This inspection took place on 18 May 2018 and was unannounced.

The Spinal Unit Action Group, is located in a residential area of Southport. Accommodation is provided for up to 12 people who are physically disabled. The home is fully accessible for people who require wheelchair access. It is fitted with appropriate aids and adaptations to support people in their independence and to assist people to move and transfer safely around the home. The home is in close proximity to Birkdale village and public transport links to Southport and Liverpool are within easy reach. At the time of our inspection there were seven people living at the home.

The Spinal Unit Action Group 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.

We last inspected the Spinal Unit Action Group on 28 February and 27 July 2017. We found two breaches of the Health and Social Care Act 2008 during this inspection in relation to safe care and treatment and good governance. We also made a recommendation in relation to the recording of complaints.

At this 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.

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; is the service safe, effective responsive and well led to at least good. During this inspection we saw that improvements had been made. The provider was no longer in breach of these regulations and had improved each key question to a rating of 'good'.

During our last inspection in February and July 2017 we found that risks to people's health and well-being were not always managed appropriately. This was because there was not enough detail in people's risk assessments which explained risk and how to keep the person safe. We found during this inspection that risk assessments had been re-formatted and now contained a high level of detail to help keep people safe from harm.

During our last inspection in February and July 2017 we found that audits and checks were not always consistently taking place to monitor the quality of the service. We found during this inspection the provider had taken appropriate action and a more robust checking and auditing system was in place.

People told us they felt safe living at the home and we received positive comments in relation to this. People also told us there was enough staff on duty at the home and there did appear to be enough staff.

Medication was safely managed, stored and administered. People received their medications on time.

Staff were recruited and selected to work at the home following a robust recruitment procedure. The registered manager retained comprehensive records of each staff member, and had undertaken checks on their character and suitability to work at the home.

The home was clean and tidy. There were provisions of personal protective equipment at the service, and staff were trained in infection control procedures.

Staff were able to describe the process they would follow to ensure that people were protected from harm and abuse. All staff had completed safeguarding training. There was information around the home which described what people should do if they felt they needed to report a concern.

The training matrix showed that staff were trained in all subjects which were mandatory to their role as stated in the provider's training policy. There was additional training in place which was overseen by medical professionals to

This unannounced inspection of The Spinal Unit took place on 18 February & 27 July 2017.

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.

The Spinal Unit Action Group, known as 'Weld Road' is located in a residential area of Southport. Accommodation is provided for up to 12 people who are physically disabled. The home is fully accessible for people who require wheelchair access. It is fitted with appropriate aids and adaptations to support people in their independence and to assist people to move and transfer safely around the home. The home is in close proximity to Birkdale village and public transport links to Southport and Liverpool are within easy reach. A variety of amenities such as shops, pubs, a bank, and churches are also within a short distance of the home. At the time of our inspection there were seven people living at the home.

The home was last inspected in December 2015. During this inspection, we found two breaches of the Health and Social Care Act 2008 with regards to safe care and treatment and governance of the home.

During this inspection, we found that some improvements had been made in relation to the management of medication at the home. We saw, however, that despite some improvement being made with regard to risk assessments and governance, the provider had not improved enough to have met the breaches from the last inspection. We also found concerns during day one of our inspection relating to the fire safety of the building. We asked the registered manager to take action to address these concerns. When we returned for day two of our inspection the registered manager had taken appropriate action.

During our inspection in December 2015, we found that the provider was in breach of regulation 12 of the Health and Social Care Act relating to safe care and treatment. This was because some risk assessments did not always contain sufficient and up to date information to help keep people safe. Also, some medications were not always being managed appropriately. This was because there was not a procedure in place to record when people took medication as and when it was needed, referred to as PRN medication. In addition, most people required support from staff to apply different types of topical medication (creams) to their skin. There was no accompanying MAR or chart which directed staff where to apply the creams and when. This made it difficult to tell if people had actually had their creams applied or not. Following our last inspection the provider wrote to us advising what action they were going to take, we checked this as part of this inspection. We saw during this inspection that the registered manager had added new documentation with regards to PRN medications and creams, which was easier to follow. We did see however, that the controlled drugs book (CD) s often only had one signature recorded. Controlled drugs are medications with additional safeguarding’s placed on them under the misuse of drugs act. We discussed this at the time with the registered manager who assured us that all CD’s were to be signed by two staff in future. The provider was no longer in breach of this part of the regulation. We saw, however, during this inspection that despite some improvements being made, risk assessments relating to people’s care and safety were still not robust enough or in place to help support people. The provider was still in breach of this regulation.

During our last inspection in December 2015, we found the provider in breach of regulations relating to the governance of the home. This was because quality assurance audits and checks were not as robust as they should have been. Fo

This inspection took place on 4 December 2015 and was unannounced. The Spinal Unit Action Group (SUAG) is located in a residential area of Southport. Accommodation is provided for up to 12 people who are physically disabled. The home is fully accessible for people who require wheelchair access and it is fitted with appropriate aids and adaptations to support people in their independence and to assist people in moving and transfer safely around the home. The home is in close proximity to Birkdale village and public transport links to Southport and Liverpool are within easy reach. A variety of amenities such as shops, pubs, a bank, and churches are also within a short distance of the home.

There was not a registered manager in post; they were in the process of registering with the Commission. 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.

Various risk assessments had been completed depending on people’s individual needs. Care plans were in place and completed and some reflected people’s current needs. When looking at these care plans and risk assessments we found that some of them were out of date and were of poor quality.

All of the people we spoke with told us they felt safe in the unit.

We observed caring interactions between staff and people living at the unit throughout the duration of our inspection. People spoke very highly about the staff and the manager of the unit.

An adult safeguarding policy was in place for the unit and the local area safeguarding procedure was also available for staff to access. Staff we spoke with confirmed that they understood the policy and explained what action they would take if they felt someone was being abused.

Everyone we spoke with told us their dignity was respected and protected and staff could clearly explain how they did this.

Staff told us they were well supported through the induction process, and had regular supervision and appraisals. They said they were up-to-date with all of the training they were required by the organisation to undertake for the role. Staff told us management provided good quality training. People we spoke with who lived in the home and relatives felt that the staff had the right skills to support them.

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

People’s care plans were personalised, and contained information such as their likes, dislikes and background, however some of this information had not been reviewed and did not give a true reflection about the person. We made a recommendation to the provider about this.

There were not always sufficient safeguards in place to ensure medicines were managed in a safe way. Medicines were administered by care staff once they had been trained to do so.

The building was clean, odourless and free from any clutter.

People were supported to access a range of external health care professionals when they needed to.

People told us they were satisfied with the meals, and could exercise full choice over what they ate and the times they chose to eat. The food looked appetising and tasted nice.

There were few activities and the home did not employ an activities coordinator. However, due to the nature of the service, most people chose to do things themselves during the day. People had mixed views about this. However most were happy to come and go as they pleased.

The home adhered to the principles of the Mental Capacity Act (2005).

During our inspection we found two breaches of the Health and Social Care Act 2008 (RA) Regulations 2014

 You can see what action we told the provider to take at the back of the full version of the report

We last inspected the Spinal Unit Action Group in May 2014. At that time we found staff members were not adequately supported to meet people's needs. For example, there were no records to show staff members had undergone formal supervisions or appraisals. Some of the systems which needed to be in place to support staff in their roles and responsibilities were not fully implemented or demonstrated. During this inspection, we checked to see whether improvements had been made. We found the provider to be compliant. Staff were being supported appropriately in their roles and responsibilities.

We did not announce our inspection prior to our visit. We 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. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived at the home told us they were treated with respect and dignity by staff. People told us they felt safe and that if they had any concerns they would raise these with staff or with the manager. There were no concerns with regards to people’s capacity to make their own decisions and people were encouraged to be independent and use the local community.

People’s health, safety and welfare were protected in how the service was provided. People got the support they needed when they needed it and risks to people’s safety were well managed.

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare.

People who lived at the home felt very much listened to and included in day to day decision making. They also felt included in making decisions about how the service was run.

Is the service caring?

People who lived at the home told us staff were caring and respectful. Staff told us they were clear about their roles and responsibilities to promote people’s independence and respect their privacy and dignity.

People were supported by attentive staff who were readily available to support them. We saw that staff showed warmth and familiarity when supporting people. People commented, “The care we get is first rate, they would do anything for us” and “The atmosphere is relaxed and friendly we have a great laugh together, we are just like a family.”

Is the service responsive?

The service worked well with other agencies and services to make sure people received their care in a joined up way. GPs, district nurses and other health professionals were referred to promptly when people required support with their health care needs.

People who lived at the home were listened to and their views were acted upon. People were asked to give feedback on their experience of the service. This was done through the use of surveys and regular resident’s meetings. People’s feedback was then used to make improvements to the service.

Is the service well-led?

Systems were in place for assessing and monitoring the quality of the service. These included regular checks on practice and seeking the views of people who lived at the home.

The service was managed in a way that ensured people’s health, safety and welfare were protected and the interests of the people who lived at the home was at the centre of how the service was run and managed.

Staff felt well supported and appropriately skilled and experienced to carry out their role. However, some of the systems required to support staff in their work were not in place. We have asked the provider to tell us what they are going to do to meet the requirements of the law to ensure the appropriate planning of care and support for people who live at the home.

We spoke to five people who used this service, all said the staff gave them choices and promoted their independence. We saw people had independent lifestyles and were supported to come and go as they please. One person told us about various days out he planned with the staff.

We looked at three care plans, all of which had a range of risk assessments, for example, falls, mobility and continence. We saw all care plans were person centred and took peoples hobbies and interests in to account. We saw people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

All five service users we spoke to said the home environment was very “homely” and they said the staff were all “very kind”. All five felt they were very well cared for. One service user we spoke to told us that staff were very knowledgeable about their conditions especially spinal injuries. We spoke to one physiotherapist who also corroborated this. The physiotherapist also said they felt the service users were very well cared for.

The way in which staff were recruited was found to be correct and safe. Staff showed evidence of previous experience and continuing professional development within healthcare.

We saw the home had developed their own medication sheets where the administration of medicines records were handwritten. Due to the evidence gathered it was established that the way in which medicines were recorded and stored were not safe.

People living in the home spoke positively about the care they received. One person told us, “I am free to come and go as I want and staff help me in the way I want it. The staff are good and the food is excellent. All I can say is it’s just like a family here.”

People we spoke with told us they were fully involved in deciding what care and support they required and how and when this would be provided. One person commented, ”No-one forces anything on you. They are always about to help but they don’t tell you what to do. They don’t assume anything.”

Training records confirmed that staff had safeguarding training as part of their mandatory training and refresher training was also part of the ongoing training plan.

We saw written procedures for the safe ordering, receipt, storage and administration of medication. We found that medication was stored securely and the home had systems in place to monitor how medication was managed and identify any actions required.

We looked at the staffing levels within the home and found that they were based on the needs of the people living there. People we spoke with told us that there were always staff about when they needed them.

The service had accurate and up to date records related to the running of the home which assisted in maintaining a safe environment for people and staff to live and work in.

We chatted with two people living at the home, who gave us very positive comments about what life was like at Weld Road.

They both told us their privacy and dignity was always respected and they were supported to maintain their independence, as far as possible. They said they felt safe living at the home and had every confidence in the staff team.

Comments received included:

"They (the staff) treat me like a human being. I can have a laugh with them. They make me feel younger. I can come and go as I want. I go into town, to the park, pub or village."

"The staff are lovely. Everyone treats me well. I can talk to them and they help me make decisions."

"There is a weekly menu. It's like a restaurant here. Last night I had mixed grill. The home made soup is gorgeous."