This inspection visit took place on 20 September 2016 and was unannounced.

At the last inspection on 18 June 2014 the service was meeting the requirements of the regulations that were inspected at that time.

College Green provides accommodation for 21 older people who have dementia. It has 15 single rooms and three double rooms, some with ensuite facilities. Respite care is provided subject to availability. College Green is a converted Victorian house with a front car park and a secluded rear garden. There is a passenger lift to bedrooms on the upper floors. The home is situated in a residential area of Crosby, opposite a park and close to bus routes, local shops and restaurants. At the time of our inspection visit there were 20 people who lived at the home.

There was a registered manager in place. 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 looked at the recruitment of two recently appointed staff members. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

Staff spoken with and records seen confirmed a structured induction training and development programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

Staff spoken with and records seen confirmed training had been provided to enable them to support people who lived with dementia. We found staff were knowledgeable about the support needs of people in their care.

We found the registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

The environment was maintained, clean and hygienic when we visited. No offensive odours were observed by the inspectors. We spoke with four people who lived at the home who all said they were happy with the standard of hygiene at the home. One person said, “My room is lovely and clean.”

We found the environment offered dementia-friendly features to support people with visual, hearing and mobility impairments associated with dementia. The building was well lit and made as much use of natural light as possible. Clear signs (using pictures and words) had been put in place to enable people to move around the building confidently.

We found sufficient staffing levels were in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed. One person who lived at the home said, “Plenty of girls around to help me when I need them.”

We found equipment used by staff to support people had been maintained and serviced to ensure they were safe for use.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. One person we spoke with said, “Yes I enjoy all m

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?

The recruitment process was thorough and all new staff underwent security checks before they were allowed to start work at College Green Rest Home. All staff members had received training related to the safeguarding of vulnerable people, and were aware of the whistleblowing procedures at the rest home.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us an application for a DoLS had been made within the last twelve months and we noted all the required paperwork had been completed appropriately. The CQC are now responsible for monitoring the use of DoLS and in line with requirements, the provider had notified CQC of the application.

Is the service effective?

People who used the service had their care and support needs assessed with them and when possible, their families. We noted one person was a vegetarian, and specialist dietary requirements had been put in place.

At the time of our inspection, care plans were being revised but those we observed contained relevant and up to date information related to the needs of all people. This meant people received care that met their needs.

Is the service caring?

We spoke with all staff members who were on duty during our inspection and they all had a good knowledge of the care needs of all people who used the service. We observed patient and caring interaction between people and staff members. At lunch time, we saw staff helping people with their food which helped ensure they received the nutrition they needed.

One person who used services told us, "All the staff are fine with me" and a family member told us, "They all work so hard and it`s not easy for them sometimes. They understand what people need." We saw staff who encouraged people continually in a kind and attentive manner.

Is the service responsive?

A complaints procedure was in place at the rest home which people were aware of. We saw evidence that all accidents and incidents had been recorded appropriately. We were told these were discussed with staff members so the service continued to improve.

We saw several activities during our inspection, which included armchair exercises and a music session. However, two people who used the service told us, "I wish there was more to do, I would like to go out more. It`s a nice day and a walk around the park would be nice."

Two family members made similar comments to us.

Is the service well-led?

We observed an internal and external quality assurance system was in place, and we saw that any identified concerns had been addressed. As a result the quality of the service continually improved.

All staff we spoke to had a clear understanding of their roles and responsibilities. This helped ensure all people received a good quality of care at all times. Several new initiatives were being planned which included a new keyworker system. Staff we spoke to told us they had been consulted about the new approach to providing care and their views had been taken into consideration.

We used a number of different methods to help us understand the experiences of some of the people living at College Green. This was because some of the people who lived at the home had complex needs, which meant they were not all able to verbally tell us about their experiences.

We carried out some short observations between staff and the people who lived in the home. We observed some examples where staff supported people well, such as encouraging people with a game and using appropriate communication with people.

We spoke with two relatives to gather their views and experiences of the service. Some comments we received were as follows; ”The staff are very patient with my family member; they should be applauded”, ” The manager keeps me informed about my relative’s welfare” and “The staff are great but the place could do with a lick of paint.”

We looked at four people's care records. We found they contained relevant and current information about the person's needs.

On checking medication management we found people received their medicines as prescribed. We found records regarding medication were accurate.

We observed staff interacting with people who lived in the service during our visit. We saw some examples of where staff supported people well, such as assisting them around the building and supporting them to do a particular activity.

We spoke with two staff about how they supported the people who lived at the home and the activities they did each week.

People expressed their views and were involved in making decisions about their care and treatment. One relative told us “I am always kept informed about my mother’s health”

People's needs were assessed. Care and treatment was planned and delivered in line with their individual care plan. We spoke with one person who told us how staff had supported them with what they needed.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw that people who lived at the house were very relaxed and confident around staff. This shows that people felt safe in the home.

Staff received appropriate professional development. People we spoke with told us that

they were supported well by College Green and staff were always available to assist and help as needed.

People who use the service, their representatives and staff were asked for their views

about their care and treatment and they were acted on. All of the people we met with were living in accommodation that suited their needs. They told us they enjoyed living in their home.