This unannounced comprehensive inspection took place on 18 December 2017.

At the previous inspection we found breaches of regulation in relation to; the safe administration of medicines, governance, safe recruitment and staff support. As part of this inspection we checked to see if the necessary improvements had been made and sustained. The service was now meeting regulatory requirements.

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; Safe, Effective and Well-led to at least good. We found that improvements had been made in accordance with the action plan in each of the key questions.

Garswood 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.

Garswood is located in Southport close to public transport links and Birkdale village. Accommodation is arranged over four floors with lift access to each floor. The home is registered to accommodate 39 people and includes a dedicated unit (Hazelwood) to accommodate seven people who are living with dementia. At the time of the inspection 22 people were living in the main building with a further seven in Hazelwood.

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.

We observed a member of staff while they administered some medicines and checked records, storage arrangements, stocks and audits. The medication policy was comprehensive and audits had been effective in identifying errors. The provider was no longer in breach of regulation 12 with regards to the safe administration of medicines.

We checked four recruitment files and found that they reflected safe recruitment practice. Each file contained an application form with a detailed employment history, photographic identification, references and evidence of a DBS check. The provider was no longer in breach of regulation 19 regarding the recruitment of fit and proper persons.

The majority of supervision and appraisals had been completed in accordance with the provider’s schedule. Where meetings had not taken place the reason was recorded and alternative dates had been entered onto an electronic record. Staff told us that they were well supported by the management team and could request additional support through informal or formal supervision as required. The provider was no longer in breach of regulation 18 regarding staff support.

During this inspection we saw evidence of regular audits being conducted and action taken when issues were identified. Audits looked at a full range of relevant areas such as; health and safety, MCA/DoLS status, medicines, welfare, maintenance and activities. The provider was no longer in breach of regulation 17 regarding quality assurance processes.

The staff that we spoke with were able to explain how they helped to keep people safe and safeguard them from potential abuse. Information about safeguarding was clearly displayed within Garswood and the staff we spoke with were able to explain their responsibilities to report concerns both internally and externally (whistleblowing) if required. Individual risk was appropriately assessed and reviewed to ensure that people were kept safe without unnecessarily restricting their independence.

Garswood had a robust approach to the recording and monitoring of incidents and accidents. The records that we saw were detailed and showed evidence of review and analysis by the registered manager.

The home was operating in accordance with the principles of the M

This inspection took place on 3 and 4 November 2016 and was unannounced.

Garswood care home is located in a residential area of Southport close to public transport links and Birkdale village. Accommodation is arranged over four floors with lift access to each floor. The home is registered to accommodate 42 people with a dedicated unit to accommodate seven people who have dementia. The service is part of the Christadelphian community but also offers support to people outside of that faith. During the inspection, there were 33 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.

We looked at the systems in place for managing medicines in the home and found that best practice guidance was not always followed when administering controlled medicines. We looked at people’s MAR charts and found that there were a number of missing signatures for medicines that had been administered. Audits completed had identified this issue and the registered manager told us they planned to implement an electronic medicines system in January 2017 and hoped that this new system would help to solve this issues.

Most personnel files we viewed showed that relevant checks had been made prior to staff being employed, however one staff member did not have the required checks completed. Since the inspection the registered manager has told us they have applied for a DBS check for this staff member.

We looked at the environment and found that there were not always fire exit signs in sight to guide people to the nearest emergency exit as required. Since the inspection, we have been provided with evidence to show that additional signage has been put in place to ensure people can locate the nearest emergency exit from all areas within the home.

People told us they felt safe living at Garswood and told us there were adequate numbers of staff on duty to meet their needs. Staff however felt they were quite busy at times and the registered manager was looking at recruiting more bank staff to help support people at busy times throughout the day. Staff had a good understanding of safeguarding and how to report any concerns they may have.

The care files we looked at showed staff had completed risk assessments to assess and monitor people’s health and safety. A fire risk assessment was in place and people who lived at the home had a PEEP (personal emergency evacuation plan) to ensure their safe evacuation in the event of a fire. Internal and external arrangements were in place for checking the environment and equipment to ensure it was safe and well maintained.

We looked at accident and incident reporting within the home and found that incidents were reported and recorded and appropriate actions taken.

There was no record of annual appraisals and some staff had not received a supervision in 2016. The policy for the service stated that staff should receive three supervisions each year as well as a formal annual appraisal. Since the inspection the registered manager has told us more supervisions have been completed and that this will continue.

Applications had been made to deprive people of their liberty appropriately and systems were in place to monitor these applications. Staff we spoke with told us they always asked for people’s consent before providing care and we observed this during the visit.

When able, people signed to evidence agreement with their plans of care. When people were unable to provide consent, mental capacity assessments were completed, however they were not always decision specific and it was not clear when decisions had been made in people’s best interest. The registered manager told us they would

This inspection was to follow up on a previous inspection in February 2014. At that time the home had failed to meet requirements with respect to maintaining people's care records and also holding care and staff information secure. The provider [owner] sent us an action plan following the inspection and at this inspection we checked on progress and improvements made. We found that the care plans recorded sufficient information about people's care needs to enable staff to care for them safely. We found care records and staff personnel files were kept secure to ensure confidentiality of the information held.

As part of our inspection we spent time with people and invited them to share with us their views and experience of living at Garswood care home. The people we spoke with were very positive about the care and support they received. One person said, “The care is very good and the staff are most understanding.” Another person told us, “No matter what time, day or night, you can ring the bell and the staff are there to help.”

People told us they participated in planning their care and were involved in a review of their care each month.

Care records informed us each person had an assessment of their needs. Individualised care plans had been developed for each person and they were reviewed on a monthly basis. Some of the care plans had not been revised to reflect people’s current needs.

We received positive feedback about the meals. People told us the food was good and they got plenty of choice at mealtimes. A person said, “They [staff] are very good and will try and make sure you get a meal you like.” People with specific dietary requirements were receiving meals that met their needs.

Records that needed to remain confidential were not stored securely.

Effective arrangements were in place for monitoring the safety and suitability of the equipment in the home.

During the inspection we spent time with nine people and invited them to share with us their views and experience of living at Garswood. Some of the people we spoke with were staying at the home for a period of respite (temporary care break).

People told us staff were respectful of their wishes and choices. One person said, “Everything here is absolutely excellent.” Another person said, “I can go to bed whenever I want.” We heard the staff described as kind and caring.

People told us they had everything they need at Garswood, including regular activities and trips out. One person said, “There is a lovely atmosphere here and plenty to do.”

Care records informed us that assessments and care plans had been developed for each person and these were reviewed on a regular basis. People confirmed they were involved in decisions about their care.

Arrangements were in place for ensuring the environment was clean. Complaints were managed in a timely and efficient way. Effective processes were in place to ensure sufficient staff were available to support people at all times.

When we carried out an inspection of the service in October 2011 we spoke with people living at the home. The feedback we received was positive and people were satisfied with the care and support they received. We heard staff and management described as approachable, respectful and caring. We did not seek further views from people during this visit to review improvements.