Royal British Legion Industries Care Agency

The service is provided as part of an assisted living scheme. The scheme comprises 40 self-contained flats. Each person had their own tenancy agreement and could choose who provided their personal care. At the time of the inspection there were 38 people receiving a service from the agency. Some of the people using the service only received help with housework. Other people received assistance with personal care including washing and dressing, bathing and managing medicines. This assistance was provided by care staff completing care calls to peoples' flats on planned dates and at set times.

The service was run by a charitable body who was the registered provider. 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. In this report when we speak about both the charitable body and the registered manager we refer to them as being, 'the registered persons'.

At the last comprehensive inspection on 11 February 2016 the overall rating of the service was, 'Good'. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found that the service remained, 'Good'.

People were safeguarded from situations in which they may be at risk of experiencing abuse including financial mistreatment. Risks to people's safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Medicines were managed safely. There were enough staff to provide care calls in the right way. Background checks had been completed before new care staff had been appointed. Suitable arrangements were in place to prevent and control infection and lessons had been learned when things had gone wrong.

Care was delivered in a way that promoted positive outcomes for people. Care staff had the knowledge and skills they needed to provide support in line with legislation and guidance. This included respecting people's citizenship rights under the Equality Act 2010. When necessary people received individual assistance to prepare their meals and they were helped to have a balanced diet to promote their good health.

Suitable steps had been taken to ensure that people received coordinated and person-centred care when they used or moved between different services. People had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. People were supported to maintain and decorate their accommodation so that it met their needs and expectations.

People were supported to have maximum choice and control of their lives. The registered persons had also taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible. Policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they had been given emotional support when needed. They had also been supported to express their views about things that were important to them. This included them having access to lay advocates if necessary. Confidential information was kept private.

People received personalised care that promoted their independence. Information had been presented to them in an accessible way so that they could make and review decisions about the care they received. People were supported to pursue their hobbies and interests. The registered manager and care staff recognised the importance of promoting equality and diversity. There were arrangements to ensure that people's complaints were listened and responded to improve the quality of care. Suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

The registered persons had promoted a person-centred culture in the service and had made the arrangements necessary to ensure that regulatory requirements were met. People who used the service, their relatives and care staff were actively engaged in developing the service. There were systems and procedures to enable the service to learn, improve and assure its sustainability. The registered persons were actively working in partnership with other agencies to support the development of joined-up care.

Queen Elizabeth Court is a 40 flat housing with care (HWC) scheme situated in the Royal British Legion Village with a dedicated Domiciliary Care team. The care team assisted people to maintain their independence by helping them with things like preparing meals or cleaning. Personalised care was also provided to maintain people’s health and wellbeing, assist with personal care and work with the community team’s delivery of dignified end of life care.

The scheme is designed to enable those of 55 years and over to live independently with the security of 24 hour on-call emergency assistance and day to day good quality and reliable personal care. There is an emphasis on delivering the military covenant. (The armed forces covenant is a promise from the nation that those who serve or have served, and their families, are treated fairly.) Each of the flats has its own lounge, kitchen and wet room and is fitted with emergency call facilities. A lift was available to take people between floors.

There was a registered manager employed at the service. 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.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (2005) Code of Practice. The registered manager understood when the code of practice needed to be used so that decisions people made about their care or medical treatment were dealt with lawfully.

Having access to dedicated staff on-site made people feel safe. Staff were experienced and understood their responsibilities to protect people from harm. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

People told us the service they received often exceeded their expectations with a whole range of support available to them. This included re-enablement back to independence after illness, accompanied activities outside of the service and light touch assistance such as getting shopping or carrying out small tasks when people were unwell.

The registered manager and care staff used their experience and knowledge of people’s needs to assess how they planned people’s care to maintain their safety, health and wellbeing. Risks were assessed and management plans implemented by staff to protect people from harm. Staff were trained to such an extent that they could effectively support people’s decisions about end of life care. Staff were enabling people to stay at home and receive care until they died.

There were policies and a procedure in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

People and their relatives described a service that was exceptionally welcoming and friendly. There was a heavy emphasis put on welfare, community involvement and belonging. This was underpinned by the appointed welfare director. Staff provided friendly compassionate care and support. People were fully getting involved in how their care was planned and delivered. Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected.

The registered manager involved people in planning their care by assessing their needs when they first moved in and then by asking people if they were happy with the care they received. Staff knew people well and people had been asked about who they were and about their life experiences. This helped staff deliver care to people as individuals.

Incidents and accidents were recorded and checked by the registered manager to see what steps could be taken to prevent these happening again. The risk in the service was assessed and the steps to be taken to minimise them were understood by staff.

Managers ensured that they had planned for foreseeable emergencies, so that should they happen people’s care needs would continue to be met. Emergency life line and staff on call systems were in place. The premises and equipment in the service were well maintained.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. The registered manager ensured that they employed enough staff to meet people’s assessed needs. Staffing levels were kept under constant review as people’s needs changed.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink.

If people complained they were listened to and the registered manager made changes or suggested solutions that people were happy with. The actions taken were fed back to people.

People told us that the service was well led. They told us that managers were approachable and listened to their views. The registered manager understood the balance they needed to achieve by providing and developing the best care packages for people, whilst recognising people’s autonomy, independence and lifestyle choices. The registered manager of the service and other senior managers provided good leadership. The provider and registered manager developed business plans to improve the service. This was reflected in the positive feedback given about staff by the people who experienced care from them.

Comments from people that used the service included 'It is an excellent place, the food is excellent', 'The staff are excellent, very devoted', 'Staff are kind and helpful', 'The carers set a high standard', 'Love my flat', and 'Overall, views and wishes are taken into consideration'.

We found that the service obtained suitably detailed information about people's needs to enable staff to provide effective care.

People were asked for their consent before any care or treatment was given.

People had been involved in the planning of their care. They received care and support that was well planned and sensitively delivered.

There were effective systems in place to reduce the risk and spread of infection.

We found that there was a robust recruitment process in place that helped to make sure that only people who were deemed as suitable were employed to care for people that used the service.

Effective quality assurance procedures ensured that people were provided with a good service.

People told us that they felt listened to and that their independence was respected.

People said that all aspects of their care packages were good. This included how their flats were cleaned, and how their clothes and other items were laundered. People had been involved in the planning of their care.

One person told us that the food in the caf' was 'Really excellent.'

People said that the staff knew them well and understood their individual needs and preferences.

People said they felt safe and comfortable living at Queen Elizabeth Court. One person told us 'I would talk to the manager if I wasn't happy with anything.

People said they knew how to make a complaint and were confident any issues they had would be dealt with. One person said 'Its not often we find anything to object to'.

People said they were encouraged to express their views and this included being asked their opinions about the food. We found that the service used a number of systems to sample the quality of care that people experienced.