This inspection took place over two days on 26 April and 02 May 2018. The first day was unannounced and the second day was announced.

The last inspection of the service was carried out in June 2017 and during that inspection we found breaches of regulations in respect of the safety of the environment, staff training and supervision, dignity and respect, records and assessing and monitoring the quality and safety of the service. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; is the service safe, effective, caring, responsive and well-led.

During this inspection we found improvements had been made and that further improvements were required.

Eccleston Court 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. Eccleston Court accommodates up to 54 people who require personal and nursing care. At the time of the inspection there were 46 people using the service. The service consists of two units, one of which provides nursing support to people who primarily have a physical health need and another that provides nursing support to people living with dementia.

The service has 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.

Improvements had been made to people’s safety. Hazards associated with the environment which posed a risk to people’s safety were mitigated. Rooms and cupboards containing hazardous equipment and materials were kept locked when not in use. A serving oven was closely supervised by staff when it was being used in communal areas. Fluid thickener which can pose a risk to people if ingested was stored in a safe place and closely supervised by staff when it was being used in communal areas.

Improvements had been made to the way people were treated and how confidential information was managed. Staff had undergone training and supervision to help raise their awareness about treating people with dignity and respect and person centred care. Staff were kind and patient in their approach and they provided people who needed it with emotional support. Staff spoke with, and about people in a respectful way and they maintained people’s privacy and dignity when providing them with personal care. Personal information about people was kept confidential, records were securely stored and discussions about people took place in private. Family members were made to feel welcome at the service. They were offered refreshments and were given a choice of where they spent time with their relative.

Improvements had been made to staffing. Staff had undergone training and supervision for their job role. A programme of ongoing training was in place for all staff which covered mandatory topics such as health and safety and topics relevant to people’s needs. Staff reported that they felt well supported by the management team and were confident about approaching them should they need advice or support. Staff were provided with formal one to one supervisions and underwent observations of their practice. These provided staff with an opportunity to reflect on their work, discuss their training and development needs and explore how they could develop in their role.

Improvements had been made to care records, however further improvements were required to ensure that they were up to date and accurately reflected people’s needs. Care plans had not been developed for some people’s needs which were identified in assessment records. In addition some r

This inspection took place over two days and was unannounced on the 1 June 2017, and announced on the 2 June 2017. The last inspection was completed in May 2015 and was awarded a rating of ‘good’.

Eccleston Court is registered to provide nursing and personal care for up to 54 people with physical health needs, or people living with dementia. At the time of the inspection there were 45 people using the service. The service consists of two units, one of which provides nursing support to people who primarily have a physical health need and another that provides nursing support to people living with dementia.

At the time of the inspection there was no registered manager in post within the service. The previous registered manager had left in December 2016. A new manager had started within the service, just prior to the inspection in May 2017.

During the inspection we identified breaches of Regulations 10, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We are taking a number of appropriate actions to protect the people who are living in the service.

People within the service were not always safe. It was standard practice for sluice rooms in one unit to be left unlocked which placed people at risk of harm through coming into contact with hazardous materials. Fluid thickener was kept unsecured in people’s bedrooms, which can pose a risk of death if ingested inappropriately. Cupboards containing cleaning materials and alcohol had been left unlocked in the kitchenette in one unit, and staff did not know where the keys were to secure these. An oven was being used to cook people’s food in a communal area, and adequate action had not been taken to address the risks around this following a ‘near miss’ incident that had occurred a short time prior to the inspection visit. This showed poor risk awareness.

People were not always treated with dignity and respect. Staff did not always work in a person-centred way, and we observed examples where people living with a sensory impairment were treated in an undignified manner. People’s family members did not always feel welcome within the service, and some of them commented that they felt there may be reprisals from making a complaint. Staff took their breaks in communal areas; these areas were meant for people using the service, which gave the environment a feel of being oriented to meet the needs of staff rather than the people they cared for.

Staff did not have up-to-date training in areas needed for them to carry out their role effectively, and supervisions and appraisals had not been completed. Staff did not always demonstrate a good knowledge around health and safety, or person-centred care which demonstrated a lack of training in these areas.

Care records did not always contain accurate and up-to-date information about people’s needs, which meant that relevant information was not available to staff around how to support people. Staff did not always fill in daily monitoring charts correctly. For example one person’s nutritional monitoring chart incorrectly recorded that a person had eaten their porridge, however we observed that they had, in fact not eaten this.

People’s confidentiality was not protected. Staff spoke without discretion about people’s needs in communal areas, and personal information was not stored securely. Staff confirmed that handovers took place in a communal area, during which personal information about people’s needs was openly discussed.

Audits were not being completed by the service. For example, an analysis of information relating to care records, accidents and incidents, pressure wounds had not been undertaken which meant that trends and patterns could not be identified. The registered provider had completed a quality monitoring visit, which had identified areas that required improvement. However, we found that this process had not picked up on other issues. We also found that whilst action had been taken to a

We spoke with seven people who lived in the service. Their comments included:

"There always seems to be someone about to assist, I never have to wait long”, “The staff do work hard but that’s to be expected if I need anything I just act”, “My mother is very positive about the staff and would tell me if there was a problem” and "I feel well looked after here. The staff are really kind and try to help me".

Nine relatives/visitors were spoken with. One person told us, “This was not an easy decision. It upset us all for a long time but since [name of relative] has been here she has improved a lot and looks happier. I don’t worry about her anymore. I go home knowing that she so much safer and so much healthier.”

At this inspection we found that improvements had been made in the management of medicines.

We looked at a variety of records regarding six peoples care including, assessments, care plans, medication records and daily records. We saw that the care plans were not based on the individual person’s choices and needs. Staff had informed us that they found the care records difficult to work with and found that information was repeated in several areas. We also saw that confidential records regarding people’s care were not kept securely at all times.

A selection of audits (checks) carried out by the manager were viewed. These provided information covering various areas of management within the service, including the environment, records and health and safety. The checks showed that the service checked on the quality that it provided in order to recognise any areas that needed development.

We spoke with seven people who lived in the service. They spoke positively about the staff saying that they were all “very nice”. People who lived in the service also told us that they made choices in their day to day lives. During our observations we saw that people were not always offered a choice of food at lunchtime. We did see one member of staff show a person two pudding dishes and encourage them to choose between the two meals. This supported the person to make their own choices.

Relatives spoken with told us that they were happy with the care and support their relatives received. They told us that they were always made to feel “welcome” in the service and were kept up to date about their loved ones needs.

On checking medication management we found that people did not always received their medicines as prescribed. Records regarding medication did not always follow best practice. Management staff in the home told us that this would be addressed as a matter of urgency. We will be arranging for a pharmacist inspector to check on progress in the future.

We observed staff interacting with people who lived in the service during our visit. We observed some examples of where staff supported people well, such as acknowledging anxieties and attempting to reassure them. We spoke with some people living in the home during our visit they told us that "I like the staff they are very kind” and “it’s not my home but it will do as they do look after you here”.

People living in the home that we spoke with told us staff were polite and respectful and asked how they wanted their care to be carried out. One person said, “The staff knock before they come in they don’t just ‘barge in’. They are very polite and friendly.” A relative said, “The staff here are great, they are patient and give people time to help with their care, rather than just do things for them”.

People living in the home said that routines in the home were flexible and they were encouraged to make their own decisions about their daily routine and choose what activities they wanted to get involved in. We observed staff interacting with people during our visit. Staff supported people living in the home well. They assisted people sensitively, chatting as they carried out tasks and activities with people. We observed staff quietly chatting to one person who was becoming distressed. They took the time to explain information that the person had forgotten and then discussed a topic that the person was interested in staying with them until they were settled.

People living in the home were praising about the care and support they received. One person said "The staff are so good. I wouldn't want to be in any other home." Another person said, “The staff are so kind and look after us well.” We also spoke with relatives. One relative said, "The staff are wonderful, so caring, they are excellent". Another relative said "I had to wait a while for [my family member] to get in here but it was worth it." I looked at many other homes but knew this was the best.”

It was clear from talking to people living in the home and their relatives that their views were taken into account when planning their care and support needs. Relatives said they were kept informed and involved in what was happening with their family member and in the home generally.

People living in the home said the staff were good and they felt safe at Eccleston Court. They told us that they would tell staff or their relatives if they were upset about anything and they would deal with the problem.

Staff told us that they had frequent, relevant training. One member of staff said, "We are offered training in different health conditions to help us do our jobs." Another member of staff told us there was a good system for making sure everyone received appropriate training and it showed them when refresher training was due.

The people living in the home said they were well supported by the staff team at Eccleston Court and they could tell them if they were worried about anything or wanted to do things differently.

This unannounced inspection of Eccleston Court Care Home took place on the 4 & 7 May 2015.

Eccleston Court is registered to provide accommodation for people with nursing care needs.The service is in two buildings with the main building containing the administration and management. Eccleston court is owned by Community Integrated Care (CIC) and is situated close toTaylor Park in St Helens. The service is registered to provide a service to 50 people.

During our inspection there were 49 people living in the home, with 15 people living in the Haydock suite and 34 people living in the Eccleston suite.

The service had a registered manager who had been in post for two years. ‘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 our last inspection we found that the registered provider was not meeting one regulation, which related to people not being protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. We judged that this had a minor impact on people who used the service. The registered provider sent us an action plan advising how they had actioned this. We found that those improvements had been maintained.

The Haydock suite was in the process of receiving a complete refurbishment, including full redecoration, new flooring and new furniture. People living there and their representatives had been fully consulted over the refurbishment and how it would affect them.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse.

We found there were enough staff on duty to keep people safe. People who lived in the home said, “The girls are very good”, It’s very good, day and night” and “I always feel really safe”.

Throughout the inspection we observed members of staff interacting in a positive way with the people who lived in the home and with their visiting relatives.

We saw that people received their medicines in a safe and timely way.

The Registered provider carried out the necessary health and safety checks to ensure the premises were safe for the people who lived and worked there.

The food menus were varied and two choices were offered at every meal. One person said, “The food is excellent”. We observed some people being supported with their meals by members of staff. Some people had specific dietary needs, which were appropriately catered for.

There were effective systems in place to assess and monitor the quality of the service. This included gathering the views and opinions of people who used the service and their families and monitoring the quality of the service that was provided. We were told by people who lived in the home, their relatives and members of staff that the manager was approachable and supportive. The registered provider had consistently carried out a range of audits, in order to check the quality of the care being delivered.

A complaints policy and procedure were available. People who lived in the home and their relatives told us they would feel confident to raise any concerns if they needed to.

Staff we spoke with had a good understanding of the needs of people they supported and were positive about their role and the support they received from the service. Staff received on-going training to ensure they had up to date knowledge and skills to provide the right support for the people they were supporting. They also received regular supervision and appraisals.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLs) and to report on what we find. DoLs are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection of Eccleston Court there were 12 people who were subject to a DoLs authorisation. The registered manager and the nursing staff had received training and had a good understanding of the Mental Capacity Act 2005 (MCA) and best interest decision making, when people were unable to make decisions themselves. We found that people who lived in the home had been asked for their consent before receiving support. We saw consent forms which had been signed and dated by the person who used the service or their representative, with the person’s permission and consent.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the treatment they needed.

A variety of activities and entertainment were available for people. The registered provider focused on special dates / events. Observed VE (Victory in Europe) day celebrations including, World war II memorabilia displayed. The people who lived in the home had been actively involved in this activity. One person said, “The tea party and the entertainment for VE day was fabulous, everybody had a good time”