We carried out our inspection on 21 and 28 September 2016. The inspection was unannounced. We returned announced on the second day.

The service provides accommodation for up to 56 people older people, including people living with dementia and similar health conditions. There were 53 people using the service at the time of our inspection.

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.

Staff knew to respond to any concerns they had about people’s safety and welfare. This protected people from abuse and avoidable harm. The provider had effective systems in place to assess and support people’s needs in the event of an emergency.

There was enough staff to meet people’s needs. The registered manager assessed people’s needs and used this to deploy sufficient numbers of staff. Staff managed people’s medicines safely and administered them in accordance with people’s prescriptions. The premises and environment were well maintained, spacious and kept in a safe condition.

The provider completed relevant checks which assured them that staff had the right skills, experience and knew how to support people safely. Staff had access to initial induction and continued to receive a range of training. This equipped them with the relevant skills they required to meet people’s needs.

People were supported in accordance with the Mental Capacity Act (MCA) 2005. People were not unlawfully deprived of their liberty. Staff sought people’s consent to their care and treatment. People were supported promptly with their health needs.

People’s nutritional needs were met. They had access to a variety of healthy meals that they told us they enjoyed.

Staff were kind and compassionate to people. They were knowledgeable about the needs of the people they supported and treated them with dignity and respect. They provided the support that people needed to be involved in decisions about their care.

Care was focused on people’s needs. Their care plans reflected the support that they received. People and their relatives were involved in developing and reviewing their care plans. Staff provided people with ample opportunities to access a variety of social activities and supported them to follow their faith. People were supported to be part of the community they lived in. They were also supported to maintain links with the wider community.

People had opportunities to give their feedback on the service they received. The provider listened to feedback from people using the service and their relatives and acted on this.

The provider had effective procedures for monitoring and assessing the service in a way that promoted continuous improvement. People and their relatives were satisfied with the service they received. Staff felt supported in their role which enabled them to deliver a good standard of care.

This inspection took place on 12 November 2014 and was unannounced.

Aigburth is registered to provide personal care and accommodation for up to 56 older people, some of who are living with dementia and physical disabilities. At the time of our inspection there were 47 people using the service. The home is purpose built and all the bedrooms are single with en-suite washrooms. There was a lift and a set of stairs to access the first floor The garden was easily accessible to people with limited mobility or for those people who used a walking frame or wheelchair.

At the last inspection on 16 May 2014, we asked the provider to take action to make improvements to the storage, administration and management of medicines and the management of complaints. During this inspection we found that the management of medicines and complaints had improved.

A registered manager was 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.

Since our last inspection in May 2014 a number of concerns had been brought to our attention with regards to the health, safety and wellbeing of people who used the service. At the time of this inspection the local authority’s safeguarding team continued to investigate concerns about the service. The provider was working with the local authority that was monitoring the service’s action plan to ensure that people’s needs were met and improvements sustained. This included monitoring the impact of new admissions which were being phased in gradually.

People told us that there had been an improvement in the consistency of care staff and that agency staff were no longer used. People and relatives of people who used the service told us that they were satisfied with the care and support provided, but there were times when sufficient numbers of staff were not available. We saw that the allocation of staff and staffing levels were not effectively co-ordinated or managed at busy times of the day and during unplanned staff absences. Staff worked over three floors in order to meet people’s care needs. However, staff availability at lunchtime on two of these floors was limited because all the meals were being served at the same time and there was not enough staff to help. Three people who needed support to eat their meals had a cold meal because staff were not available to support them in a timely manner. One person who needed prompting and guidance at lunch time was not supported because staff were busy helping others. This meant that not all people were receiving the support they needed at meal times to maintain their health and wellbeing.

We received mixed comments from people who used the service about the quality of meals provided. Some people gave positive comments but others felt the quality of meals could be improved. People identified at risk of malnutrition had been referred to the dietician and prescribed food supplements and fortified diets. The chef had information about people’s dietary needs and was due to attend further training in the nutritional needs for older people.

We viewed five people’s care records. We saw that assessments of their needs had been undertaken and plans of care developed and reviewed regularly providing clear guidance for staff to follow. Records showed that people’s safety had been considered in the delivery of care.

People received their medicines at the right time. Staff were trained and their competence to administer medicines had been assessed. The provider had taken steps to ensure the management; storage and administration of medicines were safe.

People were supported to maintain good health. Records showed people’s health needs were met by health care professionals. Staff sought medical advice when there were any concerns about people’s health and knew the procedures for reporting accidents and incidents.

Staff recruitment records showed that staff had undergone a robust recruitment process. A staff training matrix we looked at and discussions with staff showed that staff were provided with training appropriate to their job role in the delivery of care that promoted people’s health, safety and wellbeing.

People who used the service and relatives of people who used the service told us that they were satisfied with the care provided and that they felt safe. People were confident to speak with staff if they had any concerns or were unhappy with any aspect of their care. Staff had undertaken training in promoting people’s dignity and rights and knew how to protect people under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguard (DoLS).

People told us that they were treated with care and compassion and that staff treated them with dignity and respect. Our observations confirmed this to be the case.

Staff had a good understanding of the needs of people and supported them to take part in activities that were of interest to them. A weekly religious service was held and the home organised social events and entertainers. The home also used volunteers from the community that helped with activities and planned social events.

There were effective systems in place for the maintenance of the building and equipment which ensured people lived in an environment, which was well maintained and safe. Audits and checks were effectively used to ensure people’s safety and their needs were being met. The provider acted on concerns and complaints and encouraged feedback on the quality of service and care provided.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We brought forward our visit because we had received concerns about the care and welfare of people who used the service. We spoke with four people that lived in the home, four visitors and twelve staff. Some of the people we met in the home had memory problems or difficulty with communicating their needs.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that care plans were written in an individual way that ensured people received personalised care and support. There were arrangements in place to deal with foreseeable emergencies such as individual evacuation plans in case of a serious event such as a fire.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no recent applications had needed to be submitted. Relevant staff were aware when an application should be submitted.

Medicines and confidential material such as care plans were stored securely. However we saw that there was an on-going problem with medicines and a number of errors had been made by staff. This had been recognised by the provider and checks put in place to reduce the risk to people.

Staff told us they were provided with personal protective equipment (PPE). We also saw plentiful supplies of PPE placed around the home.

However a communication breakdown by staff with a specialist nurse resulted in end of life medication being unavailable to be administered.

Is the service effective?

People’s health and care needs were assessed, and they and their representatives were involved in the agreement of their plans of care. A person using the service said, “Nothing’s too much trouble, there’s plenty of food and drink, and there’s a lovely garden outside – you get what you pay for.” Another person said, “All the staff are very kind to me” and added “I don’t need much help compared to others.”

Is the service caring?

The service worked well with other agencies and services to make sure people received care appropriate to their needs. We saw where people were supported by visiting doctors, specialists and district nurses on a regular basis.

Is the service responsive?

The staff took action to add the appropriate dates to complaints.

Is the service well-led?

Quality assurance systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, whistleblowing and investigations. However care staff were poor at communicating complaints or concerns with senior managers.

We spoke with four people using the services and nine members of staff. We found there were sufficient numbers of staff on duty to meet people's needs. People told us they were satisfied with the service received. One person told us, "The staff are always bright and cheery." We found staff had the right knowledge, experience, qualifications and skills to support people. Staff told us staffing levels had improved and they were no longer working long hours. The staff team were able to respond to changing circumstances and cover sickness and planned absences. One staff member told us, "We have the right management support in place, and we are all working together." A senior staff member told us, "The staff are very keen and want to do a good job."

We looked at the management of medicines. We found medicines were handled safely, securely and appropriately. People using the services had their medicines at the times they needed them, and in a safe way. Staff knew which medicine each person had and the service kept a complete account of medicines. The manager told us they had reviewed the administration and control of medicines at the service to address shortfalls, and had made improvements.

We spoke with four people who uses services and four relatives visiting people at Aigburth. We spoke with seven staff and two senior managers. We walked around the service and observed daily activities with people having breakfast in the dining area and in their bedrooms. We saw a group of people watching a film show as part of organised activity led by the activity coordinator. We saw people in their bedrooms and lounges relaxing, reading or watching television. We saw visitors coming and going throughout the day." There are three staff I like, they always come into my room and joke and laugh with me." People told us they often had to wait a while for call bells to be answered at night, but felt this was not intentional as staff "always looked rushed." The managers confirmed changes were being made for staffing structures at night to ensure sufficient staff with the right skills and experience were available to meet the needs of people who use services. The provider had set staffing levels but had not considered the dependency needs of people using service as a basis for deciding sufficient staffing levels. We saw some people who used services needed a higher level of care due to their care treatment and support needs. Most staff we spoke with were unhappy with the current staffing levels structures. On inspection managers agreed further improvements would be made to staffing levels to ensure people who uses services benefit from sufficient staff to meet their needs.

We spoke with four people they told us they were happy with the service. Comments received from two people: " The staff are nice and friendly and call me by my first name." "The meals are the same, we have lots of shepherds pie, meals aren't well seasoned." The acting manager agreed to raise these comments with catering staff. However we saw tea being served with a wide range of hot and cold meal options available. All the people we spoke with told us the home was clean and comfortable and they were able to move around their accommodation and the floor they resided on. One person told us they walked around the grounds independently when the weather was fine. We saw outside paths were wide, well maintained and accessible for people to move around or sit in the garden. Two people told us they attended a meeting recently and staff listened to their views and had requested trips to local places of interest. The acting manager confirmed trips were now being arranged. This meant people's comments and feedback was listened to and acted on. All the people spoken with told us they know how to complain and had confidence in the staff.

We spoke with five people living at Aigburth and the relatives of two people.

People told us,

“They treat me with respect.”

“I don’t like to spend time in the communal areas much. Staff know this and don’t pressure me.”

We observed staff treating people with dignity and respect. We saw people were assisted with personal care in private in their bedroom en-suite. Staff showed a good understanding of people’s needs, they were aware of their individual likes and dislikes.

Volunteers were available to support people individually for trips out, as escorts, touring the garden, and for planned boat trips over the summer.

People told us they were asked for their comments and complaints at regular residents meetings. They talked about menus, planned trips, events and activities. They contributed to newsletters with news and photographs of life at the home.

People were kept informed about the home being built next door, which will soon be their new home. They had been consulted about colour schemes, the layout of their rooms, and moving dates.

People told us they received the care treatment and support they required and in a way they preferred.