The inspection took place on the 4 January 2019 and was announced. We previously rated this service in November 2017 and had rated the service ‘Requires Improvement’ overall, with a rating of ‘Requires Improvement’ in Caring, Responsive and Well Led.

Unique Senior Care – Queensway Court 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. Not everyone using Unique Senior Care received the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

Queensway Court has 178 one or two-bedroom apartments. People living at Queensway Court share on site facilities such as a lift, lounge, restaurant, laundry, garden, activities room, café, a hairdressing salon and a bar.

At the time of this inspection visit, Unique Senior Care supported 57 people with personal care. Unique Senior Care also provides an on-call emergency service to everyone living in the building, not just those people who they were contracted to provide personal care to.

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.

People benefitted from a service that was very well led. The provider had robust quality monitoring arrangements through which they continually reviewed evaluated and improved people's care. People, stakeholders and staff had an opportunity to shape all aspects of the service. The provider invested in staff development to ensure people received care from experienced and caring leaders.

There was a strong emphasis on safety and staff were skilled and proactive in recognising and reducing risk. They used innovative ways to support people to stay safe in their own homes, lead fulfilling lives and minimise restrictions on their freedom. Care staff were available on site 24 hours a day to respond to emergencies in people’s homes, this included people who did not have arranged care packages with Unique Senior Care. People had alarms fitted in their home, and could chose to use these if they required immediate care or assistance, even though this might be outside their agreed package of care and their usual call times. People and families praised the exceptional skills of staff who supported them. Their comments included: “This place has definitely extended my life” And, “The staff are exceptional, especially the night care.”

Staff used best practice evidence and felt supported in their role. Innovative training methods helped staff understand people’s experience of becoming frailer, and experiencing visual impairment. They were proactive in ensuring people received healthcare quickly to reduce hospital admissions and for those people who were in hospital, or were newly discharged from hospital, increased support was provided.

The provider had strong values which shaped their service. They continually recognised the valuable contribution of their staff, re-enforced and rewarded positive staff values, attitudes and behaviours. They worked in innovative ways to enrich people's lives and improve their wellbeing so that people received a personalised service that promoted their independence and enhanced their quality of life.

The inspection took place on 7 November 2017 and 23 November 2017. Both inspection visits were announced.

This was the first inspection of this service following its registration with us in November 2016.

Home Instead Senior Care – Queensway Court 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.

Queensway Court has 178 apartments consisting of one and two bed apartments. People living at Queensway Court share on site facilities such as a lift, lounge, restaurant, laundry, garden, activities room, café, a hairdressing salon and a bar.

At the time of this inspection visit, Home Instead Senior Care Queensway Court supported 57 people in 57 apartments. Home Instead Senior Care Queensway Court also provides an on call emergency service to everyone living in the building, not just those people who they provide personal care to.

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.’

There were enough staff to provide the care and support people required, however people and relatives told us call times varied which impacted on their routines. People told us staff were friendly and caring, but continuity of care staff was not always supported. However, people said in the last couple of weeks, continuity had begun to improve.

People’s opinions of the service were mixed, with some people describing differences in how staff supported them in a way that was personalised and responsive to them. Some people experienced staff that arrived around the time expected and stayed long enough to provide their care. Other people felt staff were rushed and care call timings were not always known in advance, or provided at times they preferred.

Staff received an induction when they started working for the service and had their training updated to support them in meeting people's needs effectively.

People felt safe using the service and there were processes to minimise risks to people's safety. These included procedures to manage risks identified with people's care. Staff understood how to protect people from abuse and the action to take, to safeguard vulnerable people.

People were administered medicines by staff who were trained and assessed as competent to give medicines safely. However, we found patch medicines were not always given as prescribed and in line with manufacturer’s guidelines. Recent medicine policy changes had not been followed consistently and records showed staff’s knowledge of how and what medicines should be recorded, needed more to time to embed to be effective.

The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who used the service.

The management and staff followed the principles of the Mental Capacity Act (MCA). Staff respected decisions people made about their care and gained people's consent before they provided personal care.

Care plans required improvement and needed to be more detailed so staff had sufficient information about people's care needs and instructions of what they needed to do on each care visit.

Staff supported people to attend activities provided within the extra care housing complex

People at Home Instead Senior Care Queensway Court were able to acces