they could be met. The agency had developed care plans for each person detailing the support required and when this was to be provided.

People told us that the care workers understood what help and support they needed each day. One person described how staff came in each morning to help them get showered, dressed and to take their medicines.

We found that staff were administering medicines for some people but it was not always clear these were being given as prescribed.

One person who suffered with confusion was not able to tell us how staff supported them. We observed that staff prompted this person to go into the dining room at lunchtime and to join in the bingo that afternoon. We also saw that a member of staff prompted the person to sit inside after sitting out in the sun for a length of time.

We received positive comments about the staff that were providing support to people. These included: “I have found staff to be extraordinary kind”. “I think I am treated very well”. “People here are very good, there is nobody to complain about”.

No concerns were raised with us about the support people were receiving. People told us they felt comfortable in raising any concerns with staff or the duty manager if required.

A quality monitoring survey completed by the agency in August 2010 showed that people were happy with the care they were receiving. Comments included: “On the whole ok, very lucky”. “Very pleased, always on time”. “No complaints”.