This inspection took place on 23 and 24 July 2018 and was unannounced.

Kavanagh Health Care Limited is owned by Exemplar Health Care and is situated in the Kirkdale area of Liverpool. Kavanagh Health Care is ‘care home’ and provides support for up to 40 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Kavanagh Health Care Limited is registered to provide accommodation with nursing and/or personal care to people with mental health support needs including early onset dementia, neurological disorders and complex physical disabilities.

At the time of the inspection there was a registered manager 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. During the inspection we found the registered manager to be open, transparent and receptive to the feedback provided.

At the last inspection which took place in June 2017, we identified breaches of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Kavanagh Health Care Limited was awarded an overall rating of ‘Requires Improvement’. Following the inspection, we asked the registered provider to complete an action plan to tell us what improvements they would make and by when.

During this inspection the registered provider was found to be complying with all Health and Social Care Act regulations and was awarded an overall rating of ‘Good’.

At the last inspection we identified that some medication management procedures were not safely in place. Topical preparations (medicated creams) and prescribed thickeners (prescribed thickening agents for people with swallowing difficulties) were not recorded appropriately. We also found several omissions on medications records which indicated some diet supplements had not been given as prescribed. During this inspection, we found that the medication management processes had improved. Staff were complying with all medication policies and procedures and people safely received medicines that had been prescribed. The registered provider was no longer in breach of this regulation.

Care plans and risk assessments were safely in place. People were suitably assessed, risks were identified and support measures were implemented to manage and mitigate risk. Risk assessments were regularly reviewed and the appropriate clinical tools were completed to manage the level of risk which had been identified.

All four units were sufficiently staffed and people received the level of care and support they required. We received positive feedback from relatives and staff about staffing levels within the home. We were informed that staffing levels were appropriately managed and people received safe care from people who had the necessary skills and competencies. Staff were visible throughout the inspection and were responsive to people’s needs.

Staff were safely recruited which meant that people received safe care and support from staff who were assessed as being ‘fit and proper’ to work with vulnerable adults. Staff recruitment files we checked contained the relevant records, documentation and Disclosure and Barring Service (DBS) checks.

Staff were knowledgeable around the area of ‘safeguarding’ and ‘whistleblowing’ procedures. Staff explained who they would report their concerns to and how they would report their concerns. Staff received the necessary safeguarding training, there was an up to date safeguarding policy in place and staff were aware of how to access such policies if needed.

Accidents and

Kavanagh Health Care Limited is owned by Exemplar Health Care and is situated in the Kirkdale area of Liverpool. It is a modern, purpose built two storey building, divided into four wings and provides care for people with mental health needs including early onset dementia, neurological disorders and complex physical care needs for up to 40 people.

This was an unannounced inspection which took place on 14 and 16 June 2017. The service was last inspected in May 2016 and at that time was given a quality rating of ‘good’.

There were 38 people accommodated at the time of our inspection.

There was a registered manager 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 reviewed the way people’s medication was managed. We saw there were systems in place to monitor medication. Some medicines given such as external medicines [creams] and prescribed thickeners (used for thickening fluids for people with swallowing difficulties) were not being recorded appropriately. We found some omissions on records which indicated some diet supplements had not been given as prescribed.

The registered manager was able to evidence a series of quality assurance processes and audits carried out internally and externally by staff and from the provider’s visiting senior managers. We found these were developed to help ensure effective monitoring and development of the service as well as helping to ensure standards were continually maintained. We found however, that audits for medicines management had not identified the concerns we found on inspection.

The manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed on a regular basis where obvious hazards were identified.

Planned development / maintenance was assessed and planned well so that people were living in a comfortable environment. We found some examples where access to facilities could be improved for people. The development of environmental cues for people living with dementia would help orientate people with their surroundings to promote their wellbeing.

People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained. Most people were satisfied with living in the home and felt the care of offered met their care needs. People we spoke with said they were consulted about their care and we saw some examples in care planning documentation which showed evidence of people’s input.

We saw written care plans were formulated and care reviews were ongoing. Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

The registered manager had made referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the applications were completed and were being monitored by the registered manager.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We s

This unannounced inspection was conducted on 9 May 2016.

Situated in North Liverpool and located close to public transport links, leisure and shopping facilities, Kavanagh Place is registered to provide accommodation for up to 40 people with personal and nursing care needs. At the time of the inspection 38 people were living at the home. The location is a two storey property with a passenger lift between the floors. It has four separate units that provide care for people with specialist nursing needs. Each bedroom has its own en-suite facilities.

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. The registered manager was not available on the day of the inspection.

Each of the three people that we spoke with told us that they felt safe living at Kavanagh Place. Staff had received training in safeguarding and were able to explain what they would do if they suspected that someone was being mistreated.

People living at the home had detailed care plans which included an assessment of risk. These were subject to regular review and contained sufficient detail to inform staff of risk factors and appropriate responses.

Accidents and incidents were accurately recorded and were subject to assessment to identify patterns and triggers. Records were detailed and included reference to actions taken following accidents and incidents. Reference was also made to behaviours, observations and other issues that may have led to an accident or incident.

Staffing numbers were adequate to meet the needs of people living at the home. The provider based staffing allocation on the completion of a dependency tool. We were provided with evidence that this information was reviewed following incidents where new behaviours were observed which might increase or change people’s dependency level.

People’s medication was stored and administered in accordance with good practice. We spot-checked medicines administration records and stock levels. We saw that records were complete and that stock levels were accurate.

Staff were suitably trained and skilled to meet the needs of people living at the home. The staff we spoke with confirmed that they felt equipped for their role. The training matrix and staff certificates showed that the majority of training was in date.

The records that we saw showed that the home was operating in accordance with the principles of the MCA. Capacity assessments were not generic and were focused on the needs of each individual. Applications to deprive people of their liberty had been submitted appropriately.

Food was produced using fresh ingredients to a high standard and offered good choice. People could choose to eat in dining rooms or other areas of the home. Drinks were provided at regular intervals and on request.

People were supported to maintain their health through regular contact with healthcare professionals.

Throughout the inspection we saw staff engaging with people in a positive and caring manner. Staff spoke to people in a respectful way and used language, pace and tone that was appropriate to the individual.

Each of the people living at the home that we spoke with said that they were encouraged and supported to be independent. Throughout the inspection we saw people moving around the building independently and engaging in activities of their own choosing.

Staff spoke with people before providing care to explain what they were doing and asked their permission. Where people didn’t respond staff repeated or re-worded the question to ensure that the person understood.

Staff were attentive to people’s appearance and supported them to wipe their hands, face and clothing when they had finished their

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

At the time of our inspection the home 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 [owners], 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 carried out this unannounced inspection on the 9 October 2014. Prior to this a previous inspection was undertaken in January 2014. There were no breaches of legal requirements identified at the last inspection.

Kavanagh Place is situated in the Kirkdale area of Liverpool. It is a modern, purpose built two storey building, divided into 4 wings and provides care for service users with mental health needs including early onset dementia, neurological disorders and complex physical care needs for up to 40 people.

On the day of the inspection we spoke with three people who lived at Kavanagh Place. We also spoke with the manager, team leader and two support workers. As part of the inspection we also spoke with four relatives who visited the home.

During our visit to the Kavanagh Place, we spoke with people living at the home, staff, relatives who visited the home during our inspection and the registered manager. We also looked at the care records for seven people and looked at records that related to how the service was managed.

We asked people who used this service and the staff who supported them for their views of the service and we observed how the support staff interacted with people. On the day of our visit we saw people looked well cared for. We observed staff speaking calmly and respectfully to people who lived in the home. People living in the home and relatives we spoke with told us that the staff were kind and compassionate. We saw records which confirmed that people were involved in making decisions about their care and the staff we spoke with were aware of people’s preferences. People accessed a variety of activities and work to meet their needs.

The service had safe recruitment systems to ensure that new staff were only employed if they were suitable to work within the home. The staff employed by the service were aware of their responsibility to protect people from harm or abuse. They told us they would be confident reporting any concerns to a senior person in the service.

There were sufficient staff, with appropriate experience, training and qualifications to meet people’s needs. The service was well managed, the registered manager told us they set high standards and took appropriate action if these were not met. The staff we spoke with were aware of the individual risks and needs of the people living at the home and how they should be supported. The staff we spoke with told us that they were effectively trained and supported to carry out their roles.

People we spoke with who lived in Kavanagh Place, relatives and staff told us that they were comfortable raising concerns about the service if they had any. We noted that there were forms available in the reception area of the home for people to use to express their views on the service. There was a complaints procedure which staff were aware of and regular meetings which sought people’s views of the service were held.

Comments from people included, “They ask me all the time whether I am ok and happy about the care I get.” “They listen to me and they are always helpful, make sure I have all the help I need.”

We carried out an inspection on 22 July 2013 and published a report setting out our judgement. We asked the provider to send us a report of the changes they would make to comply with the standard they were not meeting.

We have followed up to make sure that the necessary changes have been made and found the provider is now meeting the standard included within this report. This report should be read in conjunction with the full inspection report.

We visited Kavanagh Place as part of this review. We reviewed records and spoke to staff. This confirmed that they were now meeting the standards.

Kavanagh Place was a modern purpose built facility that was divided into four specialist wings of 10 en suite bedrooms. There was a multi-sensory room and each wing had a sensory bathroom and specialist bath. The home also has a fully equipped physiotherapy suite with a full time chartered physiotherapist on site and a training and cinema room. All of the bedrooms were decorated and fitted to the individual's requirements and choice.

During our visit we spoke with 10 people who used the service, visitors and staff. We looked at the care records of people who used the service to see how their needs should be met. We also looked at staff rotas, audit information and information on complaints.

During our visit we observed that rapport and interaction between the people who used the service and staff was variable, depending on which of the four separate wings we were on. People who used the service told us that although they were given choices they were very limited.

Some people who used the service had limited verbal communication but could communicate in a number of other ways. They were supported by staff who knew the appropriate way to communicate with them when decisions needed to be made about their care and welfare.

All people who used the service had an individual care record. We noted that although people who used the service were asked about their choices and preferences, consent was not consistently recorded in their care records.

There were enough qualified and skilled staff on duty to meet the needs of the people who used the service. However we observed that staff were involved in the completion of tasks rather than interaction with the people who used the service.

We found that Kavanagh Place was a modern purpose built facility that was divided into four specialist wings of 10 bedrooms each with an en suite. Additionally there was a well equipped multi-sensory room on the ground floor and each wing had a sensory bathroom and specialist bath. The home also has a fully equipped physiotherapy suite with a full time chartered physiotherapist on site and a training and cinema room. All of the bedrooms were decorated and fitted to the individual's requirements and choice.

We spoke with three service users two family members four member of staff and two stakeholders. Everyone was positive about the service and made comments such as ''my relative is settled and has progressed since moving here''. ''There is nothing that they could do better'' and ''My relative has had good access to the community and a choice in the bedroom decoration to suit their age and taste and has a good programme of physiotherapy''.

Staff members felt supported and enabled to continue their own training and development.

In addition to accessing the local community facilities there was a varied programme of events taking place within the service including massage and relaxation therapy, baking, movie afternoons and games of football. Kavanagh Place also has its own mini bus to facilitate trips out and holidays.

During our visit people were seen to be interacting well with each other.