This inspection took place on 5 June 2018 and it was unannounced. We last inspected Arranmore Park Rest Home (Arranmore Park) on 3 September 2015. At that time we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to premises and equipment and safe care and treatment around the management of medicines and infection control practices.

Following our last inspection we asked the provider to complete an action plan to show us what they would do and by when to improve the key question of safe to at least good. At this inspection we found the provider had made the improvements required in accordance with their action plan, so the key question of safe was found to be rated as good.

Arranmore Park is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Arranmore Park provides accommodation in single and shared rooms over three floors for up to 35 adults, who require help with personal care needs. The home is situated in a residential area of Burscough, with the village centre and local amenities being nearby. Some rooms have en-suite facilities and a passenger lift is provided for access to the first and second floors. Some parking spaces are available at the front of the building and there is easy access to public transport links and the motorway network.

There was a registered manager in place. The registered manager assisted throughout 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 the premises to be well maintained, clean and hygienic throughout. However, the extension beyond the manager’s office on the ground floor was tired looking and in need of freshening up.

We noted one mattress to be longer than the bed base and could pose a risk to people if they sat on the end. Personal Emergency Evacuation Plans (PEEP’s) were in place. However, these could have been more informative. We made a recommendation about this.

We found a wide range of risk assessments had been conducted in relation to the environment and people’s health and social care needs. However, these had not always been updated at regular intervals. We made a recommendation about this.

People told us they felt involved in their care and making decisions. The plans of care we saw supported this information. We found people’s care plans varied in quality. Some were very informative and were written in a person centred way. Others provided basic details only. We made a recommendation about this.

At this inspection, we found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We found areas covering the mental capacity act and consent to be satisfactory. People’s decisions had been made in their best interests and good information was provided around Lasting Power of Attorney. This helped to ensure people received care and support in a way which was best for them.

During our inspection we observed staff transferring people. Each manoeuvre was conducted in a safe and competent manner with people’s privacy and dignity being protected. Systems were in place to ensure accidents and incidents were recorded appropriately

Medicines were being managed safely, although there were some minor areas where improvements could have been made. The registered manager addressed these at the time of our inspection.

People had access to external health care professio

Arranmore Park provides accommodation in single and shared rooms over three floors for up to 35 adults, who require help with personal care needs. The home is situated in a residential area of Burscough, with the village centre and local amenities being nearby. Some rooms have en-suite facilities and a passenger lift is provided for access to the first and second floors. Some parking spaces are available at the front of the building and there is easy access to public transport links and the motorway network.

We last inspected Arranmore Park on 12 May 2014, when we found the service to be compliant with five of the six outcome areas we assessed at that time. The home had failed to provide staff with training in relation to the Mental Capacity Act (MCA). We followed this up in July 2014 and found the shortfall had been appropriately met. This unannounced inspection was conducted on 3 September 2015. The registered manager was on duty when we visited Arranmore Park. She had managed the day-to-day operation of the service for many years. 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 of the Health and Social Care Act and associated regulations about how the service is run.

There were sufficient numbers of staff on duty to keep people safe. Staff members were well trained and had good support from the management team. They were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who lived at the home. The recruitment practices adopted by the home were robust. This helped to ensure only suitable people were appointed to work with this vulnerable client group.

Some areas of the premises had been pleasantly decorated and refurbished. However, other areas of the home were in need of upgrading and redecorating. Equipment and systems had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use. This helped to promote people’s safety.

The planning of people’s care was based on a thorough assessment of their needs, with information being gathered from a variety of sources. However, the planning of people’s care varied greatly. Some care plans were well written, person centred documents, whilst others lacked individualisation and failed to include some areas of assessed needs. A range of assessments had been conducted within a risk management framework, but these had not always been reviewed when areas of further risk had been identified. These did not always promote people’s safety and well-being.

People were helped to maintain their independence. Staff were kind and caring towards those they supported and interacted well with the people who lived at Arranmore Park. Assistance was provided for those who needed it in a dignified manner and people were enabled to complete activities of daily living in their own time, without being rushed.

Staff we spoke with told us they received a broad range of training programmes and provided us with some good examples of modules they had completed. They confirmed that regular supervision sessions were conducted, as well as annual appraisals.

Staff spoken with told us they felt exceptionally well supported by the registered manager of the home. They spoke in a complimentary way about her management style and described her as being, ‘approachable’ and ‘caring’.

Medicines were not being well managed. This did not promote people’s safety and could have potentially put people at risk of harm.

We found three breaches of the Health and Social Care Act 2008 *(regulated Activities) Regulations 2014 in relation to medicines, infection control and the environment.

You can see what action we took at the end of this report.

This visit to Arranmore Park was conducted by two inspectors from the Care Quality Commission (CQC). We gathered evidence against the outcomes we inspected, to help us answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with those who used the service, their relatives, support staff and the managers of the home. We also looked at a wide range of records and documents. Many of those who used the service were able to communicate with us. They all gave us positive responses to the questions we asked. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People we spoke with said they felt safe living at Arranmore Park. They told us their independence was promoted and their dignity was always respected. This was observed several times whilst we were at the home and we saw people being helped to mobilise in an appropriate manner. People's needs were taken into account enabling them to move around the environment freely and safely. Equipment was well maintained and serviced regularly. We noted a bath hoist had been deemed unfit for use. However, a new one had recently been installed. Therefore, people were not put at unnecessary risk. Those who lived at the home (or their relatives) were involved in making decisions about the care and support provided.

Evidence was available to demonstrate that, when necessary disciplinary procedures were followed in day to day practice and relevant health and safety training was provided. The home had policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, although staff had received DoLS training, no learning had been provided in relation to the MCA and staff spoken with had little knowledge of this important area. The manager of the home informed us the day after our visit that she had arranged this training for the staff team.

Is the service effective?

Information was readily available about the local advocacy service, if people needed it. This meant that people could access additional support, when required. The health and personal care needs of those who used the service had been thoroughly assessed and a wide range of external professionals had been involved in their care and support.

Systems were in place to ensure the home was effectively assessed, so the quality of service provided could be consistently monitored. We saw the staff team delivering effective care and support for those who lived at Arranmore Park. Visitors confirmed they were able to see people in private and visiting times were flexible. This was observed at the time of our visit to this location.

Is the service caring?

We asked those who lived at the home about the staff team. Feedback from them was very positive. They said staff were considerate and friendly towards them and helped them to meet their needs. When speaking with staff it was clear they genuinely cared for those they supported and were observed speaking with people in a respectful and empathetic manner. People's preferences and interests had been recorded and care and support was provided in accordance with their wishes.

We talked to people about the staff team. One person told us, "They are smashing." Another commented, "They will do anything for us. They really are a lovely lot. I don't think we could be in a better place."

Is the service responsive?

People participated in a range of activities in accordance with their interests and wishes. Some people enjoyed outdoor activities, which helped to keep them involved with their local community.

Staff were seen to be responding to people well by anticipating their needs appropriately.The service worked well with other agencies and services to make sure people received care and support in a consistent way. Evidence was available to show the

home responded well to any suggestions for improvement and appropriate action was taken to rectify any shortfalls identified.

Is the service well-led?

The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result, the quality of service provided was continuously monitored. Staff were confident in reporting any concerns and they felt well supported by the managers of the service. People who lived at Arranmore Park and their relatives completed annual satisfaction surveys. Where shortfalls or concerns were raised these were taken on board and dealt with appropriately.

You can see our judgements on the front page of this report.

During our inspection we were able to speak with nine people living at the home, who all provided us with positive comments. They told us they felt safe living at Arranmore Park, with their needs being met by a kind and caring staff team. They said independence was promoted and they were able to make decisions and choices about what they wanted to do, whilst living at the home.

We found staff to be well supported and those living at Arranmore Park looked comfortable in their presence. We also spoke with several relatives who were all very complimentary about the staff team and the managers of the home.

Comments from those living at Arranmore Park and some relatives included:

" This is a very well managed home."

"I have been so impressed with Bev (manager) and Pam (deputy manager). They are so responsive and always act on any issues immediately."

"Staff do respond well to Bev. She is marvellous. She is very much on the ball."

"There are some excellent carers, who anticipate mum's needs extremely well."

During our inspection we assessed standards relating to consent, care and welfare. We also looked at cleanliness and infection control. Standards relating to recruitment and monitoring the quality of service provision were also inspected. We did not identify any concerns in any of the outcome areas we assessed.

People living at the home, who we spoke with, told us they felt safe living at Arranmore Park, with their privacy and dignity always being respected and their needs being met by a kind and caring staff team. They said independence was promoted and they were able to make decisions and choices about what they wanted to do, whilst living at the home.

We found staff to be well supported and appropriately trained and those living at Arranmore Park looked comfortable in their presence. People we spoke with were very complimentary about the staff team and the managers of the home.

Methods for monitoring the quality of service provided had been established, although these could be extended in some areas. Systems had been developed, in order to protect the health and safety of those living at the home.

Comments from those living at the home included:

“It is very comfortable here. The staff are very kind to me. I can do what I want. For instance it was 9am when I got up this morning, because I fancied a lie in. I can go to bed when I want, too.”

“The staff are marvellous. We are well looked after, but we sometimes have to wait a long time for our ‘buzzers’ to be answered.”

We talked with a number of people using the service and their relatives. We received positive comments from everyone. People told us they were treated with respect, their privacy and dignity being maintained at all times. They all felt their needs were being met and they were supported by a friendly, caring staff team.

Comments from people living at the home included:

"You always get a service with a smile. The staff are really lovely."

"This place deserves 100%. I have no complaints at all. Everything is A1."

"I picked the right place when I came here. I have no regrets."

"We would give them ten out of ten for everything. It is marvelous."