This inspection took place on 14 December 2015 and was unannounced.

Annandale Rest Home provides accommodation and support for up to ten people. It is situated in a residential street, close to bus routes and shops. The building is a converted Victorian property with steps to the front and rear entrance. Communal areas include a large lounge and a separate dining room. There is a chair lift to the upper floor. The accommodation consists of one double and eight single bedrooms.

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.

Staff told us they were trained in all mandatory subjects, and we saw evidence that training takes place. However, we found both staff and the registered manager were not trained in The Mental Capacity Act 2005 and DoLS (Deprivation of Liberty Safeguards).

The registered manager was not confident in telling us how they would ensure a decision was made in a person’s best interests if it was deemed that the person did not have the mental capacity to make a specific decision.

People living at the home were not always protected against the risks associated with the safe management of medicines.

There was not much going on during the day, people were mostly wondering around or watching television. Some people told us they felt bored during the day. People who lived at the home and their relatives told us they felt safe in the home.

People told us and we observed there were enough staff to keep people safe.

Risk assessments were in place and personalised.

The staff we spoke with were aware of what constituted abuse and how to report an alleged incident.

Recruitment procedures were robust to ensure staff were suitable to work with vulnerable people. Systems were in place to maintain the safety of the home. This included health and safety checks of the equipment and building.

The home had aids and equipment to meet people’s needs and promote their independence.

We found the home to be clean, warm and homely, although the décor required attention in some places. We found some elements of the home were not dementia friendly.

Everyone told us the staff were caring and we could see evidence that the staff genuinely cared about the people they supported.

Food was fresh and home cooked. Everyone we spoke with told us that they enjoyed the food.

Staff worked well with health and social care professionals to make sure people received the care and

Support they needed. Staff referred to outside professionals promptly for advice and support.

There were quality assurance procedures in place for health and safety checks and the use of equipment; however the systems failed to highlight some of the shortfalls with regards to peoples care planning.

During this inspection we identified one breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we have told the provider to take at back of this report.

This inspection took place on 1 & 2 February 2017 and was unannounced.

Annandale Rest Home provides accommodation and support for up to ten people. It is situated in a residential street, close to bus routes and shops. The building is a converted Victorian property with steps to the front and rear entrance. Communal areas include a large lounge and a separate dining room. There is a chair lift to the upper floor. The accommodation consists of one double and eight single bedrooms.

The home was last inspected in December 2015. During this inspection we identified a breach in relation to assessing people’s capacity to consent to care and treatment. This was because some people were being deprived of their liberty without appropriate referrals being in place also the registered manager was not confident in accessing mental capacity or the process for acting in people’s best interest. The ‘effective’ domain of our report was rated as ‘requires improvement.’ Following this inspection the provider wrote to us to tell us what action they were going to take to ensure this breach was met. We checked this as part of this inspection.

On this inspection we found that improvements had been made and people living at the home had had their capacity re-assessed for individual decision and applications to the local authority had been when needed. In addition, the registered manager and the staff team had familiarised themselves with the Mental Capacity Act (MCA) 2005 by attending additional training. The MCA is the legislation that underpins mental capacity and how it is applied in care settings. The service was no longer in breach of regulation.

A registered manager in place. 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.

There were safe practices in place to ensure people received their medications safely and on time. Medications were stored in a designated area of the home and were only given out to people by staff who were training to do so.

There were recruitment checks in place to ensure that staff were safe to work with vulnerable people. There had been no new staff recruited to work at the home since our last inspection, and the staff that worked at the home had done so for a long time.

Staff were able to describe the course of action they would take if they felt someone was being harmed or abused in any way. This included raising and reporting safeguarding concerns. Staff also said the home’s whistle blowing procedure was discussed regularly with them, and they would not hesitate to enforce this procedure if need be.

Risk assessments were up to date and contained good information for staff to follow to minimise any risks to people’s safety. Risk assessments were reviewed every month or when people’s needs changed as a result of a medical condition or diagnosis.

Incidents and accidents were recorded and analysed monthly for any emerging patterns or trends.

Rotas showed there were enough staff on duty at any one time to keep people safe. We observed a calm, relaxed environment.

Staff had the correct skills and training to support them in their role, which included a range of courses in mandatory subjects as well as access to external qualifications. Staff were supervised in line with the providers policy, and had an annual appraisal.

Meals were served in the dining room, and people were provided with a menu which showed meal choices for a week based on a four weekly programme. Meals were home cooked and people said they enjoyed the food.

People were supported to access medical treatment when they required it. The home was taking part in a pilot scheme which involved them being able to access support from the community matron wh

We spent time with people who were living in the home over lunch. Two people were able to tell us about their views and experiences of Annandale Rest Home. Both people told us they were satisfied with the care and support provided to them. One person said, “It is very good here. They always make sure you have everything you need.” Both people we spoke with said they were always treated with dignity and respect. We were told the food was enjoyable and that their preferences were taken into account.

We spoke with a relative of a person who was about to move into the home for a period of respite care. They told us they had thought the home would be a good choice as it felt homely and they had found the manager and staff helpful and friendly.

The manager told us that activities take place at the home such as board games, quizzes, reminiscence boxes and beauty treatments. There were no external trips planned although some people, did on occasion, go out with their families. One person told us that the home suited them as they could take part in what they wanted to but could also go and read in their bedroom if they preferred. Another person said they would like access to more recreational activities.

We found improvements had been made since our last inspection in June 2012 where we had concerns relating to the storage of medication and staff not having adequate access to records.

We spent time with five people living at the home who were keen to share with us their views and experience of the care home. They all said they were happy living there. They told us that the staff were kind and caring. One person said, “The staff will do anything for you”.

The people we spoke with said they can get up and go to bed at whatever time they choose. We heard that the food was good with one person stating that, “The food is perfect; I have not refused a meal yet”. They told us that drinks were available throughout the day.

When we visited Annandale Residential Care Home we had the opportunity to observe the support that was being given to people living there. We saw many examples of good communication and patience by the care staff, who interacted with people they were supporting in a positive manner. Staff were warm, friendly and respectful to the people they were supporting.

We spoke with three people who were living in Annandale residential care home and met other people throughout the day. They felt the standard of care provided by the staff was very good. People told us that staff who supported them treated them well. They told us that they know all the staff as they had been there for a long time.

They told us:

“The staff are very good we want for nothing”

“Most of the staff are lovely”

One relative was able to tell us that they were very happy with the care and that the standard of care was always very good whenever they visited. They felt that the home was always clean and tidy and never had any unpleasant smells.

When we visited we noted that everyone was well dressed and well groomed.

We had also contacted the local authority contracts and monitoring team for Sefton Social Services before we visited the service. They had no issues of concern to report. Following our unannounced visit to the home we have shared various issues of concern noted within this report with Sefton contracts team.

This was an unannounced inspection of Annandale 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?

People told us they received good support and attention at Annandale Rest Home. Their comments included, "I get all the help I need" and "I only have to ask and the girls make sure I am alright."

We found the home to be clean and odour free. Measures were in place to ensure the environment was safe and suitable for the people who were living there. We did, however, find that some improvements were needed for the control of Legionella and also fitting window restrictors to ensure people's safety. On the second day of the inspection the manager informed us that window restrictors were being fitted. This helped to ensure people lived in a safe environment.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act [2005]. At the time of the inspection there was no person subject to a Deprivation of Liberty Safeguard [DoLS] application. 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.

Is the service effective?

People's health and care needs were assessed with them and/or with a family member and/or health professional. People told us the staff talked with them about the support they needed and wished to receive. Care plans recorded people's care needs though not all documents seen had been updated to reflect a change in care provision. Our observations and discussions with staff did however confirm their knowledge of the support people needed and received.

Where specialist support was needed, for example, the use of equipment, this had been sought in a timely manner to help improve people's health, well-being and comfort.

Is the service caring?

The people we spoke with told us the staff were considerate and helpful. People's comments included, "I am well looked after" and "The staff are marvellous.". Throughout the inspection we observed staff prompting and encouraging people in a kind, thoughtful and respectful way. Care and support was given when people requested and needed it. The staff ensured people's comfort and dignity at all times.

People's dietary needs and preferences were taken into account when planning meals. People reported the food was very good and there was plenty of choice. Staff offered support and encouragement to people with their meals and made sure food served was to their liking.

Is the service responsive?

People who lived at the home were listened to and their views were acted upon. People told us they were asked if they were happy with the service they received. We saw that people were given satisfaction surveys to enable them to give feedback about living at the home. People’s feedback was then used to make improvements to the service.

Care documents showed medical intervention had been sought at the appropriate time to help monitor people's health and well-being. Staff told us they worked closely with external health professionals, such as GPs and district nurses. A person told us the staff were prompt in arranging a doctor's appointment for them if this was needed.

People who lived at the home and family members knew how raise a concern if they were dissatisfied with something. A relative said they knew if they had concerns they could go straight to the staff and/or manager and they would be listened to.

Is the service well led?

We saw a number of internal and external audits which helped to demonstrate how the service was operating. However, we found it was not easy to track monitoring arrangements in the home as some records were not readily located. Some recommendations made from external agencies to improve the service had not all been actioned. We raised this with the manager who confirmed that monitoring systems would be reviewed and recommended actions would be taken to improve the service. We could see where improvements had been made, for example, in respect of infection control standards and actions taken had been recorded in the most recent audit [check].

People we spoke with were complimentary regarding the manager and staff. People told us the enjoyed living at the home and that it was 'well run' by everyone.

The service worked in partnership with key organisations, including the local authority and safeguarding teams to support the care provision and service development. This was evidenced through looking at a number of records and talking with the manager and staff.