Windmill Court provides care and support 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 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 looked at people’s personal care and support service.

People using the service lived in 44 self-contained one or two bedroom flats in a single building. There was a communal area on each floor and a communal dining area on the ground floor. At the time of this inspection, 32 flats were receiving a personal care and support service.

This inspection took place on 14 and 21 January 2019 and was announced. At the previous inspection which took place on 22 August 2016 the service was rated as Good.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The previous registered manager had left employment in July 2018 and the provider was in the process of recruiting to the position. A senior member of the care staff team was acting as interim manager.

Staff were knowledgeable about reporting safeguarding concerns and whistleblowing. The provider carried out risk assessments to reduce the risks of harm people may face. Recruitment checks were carried out before new staff began working at the service. There were enough staff employed to meet people’s needs and keep them safe. The provider had systems in place to manage people’s medicines safely. People were protected from the risks associated with the spread of infection. The provider had systems in place to record and learn from accidents and incidents.

The provider assessed people’s needs before they began to use the service to ensure the right care could be provided. Staff were supported with training opportunities and regular supervision. There were communication systems in place to ensure changes in people’s needs were passed onto staff coming on duty. People were supported with their nutrition and to maintain their health. The provider and staff understood the requirements of the Mental Capacity Act (2005) and the need to obtain documented and verbal consent before delivering care.

Staff were knowledgeable about people’s care needs and preferences. Staff understood how to develop caring relationships with people. The provider involved people and their relatives in the care planning process. Staff were knowledgeable about equality and diversity. People’ privacy, dignity and independence were promoted.

People’s care preferences were respected. Staff understood how to deliver personalised care. Care plans were personalised and contained people’s preferences. People’s communication needs were met. The provider had a system to record and deal with complaints. Staff received end of life care training so they would be prepared to provide this type of care appropriately should this be required.

The provider had a system to obtain feedback from people using the service and their relatives in order to identify areas for improvement. People and staff had regular meetings to keep updated on service development. The provider carried out quality audits and worked in partnership with other agencies to identify areas for improvement.

The inspection took place on the 22 August 2016 and was announced. This was the service’s first inspection.

Circle Care and Support provides supported accommodation and has 41 self-contained flats. At the time of the inspection there were 42 people using the service. The service provided accommodation and 24 hour support to adults with personal care and/or medicines where they had been assessed.

The service was newly built and opened in September 2015. The service was set in large grounds with outdoor gardens and seating areas. Each flat had its own outdoor garden and enclosed winter garden.

People could make use of the in house hair salon and pampering room. There was also a therapy room but this was not currently being used.

The service required a registered manager and the current manager was in the process of registering with the Care Quality Commission (CQC).

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 were kept safe at the service and staff told us how they would escalate concerns of abuse. However staff needed prompting to tell us outside agencies they would contact. We have made a recommendation regarding safeguarding.

People had individual risk assessments which provided staff with guidance to keep them safe at the service and in the community.

Staff were recruited safely and the service followed their policy as staff references and criminal records checks were carried out before staff could start work.

Medicines were administered safely and staff checked information on the medicine administration chart and prescription to check they were giving to the right person and to check whether there were any changes to people’s medicines.

We noted there had been an error in the records on one MAR chart where medicine had been written as given in a person’s daily log but the MAR chart had not been signed. We informed the locality business manager of this error.

People were protected from the risk of infection as staff wore appropriate protective clothing and followed appropriate hand hygiene methods.

Staff told us they felt supported and now received regular supervision and one to ones with the new manager. Staff were being supported to complete the care certificate.

Staff understood the principles of the Mental Capacity Act 2005 and how to support people to make decisions about their care. There was no one subject to a court of protection order.

People were supported to eat healthily and where people were at risk of malnutrition the service monitored these people and knew to escalate to health professionals promptly.

People were cared for by staff who were kind and listened to them and respected their privacy and dignity.

Care plans were person centred and staff worked with people to find out what their goals were and how they wanted care. People told us they were involved in their care planning and they had reviews with their keywork.

A number of activities took place at the service which included a Sunday lunch club, and a Dementia club where people painted and danced. The service asked people what they wanted to do so they could introduce more activities.

Staff said the management of the service had improved and they were supported in their role and information was shared openly. Staff enjoyed coming to work and felt the workforce and people at the service all got on well. The quality of the service was regularly being checked and a number of audits were performed by management. People and staff were invited to regular meetings where they could share their views.