This inspection took place on 20 and 22 of December 2016. It was an unannounced on the first day and announced on the second.

Avondale Mental Health Care Centre offers support for up to 54 people whose needs are associated with their mental health. There were 45 people in residence on the day of our visit. Staff provides support for adults of all ages which included 24-hour long-term care, short-term care respite and assessment periods. Avondale is a purpose-built building, in a residential area of Whiston which is close to public transport routes.

The service had 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.

At the last inspection on the 23 and 29 of March 2016 there were five breaches of regulation in relation to people receiving person centred care and having their independence promoted, for suitable arrangements and documentation relating to consent of people living at the service to be in place and to ensure that care and treatment was provided in a safe way. The registered provider did not have suitable arrangements to assess and improve the quality of the service they provided and they did not have sufficient arrangements in place to ensure that the staff were suitably qualified, competent and skilled to meet the needs of the people living at the service. We asked the registered provider to take action to address these areas.

After the inspection, the registered provider sent us an action plan that specified how they would meet the requirements of the breaches identified. They advised us that they would meet all the legal requirements by August 2016. During this inspection we found that significant improvements had been made across all areas and the registered provider was able to demonstrate full compliance with the Health and Social Care Act 2008 (Regulated Activities) 2014.

The service had robust and safe recruitment practices in place. Appropriate checks were carried out before new staff started their employment. These checks ensured only staff suitable to work with vulnerable adults was employed. All new staff received a thorough induction which included a period of time shadowing experienced staff. Staff received regular training to ensure they remained up to date with their knowledge and skills required to their role. There was enough staff to meet the needs of the people living at the service.

Individual risk assessments were completed to ensure people and staff were protected from the risk of harm. Staff managed risk effectively and supported people’s decisions, so they had as much control and independence as possible.

All staff had received regular training in adult safeguarding and demonstrated a good understanding of how to recognise and report potential abuse. There were policies and procedures in place that informed staff of how to keep people safe and these were followed.

Staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Care records demonstrated people's involvement in decision making. Mental capacity assessments were completed as required by the MCA. Best interest meetings had taken place and were clearly documented with the decision making process clearly documented for people who lacked capacity.

Medicines were managed safely. Clear processes were in place that ensured people received their medicines on time and ‘as required’. Medicines were stored, administered and recorded in accordance with the registered provider’s policies and procedures.

People told us they had been involved in the development of their care plans. People’s care plans provided staff with clear direction a

Avondale Mental Healthcare Centre offers support for up to 51 people whose needs are associated with their mental health. Staff provide support for adults of all ages which included 24 hour long term care, short term care, respite or assessment periods. Avondale is a purpose built facility, in a residential area of Whiston which is close to public transport routes.

This was an unannounced inspection on the 23 March 2016 and 29 March 2016carried out by an Adult Social Care inspector, Specialist Advisor (SpA) for mental health and a bank inspector. During the inspection we spoke with nine people who lived at the service, 12 members of staff, a member of the board of directors, the registered manager and the registered provider. 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.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found breaches of Regulations 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered provider had not followed the requirements of the Mental Capacity Act 2005 (MCA). Staff were not provided with the correct instructions and did not demonstrate that they knew how to apply the Act to support people with making their own decisions.

Staff supervision was not always consistent at the service. Some of the staff we spoke with said they had not received supervision for some time.

People did not receive care and treatment that was safe and were at risk from care practices. Risks were not appropriately determined and actioned. We saw that physical needs such as the management of diabetes and wound care were not fully assessed, planned or monitored to ensure that physical needs were safely managed.

People told us that they had been included in the planning and had agreed to the care and support provided. We saw that people had a plan which outlined some of the ways staff were to support them. Risks were not always addressed in order to fully maintain the safety of people. The care and support provided centred around tasks and not the individual care needs of people living at the service. We saw that restrictive practice or intervention that limited peoples movements or support were not fully assessed to determine that they were justified.

Some of the systems used to assess the quality of the service had not identified the issues that we found during the inspection.

People told us that they were treated with kindness, compassion and respect. We saw positive interactions and observed that people enjoyed talking to the staff in the service. We observed that staff took the time to get to know people and supported them in undertaking activities. People told us they were able to see their friends and families whenever they wanted. We saw that there were arrangements in place to support people living in the service to access the community and maintain relationships with their families.

Systems were in place that supported and encouraged people to share their views of the service they received.

The staff told us they were aware of their responsibility to protect people from harm or abuse. They knew the action to be taken if they were concerned about the safety or welfare of an individual. They told us they would be confident in reporting any concerns to the management team.

The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLS). The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restr

We spoke with three people who used the service to find out what it was like to live at Avondale. One person told us that they were happy living at the service and that the staff supported them to do lots of activities. Another person told us that they had recently visited the local market and they had enjoyed the trip out.

During the Inspection visit we observed that all the staff interacted with people living at the service in a calm and confident manner, we saw how this approach helped to reduce people's challenging behaviours. We also found that the staff encouraged people to be respectful to each other and this also helped to reduce people's challenging behaviours.

We found that people living at Avondale were well cared for. We also found that the staff working at the service had undergone robust recruitment checks prior to starting work at the service to ensure the safety of people living at the service. We noted that there were sufficient numbers of staff on duty.

We found that records relating to care were clear, person centred, detailed securely stored and fit for purpose. Records relating to the staffing and management of the service were accurate and fit for purpose.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service and a practicing professional.

We spoke with five people who used the service and a relative. They all told us they were happy living at the home, were well looked after and treated with dignity and respect. They told us they were able to make choices in their daily lives and were encouraged to be independent. People we spoke with told us:

“I love the staff, they are decent people”, “The staff are very good to me”, “It’s the best home I have ever been in”

A relative we spoke with told us:

“I would not move my sister from here, she gets well looked after and the staff are very kind”.

People we spoke with told us the food and choices of food were good, there was always an alternative if they wanted one and there were plenty of food snacks and drinks available throughout the day.