We carried out an unannounced inspection of Huyton Hey Manor on the 31st October 2017 and the 2 November 2017. The first visit was unannounced with the registered provider being aware of our second visit.

We last visited the service in December 2014. At that time the service was rated as good with no breaches of regulations identified. During that visit, we identified that the service was not always safe. This related to improvements that were needed to the environment. This visit found that these improvements had been done. People who used the service told us that the improvements made were better.

Huyton Hey Manor is a privately owned care home which provides accommodation for older people some of whom were living with dementia. The service accommodates up to 27 adults. The service is located in the Huyton area of Knowsley and is close to local public transport routes. Accommodation is provided over three floors. The majority of bedrooms are located on the first and second floor and these floors can be accessed via a passenger lift. At the time of our visit, 26 people were living there.

A registered manager was employed at the service. 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.

People felt safe living at Huyton Hey Manor. This view was echoed by relatives we spoke with. Staff had had received training in how to protect vulnerable adults and were clear about how they could report any allegations of abuse. They were also clear about the agencies they could speak to if they had concerns about poor practice within the service.

The premises were well maintained, clean and hygienic. Equipment such as hoists, portable electrical appliances and fire extinguishers were regularly serviced to ensure that they were safe. Risk assessments were in place identifying any potential hazards within the environment that could pose a risk to people and how this risk could be prevented. Personal evacuation plans were also in place to ensure the safe evacuation of people in the event of a crisis.

Risk assessments were in place highlighting the risks people faced from pressure ulcers, weight loss and malnutrition. These were closely monitored and reviewed regularly.

Sufficient staff were on duty at all times of the day. Staff rotas, discussions with people who used the service, relatives and staff confirmed this. Staff recruitment was robust with checks in place to ensure that new members of staff were suitable people to support vulnerable adults.

Medication management was good and promoted the well-being and safety of people who used the service. Checks were in place to ensure that medication was given when needed and systems in place to ensure that supplies never ran out. People told us that they always received their medication when they needed it. Staff who administered medication received appropriate training and had their competency to do this task checked.

People and their families considered that staff knew what their role was and knew all aspects of people’s preferences and their daily needs.

Staff received training appropriate to their role. Staff received supervision to ensure that they were aware of their progress and to discuss any needs they had. Group supervision in the form of staff meetings also took place. Staff of longer standing received an annual appraisal of their work.

The registered provider had taken the requirements of the Mental Capacity Act into account. This included assessments on the degree of capacity people had, how limited capacity would impact on their daily lives and how decisions could be made in their best interest. Staff had received training in the Mental Capacity Act and understood the principles associated

We inspected the service on the 3 December 2014. This visit was unannounced.

Huyton Hey Manor is a privately owned care home which provides accommodation for up to 27 older people. The service is located in the Huyton area of Knowsley and is close to local public transport routes. Accommodation is provided over three floors. The majority of bedrooms are located on the first and second floor which can be accessed via a passenger lift.

During our previous inspection of the home in October 2013 we found that the service was meeting the regulations we assessed.

The registered manager had been in post since September 2014. 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.

People told us that they felt safe living at the service. Staff knew how to keep people safe from abuse and were aware of how to report any concerns they may have in relation to safeguarding people from harm. We found that improvements were needed around the building to help ensure that people were safe.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Procedures were in place to promote people’s rights and the providers responsibilities in relation to the MCA 2005.

People told us that they enjoyed the food served and that they always had a choice.

Care planning documents and records were in place that detailed people’s needs in relation to their care and support. Staff showed that they knew people who used the service well and that they were aware of their likes and dislikes. We saw that staff supported people in a manner that was respectful and maintained their dignity.

Staff told us that they felt supported in their role. We saw that staff had the opportunity to attend training and that they were supervised on a regular basis.

Regular meetings were held so that people who used the service and their relatives were able to comment and contribute to what happens in the service.

The registered manager carried out regular checks around the home to help ensure that people were receiving the care and support they required. In addition, regular checks on people’s care plans and medicines took place.

People were admitted to the home following an assessment of their needs and an agreement that their needs could be met. They were given a contract of residence so they would know what their rights were.

We found that people who lacked capacity to make the best choices had their interests protected. Best interest decisions were made when people lacked capacity to choose for themselves.

People told us they were happy with the care and support they received from staff. They said, “I do discuss things with staff and I can decide what I want them to do to help me. I can’t walk very well. All the staff are very good really.” “I came to look around to see what I thought. The other home was closing. It was my decision to stay here I am well looked after, the staff are really good".

People said staff were attentive to their needs. We observed staff being polite, helpful and showed a caring nature when supporting people.

Activities were good and age appropriate.

People told us they were satisfied with the catering arrangements.

People lived in a safe environment. They said they were comfortable and had everything they needed.

People were cared for by staff that were of good character and had been recruited properly.

People were consulted in matters relating to their care and welfare.

We spoke with a lot of people who were living at the home and the feedback from the majority of people was positive. People made some of the following comments;

"I can't fault the place"

“I think it’s good here and I wouldn’t want to move anywhere else”

“I’ve lived here for a long time and it’s a good place”

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.

The majority of people using the service gave us positive feedback about staff. People described staff as being caring and attentive and they told us staff had readily contacted a nurse or doctor if they were feeling unwell or they needed medical attention. People’s comments included; "The staff are very helpful" and "Staff are nice and friendly".

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 very good.

People who use the service and a relative we spoke with were complimentary about the support provided by the careworkers. We watched careworkers supporting people living in the service in general they were thoughtful about the persons needs and tried to meet their care needs appropriately.

One person had recently had a fall resulting in a fracture but had not received the painkillers that careworkers had requested. An incident had occurred several months ago that had not been recognised by the service as safeguarding.

Since the last visit the service has made improvements in a number of areas particularly in relation to how they recruit new careworkers and other staff.

People who use the service and a relative we spoke with were complimentary about the support provided by the careworkers. We watched careworkers supporting people living in the service in general they were thoughtful about the persons needs and tried to meet their care needs appropriately.

People who use the service and relatives were complimentary about the care provided by the careworkers. The comments received included:

"really nice staff treat you as a person, look after me like family would",

"without them I would not be here".

"just ask for anything and the staff help".

Some people thought that although careworkers were helpful they found some staff better than others.

People living in the service told us that they did not have enough too do and were often "bored". They had told careworkers this and careworkers were aware that more activities were needed.

People living in the food were offered a choice of food. Careworkers were unaware of how to support people with special diets to make a choice as there was no information available to help them decide. The menus showed a choice of foods available at all mealtimes. We spoke with people living in the service about the food that they received. Their comments included:

"food is alright",

"I have my own soup as I don't like their soup",

"Can have your pick of food",

"there are no snacks after the evening meal, would not get a piece of toast overnight if I wanted one, there is nothing available"

"mealtimes suit me fine"

"I have my own biscuits if I want a snack"

"I am offered a choice of food I don't have a big appetite and prefer just a bowl of soup".

People living in the service told us that they did not get involved in the running of the service. They had not been involved in writing their care plans and were not aware of "residents" meetings or questionnaires about their opinions.

We spoke with people about the environment they told us:

it's always clean and tidy",

I like my room it has all my own things in it. When I moved in the let me bring some of my bits from home",

"my room is lovely and tidy ",

When we spoke to people about the levels of staff working in the home they told us that in their opinion there was enough staff available to meet their care needs.