This inspection took place over three days on 28 June and 04 and 06 July 2018. The first and second days were unannounced and the third day was announced.

The last inspection of the service was carried out in July 2016 and during that inspection we found a breach of regulation 9, person centred care. Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to make the required improvements.

During this inspection we found improvements had been made, however we found breaches of regulations 12, 15 and 17. This was because; medication was not always managed safety and parts of the premises and equipment were unclean and unsafe. In addition the quality monitoring processes failed to identify and mitigate risks to people.

Fazakerley House 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. Fazakerley House accommodates up to 45 people who require personal care. At the time of the inspection there were 43 people using the service. The service provides accommodation over two floors.

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.

The management of medication was not always safe. On the first day of inspection the medication room was unlocked with no staff present. There were items of pre-dispensed medication in pots on top of a cabinet which posed a risk to people who may have entered the room. We raised this at the time with a senior member of staff and they immediately locked the door to the medication room.

Parts of the environment and items of personal equipment were unclean and unsafe. An outside patio and a wooden summerhouse which people used were littered with weeds, cigarette ends and general waste, including used disposable gloves. Cigarette ends had been disposed of in a plastic bin which also contained used tissues and sweet wrappers, posing a fire risk. Items of personal equipment including wheelchairs and stand aids were heavily stained with food debris, dust and spillages. This increased the risk of the spread of infection. The patio and summerhouse were cleaned and made safe on the first day of inspection and by the second day of inspection personal equipment had had been cleaned.

Although people’s care was planned based on assessments carried out, some people’s care plans lacked information about how their needs were to be effectively met. Some people’s care plans did not clearly demonstrate what was the expected outcome for the person and there was a lack of monitoring of some people’s care.

The environment was equipped with aids and adaptations such as handrails and a passenger lift to help people move about safely and independently. However, there was a lack signage and stimulus for people living with dementia, such as items and focal points to support reminiscence. We were provided with information regarding plans to develop the environment.

People’s dignity and confidentiality was not always respected. Staff used dirty equipment to help people with their mobility and safety and an outside area which people accessed was unattractive. People’s confidentiality was not fully protected as files containing personal information about people were left in communal areas. Staff did however approach people in a kind and compassionate way and they used their knowledge of people to provide them with comfort and reassurance at times they were upset.

The approach to care planning for some people was person centred in that

This inspection was carried out over two days on 25 and 28 July 2016. The first day of the inspection was unannounced.

Fazakerley House provides accommodation for up to 45 older people. The service is located in the Prescot area of Knowsley. Accommodation is provided over two floors. Bedrooms located on the first floor can be accessed via a stair case or passenger lift. There were 44 people using the service at the time of our inspection.

The service has a registered manager who was registered with the Care Quality Commission in January 2016. 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 last inspection of the service was carried out in June 2014 and we found that the service was meeting all the regulations that were assessed.

Improvements are required to ensure people receive all the care appropriate to their needs. People received the care and support they needed with their physical and healthcare needs from the right amount of staff, however there was not always enough staff to meet people’s social needs. People and family members told us that staff were often too busy and did not have much time to sit and socialise with people Opportunities for people to take part in meaningful activities was limited. This was because the activities co-ordinator only worked for part of the week and care staff were required to carry out domestic tasks as part of their role leaving them little time to engage with people.

Some fire doors leading to people’s bedrooms did not fit properly into the recess which posed a risk to people’s safety in the event of a fire. The registered manager acted upon this immediately by arranging for the door closures to be adjusted. The door to a bathroom which was used to store items of equipment was wide open. This posed a trip, slip and fall hazard to people. The registered manager locked the door immediately and instructed staff to keep it locked at all times.

The registered provider had a safe and fair recruitment and selection policy. Applicant’s suitability to work at the service was assessed based on information which they were required to provide. This included details about their previous employment history, skills and experience. In addition applicants underwent a series of pre-employment checks on their character before employment was confirmed.

There were safe systems in place for managing people's medicines. Medication was stored safety in dedicated rooms which were clean and tidy. Each person had a medication administration record (MAR) and a medication information sheet detailing their prescribed medication and any instructions for use. People received their medication on time by staff who had received the appropriate training and competency checks. When required people had accessed healthcare professionals such as GPs and district nurses.

People told us they liked the food and had plenty to eat and drink. Peoples’ nutritional and hydration needs were appropriately assessed and planned for. People received the support they needed to eat and drink and appropriate referrals were made on behalf of people to dieticians and speech and language therapists.

Care plans contained good information about people’s needs and how they were to be met and they were reviewed regularly and updated with any changes to people’s needs. Daily records which were maintained showed what care and support people had received and that staff had responded appropriately to any concerns about people’s health and wellbeing.

People’s privacy, dignity and independence was respected and promoted. People were approached in a kind and caring way and they were encouraged to do whatever they could for themselves. People’s bedro

We considered our inspection findings to answer 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?

We found appropriate care plans and risk assessments in place. These were sufficiently detailed, individualised to each person and reviewed regularly with the involvement of the person and relevant others. Staff provided care and support in a warm, polite and respectful way. Staff had a good understanding of the needs of the people who used the service and they knew how to respond to any concerns they had about a person’s health or wellbeing. Staff told us the staffing arrangements during meal times did not always meet the needs of people who used the service. Regular checks on people’s care and welfare were carried out to ensure people received safe and effective care.

Is the service effective?

People told us they were happy with the care provided and their needs had been met. Our observations and discussions with staff showed they were knowledgeable about the people they supported and records we viewed showed people had received the right care and support. People told us; “They know me well and are lovely with me" and "I feel as though I am part of a big family."

Is the service caring?

Staff spoke with people in a caring and compassionate manner. When people became anxious and upset, staff dealt with the situation calmly and were attentive to people's needs. People were valued and their privacy, dignity and independence were respected.

Is the service responsive?

We saw that before a person moved into the home, an assessment of their needs and abilities was undertaken. Care plans showed how the needs of the people who used the service were to be met, including how to manage any risks. Regular reviews of each person's care took place and any changes which were needed were quickly responded to. People's personal preferences such as their preferred routines were understood and respected. People were given the opportunity to put forward their views about the service and any changes suggested by them were listened to and acted upon. People told us they knew how to complain and felt confident that their complaint would be listened to and dealt with in the right way. One person commented, “I have raised concerns in the past and they were sorted right away.”

Is the service well led?

Staff and people who used the service spoke highly of the manager and said they were listened to when concerns or suggestions were made. We saw audits of various aspects of the service's operations such as medication management, care planning, people's finances and the homes environment had been regularly carried out. Where concerns were identified, processes were in place to enable appropriate changes to be made.

People told us that they had been well cared for at Fazakerley and they had been asked for consent before any care had been carried out. People felt that the place was kept very clean and that staff had been observed to carry our regular hand hygiene.

We spoke with five people and their relatives. They were very positive about the staff and care at Fazakerley. Their comments included:

"The staff are very good."

"The staff have time for you."

"I could see my care record if I wanted to."

“Sometimes I get a bit bored."

"The staff are alright.”

We found that the service operated an effective recruitment and selection process. All the staff we spoke with were positive about working at Fazakerley House. Records relating to the care, staffing and the management of the service were accurate and fit for purpose.

We spoke with people who were living in the home and the feedback was positive.

Service users spoke positively about the staff that worked there in terms of how their needs were met.

People living in the home appeared relaxed and comfortable in their surroundings and they told us they felt safe living at Fazakerley House.

We spoke with a lot of people who were living at the home and the majority of the feedback people gave us was positive. People’s comments included;

“It’s good here”

“It’s very nice and the staff are very good”

“I’ve know this home for a long time and I’ve always felt it was a good home”

People told us that they were happy with the care and support they received and that they were making decisions about their care and support.

People described staff as caring and they told us staff had readily contacted a nurse or doctor if they had felt unwell or if they had needed medical attention.

We also spoke with a number of visiting relatives. They gave us good feedback about the service and said they felt the standards of care were good.

We asked people to give us their views about staffing and people’s comments included;

“The staff are good but they’re always very busy”

“I don’t like asking for help because I know they have a lot of other people to see to”.

“You always get what you ask for but sometimes you have to wait a while for it”

“I try to do things myself because I don’t like to bother the staff, they’re so busy”.