This inspection took place on 18 and 19 January 2018 and was unannounced.

Marina Care Home 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.

The care home provides accommodation and personal care for up to 33 people. The building is a large Victorian house with three floors and lift access to all floors. There were 29 people living in the home 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.

When we carried out a previous inspection in November 2016 we rated the service ‘requires improvement’ in safe, effective, responsive and well-led with an overall rating of ‘requires improvement’. At this inspection we looked to see whether improvements had been made to ensure the provider was meeting the fundamental standards of care. We found the home had made significant improvements to address the issues found in the last inspection.

During the previous inspection we found some areas were odorous and the care provider told us they were in the process of replacing carpets which were heavily stained to eradicate this. During this inspection we observed that the care home had been refurbished to a good standard and had addressed the previous issues. We found the home to be generally clean and free from odours. The manager told us that the refurbishments were still on-going and a number of rooms still required decorating; this was due to be completed within 2018.

We looked at whether the environment was safe including fire safety. During the last inspection in November 2016 we spoke to the fire officer who told us they had served an urgent notice of enforcement to the home which required them to carry out urgent work. We also found that there were hazards posed for people such as not all toilet/bathrooms being easily accessible or having signs. During this inspection we found that home was safe and all work had been completed and they were now compliant with fire safety regulations. All bathrooms had signs and were now easily accessible for people.

There was evidence of regular safety checks being completed by the home and action being taken where issues were identified.

Medicines were being managed and stored safely.

Staff were aware of different types of abuse and how to report safeguarding incidents. Those that were reported had been done so appropriately. They were also aware of the whistleblowing policy. Staff were able to explain how to keep people safe from abuse. People’s individual risks were appropriately assessed and reviewed in order to keep people safe. Staff had received appropriate training in safeguarding.

Staff recruitment files were found to reflect safe recruitment processes. Each file contained an application form with detailed employment history, photographic identification, references and evidence of DBS checks.

Staff had received training in areas such as infection control, health and safety and manual handling.

Accidents and incidents were reported and recorded and showed evidence of analysis and review and action taken where needed.

People living in the home told us they felt safe.

Principles of the Mental Capacity Act (MCA) 2005 legislation were being followed and Deprivation of Liberty Safeguards (DoLS) applications were completed correctly and in line with current legislation. Staff showed a basic knowledge and understanding of both MCA and DoLS. Best interest decisions were being made appropriately, however we identified that paperwork la

At the previous inspection on 31 May and 1 June 2015, the service was rated inadequate and placed in special measures with breaches of regulations 9, 11, 12, 13, 14, 15, 16, 17, 18 of the Health and Social Care Act Regulations 2014 and regulation 18 of the Registration Regulations for failure to notify us when appropriate. We took action to ensure people living at the service were protected from the risks posed and placed the service into special measures.

We conducted an unannounced comprehensive inspection on 24 November 2016. We found that the service had made significant improvements and met breaches of the regulations at the time of our inspection. The service has been taken out of special measures and is no longer rated as inadequate.

The care home provides accommodation and personal care for up to 33 people. The building is a large Victorian house with three floors and lift access to all floors.

There were 12 people living at the care home at the time of our inspection. We observed that the first and top floors of the care home were in the process of being refurbished. We were informed by the care provider that they intended to continue to refurbish the care home by also making alterations to the ground floor. There was a newly appointed manager who had been in post approximately four weeks.

A manager was in place and they were currently applying to be registered with us at the time of our inspection. 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 observed the care home was generally clean with some areas which the manager and care provider were aware needed further refurbishment which was already underway. We found some areas were odorous and the care provider told us they were in the process of replacing carpets which were heavily stained to eradicate this.

The service was not always safe. There were hazards posed for people such as not all toilet/bathrooms being easily accessible or having signs and further fire safety improvements were needed. However, work was on-going at the time of our inspection to make the progress required and the fire service were satisfied with the progress being made. There were unpleasant odours in some areas of the care home and further refurbishment needed.

Medicines were being managed and stored safely.

Staff were aware of different types of abuse and had heard of whistleblowing. Recruitment practices were safe and disciplinary procedures were being followed.

Principles of the Mental Capacity Act (MCA) 2005 legislation were being followed with a framework and DOLS applications in place. Staff had basic knowledge but further improvements were needed to ensure staff had a thorough understanding of MCA.

A new training analysis and matrix had been devised and staff were receiving training such as safeguarding and infection control. A new system of online training had been developed for staff. Staff received an induction.

There was a new system in place for staff to receive supervisions and appraisals which needed to be embedded. The manager was working towards this.

People told us they enjoyed the food and we found their nutritional needs were being met. There was a choice of meals and fresh fruit and drinks were available for people to eat and drink when they wished.

We found people were being supported to seek medical assessments and health care professionals input such as chiropody, dietetics and a General Practitioner when they needed.

The staff demonstrated they were caring; we observed staff treated people with respect, dignity and the interactions by staff displayed patience and kindness.

The staff and the manager involved people in their care planning

We carried out an unannounced comprehensive inspection of this service on 21September 2015 and identified breaches of regulation in the ‘Safe’ and ‘Effective’ domains. The breaches of regulation were in relation to not following the principles of the Mental Capacity Act (2005) and the management of medicines. This was the second consecutive breach in relation to medicines management. We asked the provider (owner) to take action to address these concerns.

We undertook an unannounced comprehensive inspection on 31 May 2016 and 1 June 2016 to check that the provider had met the legal requirements identified in ‘Safe’ and ‘Effective’. The provider had not met these requirements.

Located close to Southport promenade and the town centre, Leyland Rest Home provides accommodation and care for up to 33 people. The building is a large Victorian property with gardens to the front and back. The home has three lounge areas, a dining room and lift access to all floors.

Twenty three people were living at the home at the time of the inspection.

There was no registered manager in post. They had left the service shortly before our inspection. A new manager had been appointed and they were planning to register. 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. This happened less than two weeks before the inspection.

People living at the home were not always receiving their medicines as prescribed by the doctor and at a time when they needed them. Medicines were not always stored securely. For example, a person managed their own medicines but the medicines were not stored in their bedroom in a safe way. Plans were not in place for medicines that were given to people when they required them. This was the third consecutive breach of the regulation in relation to the management of medicines.

The way in which mental capacity assessments were undertaken was not in accordance with the principles of the Mental Capacity Act (2005). Applications to lawfully deprive people of their liberty had been submitted to the Local Authority. However, an application to urgently deprive a person of their liberty had not been considered even though the person had left the premises shortly before our inspection. This meant the person was at risk of having their liberty unlawfully restricted if staff tried to prevent them from leaving the building again. This was the second breach of regulation in relation to seeking consent from people.

The staffing levels were inadequate to ensure people’s safety was maintained at all times. The low staffing levels were identified as a concern at our inspection in March 2015. They had improved when we inspected the service in September 2015. Since then the staffing levels had been reduced again.

Care plans were not always being updated to reflect changes in people’s needs and increased risk. Sufficiently detailed care plans had not been completed for people who had moved into the home, including people who moved there over a year ago. For example, a person who moved to the home over 12 months ago still had a ‘mini’ or temporary care plan in place that did not reflect the person’s current needs. There was some confusion about the difference between a risk assessment and a care plan. People and/or their representative were not routinely involved in developing care plans or the on-going care plan reviews.

Although basic information was included in care records about preferred routines and likes/dislikes, staff engagement with people was task-orientated based on the routine of the home rather than person-centred to each person’s specific needs. There were no social or recreational activities for people to participate in. People told us they were

We carried out an unannounced comprehensive inspection of this service on 10 March 2015 and identified breaches of regulation in the ‘Safe’, ‘Effective’ and ‘Responsive’ domains. The breaches of regulation were in relation to: the management of medicines; protecting people from abuse; the management of individual risk; risks associated with the environment and equipment; standards of cleanliness; individual care plans and staff training, supervision and appraisal. We asked the provider (owner) to take action to address these concerns.

In addition, we identified minor concerns within the ‘Effective’ and ‘Responsive’ domains. We made recommendations in relation to these concerns.

Following the comprehensive inspection the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook an unannounced focused inspection on 21 September 2015 to check that the provider had met the legal requirements identified in ‘Safe’, ‘Effective’ and ‘Responsive’. We also looked at whether the recommendations identified had been addressed. You can read the report from our comprehensive inspection, by selecting the 'all reports' link for Leyland Rest Home on our website at www.cqc.org.uk.

Located close to Southport promenade and the town centre, Leyland Rest Home provides accommodation and care for up to 33 people. The building is a large Victorian house with gardens to the front and back. The home has three lounge areas, a dining room and lift access to all floors. Twenty four people were living at the home at the time of the inspection.

Although a registered manager was in post, they were not on duty at the time of the inspection. 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 found that improvements had been made in all areas we had concerns about. Improvements had been made to how medication was managed. However, we found further concerns with ensuring the safe management of medicines. You can see what action we told the provider to take at the back of the full version of this report.

Risk assessments and care plans were in place for the people living at the home. These were individualised to the person and the care plans provided clear and concise information about how each person should be supported. Risk assessments and care plans were reviewed on a monthly basis. They were revised to reflect people’s changing needs.

The staff we spoke with could clearly describe how they would recognise abuse and the action they would take to ensure actual or potential abuse was reported. Staff confirmed they had received adult safeguarding training and were aware of what to do if they had a safeguarding concern. The adult safeguarding policy had been revised and was now reflective of the service provided at the home and the local area safeguarding procedure. Information regarding the whistle blowing policy had been issued to all staff.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. People living at the home, families and staff told us there was sufficient numbers of staff on duty at all times.

Staff told us they were well supported through regular supervision. They said they were up-to-date with the training they were required by the organisation to undertake for the job. Training records confirmed this. The manager said staff appraisals were due to start.

The building was clean, well-lit and clutter free. Measures had been made more robust to monitor the cleanliness and safety of the environment, and equipment. A refurbishment programme was in place; internal decoration had taken place and damaged equipment had been replaced. We found a fire door inappropriately wedged open, which meant people were at risk in the event of a fire. We made a recommendation about this.

People told us they were satisfied with the meals. We observed the lunch time meal. Most people had their lunch at a table in the dining room. Staff support was available where needed. A cold drink was available with lunch and a hot drink after lunch.

Staff had a good understanding of people’s needs and their preferred routines. We observed positive and warm engagement between people living at the home and staff throughout the inspection. People living there told us they did not enough recreational activities to occupy them during the day.

Staff sought people’s consent before providing support or care. The home was not undertaking mental capacity assessments in accordance to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Mental Capacity Act (2005) had not been submitted to the Local Authority for people who lacked mental capacity. You can see what action we told the provider to take at the back of the full version of this report.

Staff told us the owner and manager was both approachable and supportive. They said they were listened to if they had any concerns.

A policy and procedure was established for managing complaints. The policy had been reviewed in August 2015. The complaints procedure was now being used appropriately as previously staff had been using it to report incidents and grievances.

Audits or checks to monitor the quality of care provided had been improved upon and made more robust.

This unannounced inspection of Leyland Rest Home took place on 10 March 2015.

Leyland Rest Home was inspected on 2 September 2014 and found to be in breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The breach of Regulation 10 related to inadequate processes to seek the views of people living at the home and the views of their families regarding changes to the service. In addition, managerial roles and responsibilities were not clear which was impacting on the decisions making arrangements. The Care Quality Commission (CQC) received an action plan from the provider to outline how improvements would be made. Satisfactory improvements had been made with respect to this breach.

Located close to Southport promenade and the town centre, Leyland Rest Home provides accommodation and care for up to 33 people. The building is a large Victorian house with gardens to the front and back. The home has three lounge areas, a dining room and lift access to all floors. Twenty seven people were living there at the time of the inspection.

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 found the staffing levels were inadequate to ensure people’s safety was maintained at all times. Three care staff were on duty during the day to provide care for people over three floors. Four people had high dependency needs and often required the support of two staff. Dependency assessments had been completed for each person to support with deciding on staffing levels but the assessments we looked at had not been reviewed since June 2014 so they may not have reflected people’s current needs. You can see what action we told the provider to take at the back of the full version of this report.

People’s individual risk assessments had not been reviewed in a timely way to take account of any new risks or incidents that had occurred. Risk assessments and associated care plans had not been completed for new people who had recently moved into the home. You can see what action we told the provider to take at the back of the full version of this report.

Not all staff were clear about what adult safeguarding meant. Less than half the staff team were up-to-date with adult safeguarding training. Frequent altercations between people living at the home were not being treated as, or reported as, a safeguarding concern. The safeguarding policy for the home was inaccurate as it made reference to staff using physical restraint. Staff confirmed they had not used physical restraint and were not trained in its use. You can see what action we told the provider to take at the back of the full version of this report.

Not all medicines were stored in a safe way. We observed prescribed topical medicines (creams) in people’s bedrooms were not stored securely. A risk assessment had not taken place to confirm a person was able and safe to manage their own medicines. There were a number of missing staff signatures on medication administration records. The medication policy was last reviewed in May 2009 and was not in accordance with good practice national guidance for managing medicines in care homes. You can see what action we told the provider to take at the back of the full version of this report.

Safe and effective recruitment practices were in place. Staff training was not up-to-date and staff told us they had not received regular supervision and an annual appraisal. You can see what action we told the provider to take at the back of the full version of this report.

We found that areas of the home, including bedrooms and bathrooms, were unclean and unhygienic. For example, we observed black mould on bathroom tiles and taps despite the room having recently been prepared for a new person to move in. Wheelchairs and other equipment were dirty. Furniture in shared areas was unclean and upholstery was torn. You can see what action we told the provider to take at the back of the full version of this report.

Arrangements to check the risk associated with the equipment used, such as hoists and wheelchairs were not robust. For example, wheelchair risk assessments were unchanged since 2008. You can see what action we told the provider to take at the back of the full version of this report.

Arrangements to monitor the safety of the environment were not rigorous. For example, many areas of the building, including people’s bedrooms were in a poor state of repair. The wallpaper and or paint were peeling from walls in some rooms. Not all of the hot water pipes in areas accessed by people living at the home were insulated. Some of the carpets had an unpleasant odour. Lighting was insufficient in some areas. You can see what action we told the provider to take at the back of the full version of this report.

People had access to health care when they needed it, including their GP, dentist, optician and chiropodist. A visiting healthcare professional told us staff responded promptly to people’s changing health care needs.

The staff we spoke with had not received awareness training in relation to the Mental Capacity Act (2005) and had a limited understanding of how it applied in practice. Nobody living at the home was subject to a Deprivation of Liberty Safeguarding (DoLS) plan. Some people used bedrails and there was no record to indicate how people consented to the use of this equipment. We made a recommendation regarding consent and the Mental Capacity Act (2005).

Overall, people were satisfied with the meals and access to drinks. The dining room was not well staffed at lunch time so there was limited support to encourage people to eat and to monitor what people had actually eaten. We made a recommendation about this.

Staff were caring and kind in the way they supported people. They treated people with compassion and respect. They ensured people’s privacy when supporting them with personal care activities. People had been given the opportunity to express their preferred gender of staff to provide support. People and/or their representative were not routinely involved in on-going care plan reviews.

Assessments and person centred plans had not been completed for people who recently moved into the home. We found that staff had a limited knowledge of the backgrounds and needs of the new people. You can see what action we told the provider to take at the back of the full version of this report.

A complaints procedure was in place and displayed. People we spoke with and families were aware of how to raise concerns. The complaints process was not being used appropriately by staff. For example, some incidents and grievances were recorded as complaints. A complaint a visiting family member told us they made that had been dealt with effectively had not been recorded. We made a recommendation about this.

A system to audit the care records had been developed and each of the care records were being audited three monthly. Meetings were being held at the home for people living there to express their views about service.

We considered all the evidence we gathered under the outcome we inspected. We used the information to answer the five 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?

Below is a summary of what we found –

Is the service safe?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service effective?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service caring?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service responsive?

Feedback questionnaires for families had been developed and recently distributed. The registered manager advised us that questionnaires would be distributed to people living at the home shortly and staff would provide support to people with completing the forms if they needed it.

We found that the availability of the mini bus had been limited throughout July and August 2014. This meant that alternative transport arrangements had to be made for people to access the community. The planned absence of the mini bus had not been discussed with people living at the home and/or their families. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service well led?

Limitations with how the quality of service was being monitored had been addressed since the last inspection. Audits and checks in relation to medication and cleanliness of the premises had been revised and introduced. Plans were in place for the registered manager to develop a care records audit tool.

A consistent view was expressed by the staff that they were not always clear about the roles and responsibilities between the provider and the registered manager. Some staff were uncertain of who was “in charge” and found it frustrating as they were unsure who to approach with a concern or request. A consistent structure for on-call managerial cover was not in place. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We carried out this inspection to check if the home had made progress with carrying out staff appraisal and supervision.

During the inspection we spoke with four people who were living at the home at the time of our inspection. The people we spent time with were relaxed and content. One person said, “Everything is good here.”

The care records we looked at were individualised and included each person's preferred day and night time routine. Care plans were established and we could see they, along with the assessments, were reviewed each month. Bed rail risk assessments had been completed since the last inspection.

Training had been organised for staff up until January 2014. Staff were receiving regular supervision and appraisal.

The people living at Leyland Rest Home that we spoke with were positive about the care and support they received at the home. We also spoke with visitors who were at the home at the time of our inspection and they were complimentary about the care and support provided. One person said, “The staff are nice and attentive”. Another person said, “I can get up and go to bed when I want”. We also heard that there were plenty of staff on duty. People could choose whether they were supported by male or female staff.

Care plans were in place and these were reviewed on a monthly basis to take account of people’s changing needs.

An adult safeguarding procedure had been developed for the home and the full staff team had attended safeguarding training since September 2012. In addition, the staff team had also attended training in how to support people with dementia. Overall, mandatory training was up-to-date. The provider had organised further training to address any gaps.

Staff were not receiving regular supervision or an annual appraisal and we have required the provider to make improvements in this area.

The approach to risk management, in particular the recording and management of incidents had been revised and strengthened.

People living at the home told us the staff were kind and caring and helped them when they needed it. They said the food was good and they got plenty to eat and drink. One person said “I like it here because it is relaxing and the staff are good.” People told us there was not much to do during the day as recreational activities did not happen on a regular basis.

Although assessments and care plans were person-centred, we found that they did not always address each person’s full range of needs. Processes were in place to seek the views of people living at the home and or their representatives about the quality of the service.

A consistent recruitment process was in place. However, we heard that staffing levels were low. In addition, staff told us they would benefit from further training to ensure they had the knowledge to effectively meet people’s individual needs.

We saw evidence that good quality audits and safety checks were in place. Some of the quality monitoring systems, such as the management of incidents and safeguarding processes were underdeveloped.

This was an unannounced inspection of Leyland Rest Home. The inspection set out to answer our five questions:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found there was sufficient staff on duty to meet the needs of the people who were living at the home. Arrangements were in place to monitor accidents and incidents.

A range of regular audits and checks were established, including a medication audit and health and safety audit. The audits were not sufficiently rigorous. These meant concerns were not always being identified. For example, the medication audits undertaken each month had not identified that prescribed creams and lotions were being stored incorrectly. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act (2005). At the time of the inspection nobody who lived at the home was on a Deprivation of Liberty Safeguards (DoLS) plan. Most of the staff team had attended DoLS training.

Is the service effective?

People we spent time with were satisfied with the care and said their needs were being met. Equally, the family members we spoke with were pleased with the care and support their relatives living at the home received. They said staff arranged appointments with health professionals, such as a doctor or dentist if they needed it. Care plans were in place for each person. Care plans were reviewed each month to ensure they were current.

People told us they were satisfied with the food and menus. Any suggestions about changes to the menu were listened to and acted upon.

Is the service caring?

People told us the staff were approachable and responsive if they needed support with a task or activity. One of the people living there said, “You could not get better than this home. The staff are so good to me.”

Throughout the day of the inspection we observed care staff engaging with people in a positive, respectful and individualised way. Staff had a good knowledge of each person’s needs.

Is the service responsive?

People’s needs had been assessed before they moved to the home. Records confirmed people’s preferences, interests and preferred routines had been recorded, and staff provided support in accordance with people’s wishes. People were involved in decisions about their care. They or a family member had signed the care plan. Although people were unable to recall the activities they participated in, family members and staff confirmed activities and trips out took place on a regular basis.

Is the service well-led?

Processes to seek the views of people living at the home were not sufficiently developed. Records were not maintained to demonstrate that people had been involved in in decision making about changes to the home. Opportunities to provide feedback about the service provided at the home were limited. People living there told us about concerns they had reported to staff, such as missing items of clothing, but these concerns had not been fed back to the Registered Manager. This meant people’s concerns had not been addressed. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Staff we spoke with said they felt the service was more coordinated and structured since a Registered Manager was appointed. They told us positive changes had been made to the home in recent months. Staff also informed us they received good quality training and had an annual appraisal and regular supervision.