This inspection took place on 27 February 2017 and was unannounced. We had received information of concern and had initiated a comprehensive inspection to look at the issues raised.

At our last inspection 23 March and 30 March 2016 the service had been served with three requirements for Regulation 12 and Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These requirements were for the proper and safe management of medicines, ensuring risk assessments were completed appropriately and the Mental Capacity Act 2005 (MCA) or DoLS assessments were required to be in place for people that required them.

Copperfield provides care and support for a maximum of 14 adults with mental health needs. The home is a large three storey detached building and is situated close to local amenities and is within walking distance of Liscard town centre. The service is close to transport links to all parts of Wirral and Liverpool.

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, 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.

At the time of our inspection, there was an interim manager in post as the registered manager had not worked at the service for several months due to ill health. We were told by the provider that the interim manager was going to register with the CQC as the registered manager.

We looked at the medication records for all eleven people. The medication procedure for staff was to administer their medication. Records informed that support staff would record all medication on the provider’s medication record sheets to inform medication had been provided. There was information in relation to covert medication practices for staff to follow; we were told that no person was receiving this service.

We looked at records relating to the safety of Copperfield and its equipment, which were correctly recorded. We were shown where confidential records were stored and saw they were in locked filing cabinets and electronic records were password protected.

Staff predominately prepared food and drinks but there was access to the kitchen for people to help themselves if they chose too. The people choose the meals that were provided; this was discussed at their meetings every two months. Where people’s weight changed this was recognised, with appropriate action taken to meet the person’s nutritional needs.

The provider complied with the Mental Capacity Act 2005 and its associated codes of practice in the delivery of care. We found that the staff followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights. The service was providing support to people who did not have the capacity to make their own decisions in different areas of their lives.

We found that the person centred care plans and risk assessment monthly review records were all up to date in the three files looked at. There was updated information that reflected the changes of people’s health.

People told us they felt safe with staff. The management had a good understanding of safeguarding. There had been no allegations of abuse at Copperfield in the last eighteen months. The manager told us that they would report any incidents directly to the local authority and the CQC.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidents. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

The staffing levels were seen to be sufficient at all times to support people and to meet their needs and everyone we

The inspection took place on 23 and 30 March 2016 and was unannounced. Copperfield is registered to provide accommodation for persons who require nursing or personal care for fourteen people. There are eleven bedrooms. All have private washing facilities and some have their own en-suite facilities.

The manager was registered with the Care Quality Commission. However they were not available for this inspection visit. 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 and associated Regulations about how the service is run.

We last inspected the care home on 26 April 2014. At that inspection we found the service was meeting all the essential standards that we inspected.

At the time of our inspection there were eleven people living at Copperfield and all had lived at there for a considerable time and considered it to be their home. When we arrived on the 23 March 2016 there was a team of four staff on duty; two support staff and a support staff/cleaner and the maintenance person. The deputy manager was contacted to join the inspection as this was a request made to support their development in management as the registered manager was absent. All of the staff had completed induction training and received regular on-going training by the provider.

We found Copperfield to be homely and the home had a relaxed atmosphere. The environment was warm and comfortable. We were told by staff and people living there that there had been a lot of decoration and improvements made to meet the comfort of the people living there.

The people we spoke with told us they felt safe at Copperfield.

We found that the care plan and risk assessment reviews records were not all up to date or had reflected the changes of the health of people living there. We also found areas of improvement needed in the documenting and safe storage of medication. You can see what action we told the provider to take at the back of the full version of the report.

The staffing levels were seen to be sufficient in all areas of the home at all times to support people and meet their needs and everyone we spoke with considered there were enough staff on duty.

The home used safe systems of recruiting new staff. Staff were recruited safely, with DBS checks in place and annual self-disclosure checks made with the manager. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing at the home.

Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened. Incidents and accidents were recorded and learnt from.

We found that the staff had not followed the requirements and principles of the of the Mental Capacity Act 2005 (MCA) and that there were unauthorised restrictive practices taking place.

People were able to see their friends and families when they wanted. Visitors were seen to be welcomed by all staff throughout the inspection. We observed that people were encouraged to be active and to participate in their community. People were coming and going throughout the two day’s we visited.

The staff we spoke with were able to tell us the action they would take to ensure that people were protected from abuse. All staff had received training about safeguarding.

Records we looked at showed that the required safety checks for gas, electric and fire safety were carried out.

People we spoke with confirmed that they had choices in all aspects of daily living. Menus were flexible and alternatives were always provided for anyone who didn’t want to have the meal on the menu for that day. People we spoke with said they always had plenty to eat.

The three care plans we looked at gave details of people’s medical history and medication, and informat

We gathered evidence to help us 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.

Is it safe?

We saw evidence that staff completed their safeguarding training annually, staff also confirmed this.

We saw that the provider was responsible for most people’s petty cash at the home. We saw all cash was stored securely. We saw the provider regularly reviewed risk assessments and consent forms for these people.

Deprivation of Liberty Safeguards’ (or DOLS) were introduced to protect individuals from the unlawful deprivation of their liberty as a part of the Mental Health Act 2007. The provider did not have anyone at the home subject to any deprivation of their liberty.

We saw evidence that arrangements were in place in relation to the recording of medicine and they were stored and disposed of safely.

Is it effective?

We saw the provider conducted weekly reviews with people who used the service. This looked at whether the people were pleased with their care and the activities they were involved in at the home. From the results of the questionnaires we saw people told staff they were all happy. We saw from the records one person told staff he had enjoyed gardening and wanted to do more. We saw the staff were obliging and told him this will be planned into their regular activities. The provider gave people the opportunity to review whether they were happy at the home we saw evidence that people were. This meant the home was providing a service which was effective.

Is it caring?

Staff were witnessed as being kind and promoting people's independence. We spoke to three people who lived at the home during our visit. They commented that staff were always “polite” and “kind”.

Is it responsive?

We saw the home organised a wide range of activities as a result of peoples’ personal preferences. Activities ranged from meals out to games to shopping trips. The three people we spoke to said staff always gave them choices of what they wanted to do. They felt there were enough activities planned. This meant the provider listened and took account of the peoples’ needs and responded appropriately.

We saw the provider conducted weekly reviews with people who used the service. This looked at whether the people were pleased with their care and the activities they were involved in at the home.

Is it well led?

We asked people who lived at the home and staff about the manager and their ability to deal with concerns. They all felt the manager dealt with any issues very promptly and everyone we spoke with gave positive comments about their management style and personality for example, “She is very approachable”, “Very nice and kind” and “Good manager”.

We saw the provider conducted regularly monthly audits in order to review the service. This allowed care plans, medication sheets and falls information to be scrutinised. We saw from the kitchen audit the manager ensured the kitchen was clean, and equipment was checked regularly. We saw the manager would complete action plans if anything needed updating or tidying and disseminated this to staff.

We saw the provider sent out annual feedback questionnaires to visiting professionals and relatives. We saw six questionnaires received from visiting professionals and relatives all contained positive feedback.

Records showed people who used the service were supported to make decisions about how they wished to be supported by the service and other agencies involved in their care. This included being involved in the production and review of their support plans and risk assessments. One person spoken with provided the following comment:-

“They have really helped me to make my own decisions and at times they push me to do this which is what I need.”

We spoke with two people who used the service. They said they were getting the care and support they needed. They said they had access to health professionals as they were needed. They described the staff as helpful and supportive. Some comments made were: -

“The staff are absolutely great they don’t judge you they just help and support you.”

“They have been very supportive with my health problems and support me at all my medical appointments.”

Records and discussions with people who used the service and members of the staff team showed that the service co-operated with other service providers.

We looked at the records of two new staff and found evidence that there were appropriate practices in place to ensure that staff were suitable to work at Copperfield.

There were systems in place to monitor the quality and safety of the service provided to people who lived at Copperfield.

We observed people being supported in a respectful and sensitive manner. With support workers discussing with people the plans for the day and checking that they wished to take part in planned activities.

We spoke with six people who used the service. All said they felt well supported and respected by the staff team. Some comments made were:

“I am happy living here this is my home.”

“There are always activities going on but I don’t always join in because I don’t want to.”

“I have a key worker and enjoy spending time with them.”

“The staff and Helen (manager) are very supportive and help me the way I want to be helped, they don’t judge me.”

People were able to express their views and were involved in making decisions about their care and treatment. Four of the six people spoken with confirmed they had been involved in the production of their support plans.

We sought information about the service offered at Copperfield form from Wirral Department of Adults Social Services (DASS). No issues of concern were raised.

We observed staff supporting a person who was unwell in a sensitive and supportive manner. People who used the service told us they felt confident in speaking with the manager and support workers about the level of support they felt they needed.

People who used the service told us they felt safe living at Copperfield and were confident if they had any concerns the manager would address them.