This inspection of Ann Slade care home took place on 18 January 2018 and was unannounced.

At the last inspection on 8 November 2016, we found that the registered provider was in breach of Regulation 17 (Good Governance). Following the last inspection, we asked the provider to complete an action plan to tell us what they would do to make the necessary improvements. We received an action plan that outlined what improvements the registered provider intended to make. At this inspection, we found that improvements had been made to meet the relevant requirements and the provider was no longer in breach of regulation.

Ann Slade is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ann Slade Care Home is located close to Southport town centre. The home can accommodate up to 24 people. Accommodation is provided over three floors which can be accessed by stairs and a passenger lift. Shared areas such as dining facilities and lounge space are located on the ground floor. There is car parking to the front of the building and a garden at the back of the home. At the time of the inspection there were 22 people living in the home.

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. The registered manager was supported by a care manager and deputy manager. The registered manager had delegated the responsibility for overseeing the day to day running of the service to the care manager. The care manager was in the process of applying to become the registered manager of the service.

At the last inspection on 8 November 2016 we identified a breach of regulation because the governance systems in place for monitoring the service were not robust because they had failed to identify potential risks to people with regards to the environment. At this inspection, we found that people were supported to live in a safe environment, free from hazards, and that the appropriate checks were in place to ensure this. The registered provider had taken action in accordance with our recommendation and had reviewed their procedures to ensure the safety of the environment. The registered provider had implemented a series of daily and weekly environmental audits to check the safety of the service.

We found that the registered provider had taken action to further develop and strengthen their recording procedures in respect of the best interest decision making process in accordance with the principles of the Mental Capacity Act 2005. Decisions that were made were thoroughly assessed to ensure the least restrictive option was chosen.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People told us that consent was sought and staff offered them choice before providing care.

The registered provider maintained detailed records of Deprivation of Liberty Safeguards and their efforts to ensure that any conditions attached to authorisations were adhered to.

All of the people we spoke with told us they felt safe living at Ann Slade Care home.

Medications were well managed and staff received training to administer medication safely.

Staff were able to describe the course of action they would take if they felt someone was being harmed or abused. All staff had been trained in safeguarding and understood the reporting procedures.

Staff were recruited safely and had the necessary checks to ensure they were able to work

This unannounced inspection took place on the 8 November 2016.

Ann Slade Care Home is located close to Southport town centre. The home can accommodate up to 24 people. Accommodation is provided over three floors which can be accessed by stairs and a passenger lift. Shared areas such as dining facilities and lounge space are located on the ground floor. There is car parking to the front of the building and a garden at the back of the home.

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.

During this inspection we identified a of breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that people had access to exposed hot water pipes and radiators and a window restrictor was needed in a shower room. In addition, people could easily access a cupboard that contained a switch for a main utility. Following this inspection the registered provider informed us that appropriate action had been taken in relation to the areas of improvement identified.

You can see what action we have asked the registered provider to take at the back of this report.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. However, we have made a recommendation in this report that the registered provider reviews their procedure for the recording of best interest decisions made on behalf of people to ensure that appropriate details are recorded.

Procedures were in place to protect people from harm and inform staff of how to respond to and report a concern about a person. Safeguarding procedures were available at the service. Staff demonstrated a good awareness of situations that they needed to report under the local authority safeguarding procedures.

People received care from a staff team who had received training for their role.

People told us that staff were kind and looked after them well. They told us that they never had to wait long for staff to attend to their needs.

People’s medication was managed appropriately. This helped ensure that people received their medication when the needed it.

Arrangements were made for people to have regular health checks. People had access to the optician, GP services and chiropodist appointments to maintain their health.

Prior to a person moving into the service an assessment of their needs took place and was carried out by a senior member of staff. The purpose of the assessment was to ensure that the service had the facilities and provision to meet the person’s individual assessed needs.

Care plans and risk assessment were in place detailing people’s needs and how their needs were to be met. Staff having access to how they needed to support a person helped ensure that people received the care they needed.

People knew who to speak to if they wanted to make a complaint and felt that their concerns would be listened to.

People’s views of the service were sought on a regular basis by an annual survey. Following the survey people and their relatives were sent a letter informing them of changes made in response to their comments. In addition, monthly meetings took place for people using the service to discuss any changes or suggestions they had in relation to the service they received.

Policies and procedures were in place to offer guidance and support to staff. This enabled staff to deliver safe care and support. The registered provider was currently in the process of reviewing the services policies and procedures to ensure that they contained current best practice.

Staff had carried out research on current best

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found -

Is the service safe?

There were regular audits and checks in place which were aimed at maintaining the safety of people using services including hygiene checks carried out by the local authority. The local fire service had also inspected the home and ensured emergency procedures for evacuation were in place. Deprivation of Liberty Safeguards apply to people, either in a hospital or a care home, who have a mental disorder and lack capacity to consent to the arrangements that are made for their care and treatment. Authorisation has to be approved by a supervisory body, in this case the local authority, and we were shown an application that had recently been submitted by the care home and we observed the necessary procedure had been followed by the provider. In this particular case, the application was not authorised by the local authority. We did raise concerns related to staffing levels at the care home which the provider and staff members had identified prior to our inspection taking place. Consequently, we have asked the provider to inform us of what they intend to do to ensure staffing levels were sufficient to meet the needs of all people living in the home at all times.

Is the service effective?

People living in the home had a pre-admission assessment to determine their required needs and we observed they and/or their family members had been involved in producing their care plan. Risk assessments were reviewed on a monthly basis which helped provide a continuity of care for all the people at the care home. People`s needs were accounted for with appropriate signage around the care home and the layout of the service enabled people to move around freely and safely.

Is the service caring?

We observed care and support in communal areas and saw good interaction between staff members and people using services. Staff attended to needs and assisted people in a caring and unhurried manner. People told us, `the staff are lovely here and work very hard - they are always there for you`. The care and plans were person centred which meant care was provided according to the individual needs and wishes of the person. There was also evidence of the care and support provided by staff on a daily basis.

Is the service responsive?

An activities co-ordinator was employed at Ann Slade Care Home who enabled people to take part in various activities of their choice both inside and outside the care home. Taxis were used by the provider which ensured people who wished to were able to go into the community as part of the activities programme. People attended pre-arranged meetings where any issues or concerns could be raised. One person said `if I had a problem I would simply talk to one of the staff`.

Is the service well-led?

We observed evidence that the care home adopted a multi-agency approach to providing care for the people using services. On the day of our inspection a `best interests` meeting had been arranged which approved social workers, members of the community mental health team and other professionals attended. The provider had a quality assurance system in place which included regular audits of specific areas of care which were aimed at improving the quality of care provided at the care home.

During our inspection we spent time with people and invited them to share with us their views and experience of living at Ann Slade Care Home. The feedback from people was positive. One person said, “The staff are very good. Everything you want they get for you. They do anything for us.” Another person told us, “I had tests today and they [staff] helped me get there.”

Throughout our inspection we observed staff supporting people with their personal care needs in a discrete and dignified way. People were supported to maintain their independence outside of the home and we spoke with two people who went out on a regular basis. One of the people told us they had a key to their bedroom and could keep it locked if they wished.

The care documentation we looked at was completed in a person-centred way and included sufficient detail for staff to understand a person’s individualised needs.

Previous concerns about risks associated with the environment had been addressed and plans were in place to further develop the environment.

Staff were well supported in terms of training, ongoing supervision and an annual appraisal. Arrangements were in place for monitoring the quality and safety of the service provided.

During our inspection we spent time with people living at the home and invited them to share with us their views and experience of living at Ann Slade Care Home. We also spoke with relatives who were visiting the home at the time of our inspection.

People told us they were satisfied with the care and support they received. One person said “The staff are good, they know what they are doing.” Another person said “It is very nice here and the food is good.” Relatives told us they were pleased with the care provided by staff and said the staff received good training.

Detailed care plans were in place for people and each care plan reflected the person’s individual needs. Both people living at the home and relatives said they were involved with planning care and that staff effectively communicated with them any changes to care.

We looked around the building and observed that window restrictors were not in place on all bedroom windows, particularly the windows on the upper floor. Some people living at the home had their own mobile heaters and risk assessments had not been carried out to ensure people were safe managing these heaters.

Staff were up to date with their training and received regular supervision and an annual appraisal. Complaints were managed in a timely and efficient way.

We spoke to people who use the service and family members when we visited. Overall they told us they were satisfied with the service provided at the home. They told us they were involved in care and treatment choices and their preferences were taken into account. We were told:

“It’s fantastic, they do everything well”, “Mum is happy here”, “I have no complaints”.

We were told by relatives staff always listened to their relative or themselves and took their views into account. Everything was explained to them. They were aware of the care plan with any changes communicated fully. People told us they were always respected and their dignity and privacy maintained especially when having personal care needs attended to.

We spoke to one person who used the service; she told us how she had been able to choose the colour scheme for her newly decorated bedroom and had made a rug and embroidered pictures, all of which decorated her room. Another person chose her curtains for her room and had many personal belongings furnishing the room such as chairs, tables and ornaments.

People who use the service and their relatives whom we spoke to told us they felt safe living in the home.

Summary

We considered all the evidence we gathered under the outcome we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found –

Is the service safe?

There were sufficient numbers of staff on duty throughout the day and night to maximise people’s safety.

A process for auditing or checking the medication was established to ensure people living at the home received their medication in a safe way.

Is the service effective?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service caring?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service responsive?

A policy was in place regarding the handling of complaints. No formal complaints had been received within the last 12 months. A feedback survey was conducted in 2013. Questionnaires had recently been posted out to families to inform the 2014 feedback survey.

Is the service well led?

The home had systems in place to regularly monitor the quality and safety of the service provided. People who lived at the home and their relatives had the opportunity to provide feedback about the home by completing an annual feedback questionnaire.