This inspection took place on 15 January and 1 February 2019. The inspection was unannounced.

Devonshire Manor 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.

Devonshire Manor offers accommodation for up to 15 people who require support with their personal care. There are 14 single bedrooms and one shared bedroom with communal bathrooms for people to use. At the time of our inspection 12 people were living at the home.

The home had a registered manager who had been in post for approximately one year. 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 our inspection in March 2017 we identified breaches of Regulations 11, 12 and 17. These breaches related to the management of risk, the implementation of the mental capacity act and the governance arrangements at the home.

At our last inspection in June 2018 the service had deteriorated and we identified breaches of Regulations 11,12,13,17,18 and 19. These breaches related to the management of risk, safety of the home’s environment, the management of people’s medication, safeguarding people from the risk of abuse, staff training and safe recruitment of new staff members, the implementation of the Mental Capacity Act and the governance arrangements of the home.

After the June 2018 inspection, the provider submitted an action plan to CQC outlining the action they intended to take to improve the service. At this inspection we found that the provider had taken steps to improve the service. However, on this inspection the provider was in breach of Regulation 9, 12 and 17. This is because the activities available for people and how they were supported to occupy themselves during the day did not always meet their needs or reflect their preferences; information in people’s care plans did not adequality identify the risks present in people’s support and show how these can be mitigated. The provider and registered manager had not used ongoing assessment and monitoring of the service to address these issues and also difficulties between the provider and registered manager and members of staff at the home. It was not clear what strategy or way forward the registered manager or provider had planned to tackle this problem.

There had been improvements in other areas of the home. For example, in the safety of the environment of the home and the quality of the facilities available to people, the safe administration of people’s medication, the addressing of any arising safeguarding concerns and people being consistently treated with dignity and respect.

The home’s environment was clean, well maintained and there were no unpleasant odours. People told us that staff were kind, caring and treated them well. One person told us, “The staff are very kind to me.” Another person said about the staff, “They are kind and patient.” During our visit, we observed many positive and thoughtful interactions between staff and people who lived at the home. One person told us, “I get on well with staff, we have a laugh. They hug me and say good morning.”

During our inspection we noted that there were enough staff to meet people’s needs in a timely manner. However, when we asked people, their relatives and staff, feedback about the usual levels of staff was mixed.

People told us that staff consult with them to learn their wishes and obtain their consent; one person told us that staff listen to them and act on what they say. People were encouraged to make as many choices for themselves as possible. When care planning and supporti

We carried out this inspection on 26 and 27 June 2018. The inspection was unannounced.

Devonshire Manor 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.

Devonshire Manor offers accommodation for people who require support with their personal care. There are 14 single bedrooms and one shared bedroom with communal bathrooms for people to use. A stair lift enables people’s access to bedrooms on the upper floors.

On the day of our visit, 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 manager had been in post approximately seven months at the time of our visit.

At our last inspection of the service in March 2017, we identified breaches of Regulations 11,12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the management of risk, the implementation of the mental capacity act and the governance arrangements at the home. After the March 2017 inspection, the provider submitted an action plan to CQC outlining the action they intended to take to improve the service. At this inspection we found that the provider had not taken sufficient action to address the breaches we had previously identified in accordance with their action plan. We also identified additional concerns with the management of medication, the safety of the premises, safeguarding people from the risk of abuse, staff training and recruitment. This meant the provider continued to be in breach of Regulations 11,12 and 17 of the Health and Social Care Act with breaches of Regulation 13 (safeguarding people from abuse and improper treatment) Regulation 18 (staffing) and Regulation 19 (fit and proper persons) also identified.

We looked at the care files belonging to three people who lived at the home. We found that people’s risks in relation to their care had not always been assessed. Care plans lacked clear information about the management of people’s risks and where professional advice had been given, care plans had not always been updated to reflect this. We saw that people’s care plans contained some person centred information about their individual needs, wishes and preferences but some of the information about the support people required was generic with the same standard statements made about a number of people’s needs. This aspect of care planning required improvement.

Some of the moving and handling practices used by staff to support people’s mobility was unsafe. One person’s moving and handling needs required further assessment to ensure that the support provided was effective in mitigating the risk of the person falling.

The management of medication was not always safe. People’s medication administration records contained missing signatures which meant it was difficult to tell if people had received the medication they needed on certain days. The stock of medication in the home was not always correct and some medication could not be accounted for. Records showed that the manager had identified similar issues in a number of consecutive medication audits. This indicated that the issues we identified during our inspection were repetitive and had not been adequately addressed.

The home was visibly clean and free from odours during our visit. The home’s electrical installation, fire alarm, fire extinguishers and moving and handling equipment had all been inspected in accordance with legal requirements. We saw that one of the home’s hoists was unsafe to use but

We undertook this comprehensive inspection on the 14 March 2017. The inspection was unannounced.

Devonshire Manor provides personal care and accommodation for up to 15 people. The home is a detached three storey building in Birkenhead, Wirral. It is within walking distance of local shops and had good transport links. A small car park and garden are available within the grounds. A stair lift enables access to the bedrooms located on upper floors for people with mobility issues. There are 13 single bedrooms and a double bedroom for people who wish to share. Communal bathrooms with specialised bathing facilities are available on each floor. On the ground floor, there is a communal lounge and dining room for people to use.

On the day of our visit, there was no 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. At the time of our visit, there was an acting manager in post who assisted with the inspection.

We looked at the care records belonging to five people. We saw that people’s needs and risks were identified but found that risk management information was not always sufficiently detailed or followed, to ensure safe and appropriate care was provided. Records relating to the delivery of care and the management of risk were not always complete. This meant they did not consistently show that people received the care they needed in accordance with their risk management plans. This did not demonstrate that risks to people’s health, welfare and safety were managed appropriately.

Care plans contained some person centred information about people’s needs and preferences but it was limited. Some also contained the person’s life story which helped staff get to know them but not everyone whose file we looked at, had one of these. When we checked one person’s nutritional preferences we found that they had been provided with food items that they had already advised staff they disliked. This did not indicate that this person’s preferences were always respected. When we asked the manager about this, they told us the person had just recently started to eat these food items.

On the day of our visit, we identified issues with the safety and cleanliness of the premises that had not been picked up and addressed by the acting manager or the provider. We spoke to the acting manager and provider about these issues and they acted on them immediately however, it should not have taken CQC inspectors to point these things out before anything was done. Safety certificates were in place for the gas, electric and fire alarm systems and the equipment used within the home.

We found that where people had mental health conditions that sometimes impacted on their ability to make specific decisions, capacity to consent was not always assessed in accordance with the Mental Capacity Act 2005. Some people’s right to choose for themselves and take informed risks was not always respected.

Staff recruitment was satisfactory but we spoke to the provider about the systems in place to respond robustly to information received about staff once they were employed. We found that staffing levels were sufficient to meet people’s needs and everyone we spoke with told us that staff came quickly when they needed support. Staff received training to meet people’s needs and received appropriate support in their job role.

Medicines were managed safely and people received the medicines they needed. When people became unwell or required the support of other healthcare professionals this was organised accordingly so that people received the help they needed.

People told us they felt safe and it was clear they thought highly of the staff team. They

We undertook this comprehensive inspection on the 1 April 2015, this was an unannounced visit.

At our last inspection in April 2014, breaches of legal requirements were identified. We asked the provider to take appropriate action to ensure improvements were made. During this inspection we found that the required improvements had been made.

Devonshire Manor provides personal care and accommodation for up to 15 people. The home is a detached three storey building in Birkenhead, Wirral. It is within walking distance of local shops and had good transport links. A small car park and garden are available within the grounds. The home has recently been refurbished throughout to a high standard. A stair lift enables access to the bedrooms located on upper floors for people with mobility issues. There are 13 single bedrooms and a double bedroom all of which are of a good standard. Communal bathrooms with specialised bathing facilities are available on each floor. On the ground floor, there is a communal lounge and dining room for people to use.

On the day of our visit, the registered manager was on sick leave on the day of inspection. They did not participate in 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 were assisted on this inspection by the deputy manager of the home.

People who lived at the home were happy there and held the staff in high regard. They said they were well looked after. People who lived at the home were supported to maintain their independence and were treated with dignity and respect at all times. A member of staff had recently taken over the role of activities co-ordinator and was working hard to provide a range of activities to occupy and interest people. From our observations it was clear that staff genuinely cared for the people they looked after and knew them well.

People had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime. People’s special dietary requirements were also catered for.

The home had the majority of medication supplied in monitored dosage packs from their local pharmacy. Records relating to these medications were accurate. There were however minor discrepancies with boxed medication which we spoke to the deputy manager about. All medication records were completely legibly and properly signed for. All staff giving out medication had been medication trained.

We saw that staff were recruited safely and that sufficient staff were on duty to meet people’s needs. Staff had received the training they needed to do their jobs safely and were appropriately supported in the workplace.

People told us they felt safe at the home and had no worries or concerns. Staff we spoke with were knowledgeable about types of abuse and what to do if they suspected abuse had occurred. Safeguarding incidents were appropriately reported, investigated and responded to by the manager.

We reviewed three care records. Two of the care plans provided sufficient information on people’s needs and risks and guidance to staff on how to meet them. One of the care plans however contained only an interim care plan. We spoke to the deputy manager about this.

Regular reviews of care plans took place to monitor any changes to the support people required and people had prompt access to other healthcare professionals as and when required. For example, doctors, dentists, district nurses and chiropody services.

We saw that staff asked people’s consent before providing personal care and that people were able to choose how they lived their lives at the home. Some people who lived at the home had short term memory loss or dementia type conditions. We saw that the home had made progress in ensuring people’s mental health needs were assessed and had employed elements of good practice in accordance with the Mental Capacity Act 2005 (MCA).

Where people lacked capacity however, care plans lacked adequate information on how this impacted on their day to day lives and the decisions people were able to make. Staff understanding of MCA and Deprivation of Liberty Safeguard legislation also required improvement. We spoke to the deputy manager about this.

We saw that people were provided with information about the service and life at the home. Information in relation to how people were able to make a complaint was directed more at what staff should do in the event of a complaint being made. We discussed this with the deputy manager and asked them to display more ‘people’ friendly information. People and relatives we spoke with however said they would know how to make a complaint. No-one we spoke with had any complaints.

The premises were safe, well maintained and there were good infection control procedures in place. The home was free from hazards and spotlessly clean. Equipment was properly serviced and maintained and in sufficient supply and the home had recently been awarded a five star rating (excellent) by Environmental Health.

There were a range of quality assurance systems in place to assess the quality and safety of the service received and to obtain people’s views.

People and staff told us that the home was well led. Staff told us that they felt well supported in their roles and that regular staff meetings took place where they were able to express their views. We saw that regular management meetings took place.

All the health and social care professional we spoke with said the home was well led, two healthcare professionals fed back that they would not hesitate recommending the home to anyone who needed personal care.