This inspection took place over two days on 23 and 24 May 2018. The first day was unannounced and the second day was announced.

The last inspection of the service was carried out in April 2017 and during that inspection we found breaches of regulations in relation to the safe management of medication, consent to care and assessing and monitoring the quality and safety of the service. Following the last inspection, we asked the registered 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, to at least good.

During this inspection we found the required improvements had been made.

Hurst park 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. Hurst park Court accommodates up to 41 people who require personal care. At the time of the inspection there were 40 people using the service. The service provides accommodation over two floors.

The service did not have a registered manager; however, a manager was in post and they had applied to CQC to become the 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 so that people received their medication on time and in the right way. All medication was safely stored and accounted for. There was sufficient stock available so that people received their prescribed medicines at the right times. Rooms used for storing medication were appropriately ventilated, clean and well organised. Records were in place with instructions for staff on the use of medication including the application of topical creams and pain relief patches and the use of ‘As required’ (PRN) medication. Audits showed the management of medication had improved and that the improvements had been sustained.

Improvements had been made as to how the rights of people were assessed and recorded under the Mental Capacity Act 2005. People’s mental capacity had been assessed and plans put in place to guide staff on ensuring people’s rights were protected within the law. Records demonstrated that best interest decisions were made with the involvement of people and relevant others.

Improvements had been made to how some aspects of the quality and safety of the service were monitored. The registered provider's quality assurance framework was followed effectively. The required checks were carried out on areas of the service at the required intervals. Action plans were developed and followed through for areas of improvement identified.

People felt safe living at the service. Staff completed training and had access to advice and guidance about safeguarding people. Staff understood the different types of abuse and indicators of abuse and were confident about reporting any safeguarding concerns. Records showed that appropriate safeguarding referrals were promptly made and action was taken to protect people from further risk of abuse. Risks to people’s safety were assessed and mitigated, this included risks associated with aspects of people’s care and the environment.

The environment and equipment people used was clean and hygienic and there was a pleasant smell throughout the building. Cleaning schedules were in place and being followed. Staff followed good infection prevention and control practices. This included the use of appropriate bins for disposing of clinical waste and the use personal protective equipment (PPE) to help minimise the spread of infection.

Staff were recruited safely.

This inspection took place on the 3 and 10 April 2017 and was unannounced.

Hurst Park Court is a care home which provides accommodation for up to 41 adults. The service is located in the Huyton area of Knowsley and is close to local public transport routes. Accommodation is provided over two floors and the first floor can be accessed via a stair case or passenger lift. There were 41 people using the service at the time of our inspection.

The registered manager for the service had recently resigned from their role. At the time of this inspection the registered provider was in the process of recruiting a new 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 last inspection of the service was carried out in July 2015 and we found that the service was not meeting all the requirements of the Health and Social Care Act 2008 and associated Regulations in relation to medicines management. During this inspection we found that some improvements had been made, however, we found that further improvements were needed.

During this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People's medicines were not always managed appropriately. People did not always receive their medication on time and on some occasions people's medicines were not always available. This put people at risk of not receiving their prescribed medicines safely.

Improvements were needed as to how the rights of people were assessed and recorded under the Mental Capacity Act 2005. Records did not always demonstrate that the key principles of the Act had been considered when a person lacked the capacity to make a decision.

Improvements were needed to how some aspects of the quality and safety of the service were monitored. Auditing systems were in place but had not always been effective. They had failed to identify issues relating to the management of people's medicines and improvements needed around the implementation of the Mental Capacity Act for people.

People had access to health care professional to assess and manage their health needs.

Staff had a good awareness of how to safeguard people from harm and they were confident about recognising and reporting any concerns. Staff were aware of who they needed to report any concerns to.

There was sufficient numbers of suitably skilled staff to keep people safe. Training and support was available to staff relevant to their roles and responsibilities.

People were supported by a team of staff who knew them well and offered support in a gentle caring manner.

Procedures were in place for the safe recruitment of staff. Applicants were required to complete an application form and attend an interview. A series of pre-employment checks took place to help ensure that staff were suitable to work with vulnerable people.

People’s nutrition and hydration needs were assessed and planned for and staff had a good understanding of them. People’s dietary requirements were regularly reviewed and shared with the catering staff to ensure that people were offered a suitable diet to meet their needs.

People had their own individual plans of care which demonstrated their needs and wishes. These plans enabled staff to deliver the care and support that people needed to keep safe and well. Where risks had been identified to people, action had been taken to minimise the risk of harm occurring.

The registered provider had developed an action plan to carry out and monitor improvements needed to further improve the service people received.

We asked if the home's medicine's arrangements were safe?

At this visit we found that the home’s arrangements for handling medicines were safe. Care workers had completed further medicines training and there was increased monitoring of medicines handling, helping to reduce the risk of errors.

We had previously inspected this service and found that improvement was required to ensure that people were fully supported in their care and welfare. Improvements were also required relating to the appropriate arrangements for the management of medicines.

During this inspection we found that some improvements had been made at Hurst Park Court.

We observed that people who used the service appeared happy and content living there. People were treated with care and respect. People we spoke with were very positive about the changes at Hurst Park Court. Their comment’s included:

"The staff are lovely and approachable."

"There are now more staff on the floor."

We found that people received the support they needed with their care and welfare.

During our visit we found that further improvements were still required to ensure that appropriate arrangements were in place for the management of medicines. No-one we spoke with expressed any concerns about how medicines had been handled.

We carried out this inspection to check on whether the home was compliant in outcomes relating to managing medications, care and welfare and safeguarding.

We spoke with people who used the service, relatives and carers, and staff. We used a number of different methods to help us understand the experiences of people who lived at Hurst Park Court. This was because some of the people who used the service had complex needs which meant they were not able to tell us their experiences.

We observed during our inspection that the people who used the service appeared happy and content living there. We found people were treated respectfully and given support to have their say, when possible, in how they wanted to be helped and were supported to do the things they wanted to do.

People were treated with care and consideration. We observed that staff were focussed on completing tasks for people, but always acknowledged and engaged them.

We found that appropriate arrangements were not in place for the management of the medicines.

We spoke with six people who used the service and seven relatives. They told us that the care they had received had been delivered in a way that respected their privacy and dignity. Their comments included, “Brilliant”, “Staff are lovely, kind, friendly” and “It’s like your home”.

The scheduled inspection was brought forward due to concerns raised about care at Hurst Park Court. During our visit we saw evidence that care plans were detailed and care was planned in line with individual needs and wishes. We looked in detail at nine care records of people who used the service and saw that they were up to-date and included relevant risk assessments.

People were protected from abuse and systems were in place to monitor the quality of service delivered.

There were enough qualified, skilled and experienced staff to meet people’s needs. However some people who used the service told us that they would like more time to do activities and some staff told us they would like to spend more time with people who used the service.

We had previously inspected this service on 3rd and 4th October 2012. We found areas of non compliance for which compliance actions were set. During our visit we found there had been improvements in the outcomes inspected.

We spoke with three people and four relatives who used the service who told us that the care they had received had been delivered in a way that respected their privacy and dignity. Their comments included:

"Staff are fantastic"

"Like friends"

"Mum is very settled and happy"

"Staff are friendly and welcoming"

"Communication is brilliant"

During our visit we saw evidence that care plans were detailed and people had been involved in planning their own care in line with their individual needs and wishes. We looked in detail at four care records of people using the service and saw that they were up-to-date and included relevant risk assessments.

Procedures to protect people from abuse had been reviewed and fully implemented and all incidents had been appropriately to the relevant authorities including CQC.

Staff told us they had felt well supported and had started additional training to provide them with the required skills and knowledge to meet people's needs including supporting people who had dementia.

We carried out our unannounced inspection of Hurst Park Court on the 08 and 13 of July 2015. Hurst Park Court is a care home which provides accommodation for up to 41 adults. The service is located in the Huyton area of Knowsley and is close to local public transport routes. Accommodation is provided over two floors and the first floor can be accessed via a stair case or passenger lift.

At our last inspection in July 2014 we found that people who used the service were not protected against the risks of receiving care that is inappropriate or unsafe and that the systems in place did not identify, assess and manage risks relating to the health, welfare and safety of people.

The registered provider sent us an action plan advising us how they had actioned this.

There was not a registered manager in post, however a new manager had been appointed and in post for one month, ‘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 new manager had previously been the deputy manager at the home. She informed us that she was in the process of registering with CQC as the registered manager.

At this visit we found that people were not protected against the risks associated with the administration, use and management of medicines. People did not always receive their oral and topical medicines at the times they needed them or in a safe way. You can see what action we told the provider to take at the back of the full version of the report.’

We found that 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. Throughout the inspection we observed members of staff interacting in a positive way with the people who used the service and with their visiting relatives.

The registered provider had carried out 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. We observed some people being supported with their meals by members of staff. Some people had specific dietary needs, which were appropriately catered for.

We were told by people who lived in the home, their relatives and members of staff that the manager was approachable and supportive.

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 Hurst Park Court there was one person who was subject to a DoLs authorisation. The manager and the 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. However more information on best interest decisions should be recorded in accordance with the MCA 2005.

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.

We saw that a variety of activities and entertainment had been available to people, in order to provide stimulation and motivation.