About the service: Fleetwood Hall accommodates 53 people across five separate units, each of which had separate adapted facilities. One of the units specialises in providing care to people living with dementia, and is split into a male and female side. The other unit specialises in supporting people with mental health needs, and is also split into male and female sides.

People’s experience of using this service:

Quality assurance procedures had improved since we last inspected the home in January 2017. This is because more thorough action plans were being produced when audits identified areas of improvements.

People told us they felt safe living and Fleetwood Hall and we received positive feedback from everyone except one person, which we shared at the time with permission.

People said there was enough staff, although there was still some dependency on agency staff for some of the shifts. Staff were recruited safely and checks took place on their character and suitability to work. incidents and accidents had been appropriately documented and a detailed analysis of the incident was completed by the manager.

Risk assessments were in place and contained detailed information with regards to the action the staff were expected to take to minimise the risk of harm.

The environment and equipment was safe and well maintained. There were compliance checks for gas, electricity and legionella and emergency evacuation plans were in place to ensure people were safe in the event of a fire. Medications were managed and administered safely. We raised that some creams, although they were being applied correctly, would benefit from being stored more securely in locked boxes.

The home had recently been audited by infection control and there were some actions points which required addressing. We viewed the action plan and saw that the registered provider had taken action to address most areas. Further improvements were being made to sluice areas.

There was an improvement plan in place to address some of the décor in the home, however, we saw that the unit for people living with dementia needing improving and we have made a recommendation about this.

People were being supported in line with the principles of the Mental Capacity Act. Best interest meetings were in place for people who required them.

Staff were trained and supervised in line with the registered providers policies and procedures. Some of the training percentages required improvement, however the registered provider had identified this on a recent audit and this was being addressed.

Most people told us they enjoyed the food and were offered a choice of food. People were screened for the risk of developing malnutrition and staff were keeping records in relation to this. We did raise that some records were incomplete, this was rectified on day one of our inspection.

People said the staff were caring, one person raised a concern which we followed up with permission at inspection. Care plans demonstrated people had been involved in them. People could choose how they spent their time at the home.

Care was personalised to suite people routines and choice. People were assessed before they moved into Fleetwood Hall.

Complaints were recorded, investigated and responded to in line with the registered providers complaints procedure.

There was no registered manager in post at the time of our inspection. The role had been temporally filled by the deputy manager, whom staff were complimentary about and said they felt happy to raise any concerns with them.

The registered provider showed openness and transparency regarding some of the ongoing improvements required at the service and there was a plan in place to address these. The service had improved since the last inspection and was not in breach of any legal requirements.

Rating at last inspection: Requires Improvement. Report Published 22 January 2018.

Why we inspected: This inspection was planned in accordance wi

This inspection took place on 22 & 25 January 2018.

Fleetwood Hall 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.

Fleetwood Hall accommodates 53 people across five separate units, each of which had separate adapted facilities. One of the units specialises in providing care to people living with dementia, and is split into a male and female side. The other unit specialises in supporting people with mental health needs, and is also split into male and female sides.

At the time of our inspection there were 43 people living in the home.

A registered manager was 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 home had a focused inspection in June 2017 to follow up on breaches from the previous comprehensive inspection. We found that the home had met the breaches however was still rated requires improvement. Following this inspection the home was rated as Requires Improvement overall.

This is the second consecutive time the service has been rated Requires Improvement.

Systems relating to governance arrangements were not always robust. We saw numerous incident forms and audits across the service provision which required further action to be taken which were not fully completed. This meant we could not always be sure who was responsible for overseeing that action plans were adhered to. We did see a new auditing system which had just been introduced which was more robust, however, that had not been implemented yet. Therefore, we could not check its effectiveness at this inspection. We spoke at length to the registered manager and director about this during our inspection.

There was a process in place to document, analyse and review incidents and accidents. We saw that the records were not always clear in relation to incidents and accidents and some of the information was missing. This made it difficult to see if patterns and trends had been identified. We have made a recommendation regarding this.

We saw that all checks on the environment were being completed. We did however receive a concern during our inspection that the key coded gate was not locked as it should be. On the second day of our inspection we saw that the gate was unlocked, so we raised this with the registered manager who took immediate action to rectify the problem.

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, some were due refreshers which were being booked. There was information around the home which described what people should do if they felt they needed to report a concern.

We discussed some recent safeguarding concerns with the registered manager to ensure that improvements had been made as a result of concerns raised. We saw some evidence that lessons had been learnt as a result of these.

Risk assessments were in place and were reviewed every month or when there was a change in people's needs. We saw risk assessments in place to manage people's mobility needs, falls, pressure areas, personal care and mental health and behaviour. Risk assessments were linked to an accompanying plan of care which was informative and fully described how staff were required to support the person.

We saw that rotas were fully staffed; however there was a heavy reliance on agency staff. The registered manager had a process in place to recruit new staff and we saw that some new staff were due to start working at the home. Most of the agency staff were used re

This unannounced inspection of Fleetwood Hall took place on 22 June 2016.

Fleetwood Hall is a large care home set in its own grounds on the outskirts of Southport. The home is registered to provide accommodation for up to 53 people across three units. The units include:

a mental health unit that can accommodate men and women (separately) with enduring mental health needs, a dementia care unit that can accommodate six men and women and a general nursing unit for up to 14 people, both men and women.

The service was last inspected in November 2016, and at that time was found to be in breach of regulations 12 and 11 relating to safe care and treatment and consent. We had also made a recommendation under the ‘well-led’ domain with regards to the effectiveness of quality assurance systems. Following the inspection the provider sent us an action plan detailing what action they were going to take to address the concerns we found. We checked this as part of this inspection.

This inspection was ‘focussed’ in that we only looked at the two breaches of regulations to see if the home had improved and the breaches were now met. We also checked if quality assurance procedures had improved. This report only covers our findings in relation to these specific areas / breaches of regulations. They cover only three of the domains we normally inspect whether the service is 'Safe' ‘Effective’ and ' Well led'. The domains ‘Caring’ and ‘Responsive’ were not assessed at this inspection.

During this inspection we found that improvements had been made and the provider had taken action to address the concerns raised at the last inspection. Care plans were easy to read and follow, and information was accurate, complete and up to date. Additionally, documentation around people’s capacity was updated and recorded. The registered manager had also attended an advanced course in the principles of the MCA (Mental Capacity Act). The provider was no longer in breach of these regulations. We checked the quality assurance procedure during this inspection to ensure its effectiveness had improved since our last 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.

At our last inspection in November 2016, the service was in breach of regulations in relation to safe care and treatment. This was because some records relating to people’s care and treatment were disorganised, missing, or lacked a sufficient amount of clinical detail about that person. After the inspection the provider sent us an action plan detailing what action they were going to take and we checked this as part of this inspection.

The records we saw during this inspection had been re-organised into coloured coded sections. This made it easier to find information. Care plans and risk assessments had also been recently reviewed. The provider was no longer in breach of this regulation.

At our last inspection in November 2016, the service was in breach of regulations relating to consent. This was because the registered manager did not have a full awareness of DoLs and any conditions on people’s DoLs were not being appropriately managed. Best interest processes were not being considered for some people who did not have capacity to make decisions around their care. Following our inspection the provider sent us a list of actions detailing what steps they were going to take to address this, and we checked this during our inspection. We found that sufficient improvements had been made, and the provider was no longer in breach of this regulation.

During our last inspection, we found that procedures relating to the governance of the service had improved enough for th

.This unannounced inspection of Fleetwood Hall care home took place on 15 and 17 November 2016.

The home was last inspected in March 2016 and judged as ‘inadequate’ overall and placed into ‘Special Measures.’ We identified eight breaches of the regulations. These were in relation to safe care and treatment, dignity and respect, staffing, person centred care, governance, complaints, safeguarding and consent. We imposed a condition on the provider’s registration to stop admissions into the home until the provider was compliant with the Health and Social Care Act 2008. This unannounced inspection took place to check if the provider had made enough improvements to enable us to remove the restriction on admissions to the home.

Fleetwood Hall is a large care home set in its own grounds on the outskirts of Southport. The home is registered to provide accommodation for up to 53 people across three units. The units include: a mental health unit that can accommodate men and women (separately) with enduring mental health needs, a dementia care unit that can accommodate six men and women and a general nursing unit for up to 14 people, both men and women

At the time of the inspection 26 people were living at the home.

A manager was present at the time of inspection but had not yet completed their registration with us. 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.

Care plans had been re-written and contained relevant information for most people, however we still found some inaccuracies in care plans where information was either incomplete or inaccurate. We spoke to the manager about this and they have assured us they were taking action to address this for everyone at the home. The provider was still in breach of regulation.

At the last inspection we raised concerns regarding the staffing levels in the home. The provider was in breach of regulations relating to this. Some people now told us that the use of agency staff had decreased in the last few months, and there was a more consistent staff team. Staff told us they felt there were sufficient numbers of staff available to be able to complete their roles effectively; we did not observe anyone being left waiting for assistance in any of the units throughout the day. The provider was no longer in breach of this regulation.

Previously we raised concerns about staff’s understanding of the Mental Capacity Act (MCA) 2005. At this inspection staff had a good understanding of the Act and associated principles. We found the provider had improved in this area however there were still some inconsistencies with how the MCA was applied. The provider was still in breach of this regulation.

During our last inspection we raised concerns around people’s dignity and safety. People living at the home and their relatives told us they now felt safe. The provider had made various improvements in these areas, which included separating the male and female units in the home to help protect people’s dignity. These units provided mixed accommodation at the time of our last visit.t. The women living on these units told us this segregation was better as they felt comfortable in their home and their dignity was protected. The provider was no longer in breach of this regulation.

At our last inspection we found that people were not always protected from abuse and the provider was in breach of regulations relating to this. We found that the procedure for reporting and acting on safeguarding’s had improved since our last inspection in March 2016. Records and certificates showed that all staff had completed training in this topic and were able to describe to us the action they would take if they felt someone was bei

This unannounced inspection of Fleetwood Hall care home took place on 9, 10 & 23 March 2016.

The home was inspected in January 2015 and judged as ‘inadequate’ overall. We identified eight breaches of the regulations. The provider (owner) agreed not to admit any people to the home while the breaches in regulation were being addressed. We inspected the home again in July 2015 and judged it as ‘Requires improvement’ overall. While significant improvements had been made since the inspection in January 2015, we did not revise the ratings for each domain above ‘Requires improvement’. To improve a rating to ‘Good’ would have required a longer term track record of consistent good practice. However, we did identify one breach of the regulations.

Fleetwood Hall is a large care home set in its own grounds on the outskirts of Southport. The home is registered to provide accommodation for up to 53 people across three units. The units include:

• A mental health unit that can accommodate men and women with enduring mental health needs

• A dementia care unit that can accommodate six men and women

• A general nursing unit for up to 14 people, both men and women

At the time of the inspection 33 people were living at the home.

A registered manager was 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.

Effective recruitment processes were in place to ensure new staff were suitable to work at the home. Staff told us they had not received supervision or an appraisal for some time. Staff training was not up-to-date.

Women told us they did not feel safe living at the home. They said they felt unsafe around some of the men. The previous separate male and female mental health units had been brought together and men and women were sharing the same lounge areas and bathrooms/toilets. Women told us they did not like sharing these facilities with men. Although signs were put on doors on the second day of our inspection to separate out male and female toilets, staff said some men may not adhere to this due to needs associated with memory. Staff told us some people stayed in their bedrooms because of other people living there who presented with unpredictable behaviour that was challenging.

The system to manage and monitor incidents was not robust, including the process for analysing incidents as it did not lend itself to the clear identification of any emerging themes. The incident monitoring system was not identifying the level of risk that we identified during the inspection.

There was limited understanding amongst managers, registered nurses and care staff about what constituted adult safeguarding. Training records showed the majority of the staff team were not up-to-date with safeguarding training. We found numerous incident reports that should have been reported as safeguarding concerns but had not. The adult safeguarding policy did not reflect local area procedures.

Registered nurses and care staff working on the units could not definitively tell us how many people were being lawfully deprived of their liberty. Staff had not received awareness training regarding consent and mental capacity. Mental capacity assessments were completed in a generic way and were not specific to the decision the person needed to make.

People living at the home told us there were not enough staff on duty at all times. Equally, visiting families and staff said there were insufficient numbers of staff on duty at all times to ensure people’s safety and to facilitate recreational activities. From our observations, we concluded there were not enough staff on the mental health unit at all times to sufficiently minimise risk.

The management of medicines was not robust and we

During the inspection we spent time with 11 people living at the home. They told us they were satisfied with the care and support they received at Fleetwood Hall. All the people we spent time with spoke positively about the staff and told us they felt valued, respected and well cared for. People told us staff respected their privacy and choices. A person told us, “I have a nice cosy room and can go to my room when I like. I have Sky Sports to watch.”

We observed that staff were attentive and responsive, interacting with people in a positive and meaningful way. There was a calm and relaxed atmosphere in the home throughout the inspection. One of the people living there told us, “It is a relaxed and chilled home.”

People’s care records informed us that individualised needs assessments, risk assessments and care plans had been developed. These were regularly reviewed to reflect people's changing needs.

There were sufficient numbers of staff available to support people with their individual needs.

Processes were in place for managing and responding to people’s concerns and complaints.

We spoke with six people on the younger adult unit and some people on the ‘nursing’ unit. We received positive comments about the care delivered. People spoken with confirmed they were encouraged to express their views openly. They said staff were friendly and always on hand to talk to. One person said. ''Staff help me to get out and about. They spend time and include me in trips out.''

People spoken with expressed the view they were treated with respect and dignity. They said their wishes were listened to. We saw that people [on the dementia care unit for example] were appropriately dressed and there was good attention paid to levels of personal hygiene, which helped to promote people's dignity.

We spoke with a social care professional who was involved in supporting a person in the home as well as a regular visitor from a local advocacy service. We received positive feedback from these people. One said, ‘’Initially there had been some problems with the care but the staff liaise well and these have been sorted out. They seem to be on top of things and are doing some good work with [person].’’

On the day of our visit we spent time observing the care and talking to people living in the home. Those people we spoke with said that staff supported them well. We saw there was good communication when staff carried out care.

We spent time on the younger adult women’s unit. People were relaxed and talked freely. We saw some positive interactions with staff and these were genuine and supportive. All of the people we spoke with on this unit said that they could talk to the staff who were available to listen.

We spoke with one person who said ''The staff look after me very well. They are helping me to sort out my money and are talking to my social worker. My social worker reviews my care every week.''

Another person who had recently received treatment in hospital told us, ‘’Staff came with me to my appointments. I attend physiotherapy and the staff make sure I get there.’’

We saw that three of the people on the unit were going out for a trip to town. One said, ‘’We go to the park and to the shops. The staff are organising a barbeque for the weekend.’’

All of the people we spoke with said they were regularly seen by the doctor and other care professionals such as community nurses and social workers visit to carry out reviews. One person told us they had been ill for a few days and the staff had spoken with the doctor and arranged an appointment. This showed the home was responsive to people's care needs.

We spoke with a person on another unit who told us they had chosen not to leave their room and preferred not to join in with the activities provided. Sometimes they felt a bit isolated and lonely and would prefer other activities if these could be provided. When we looked at care records they did not include reference to this particular care need or an assessment of the person’s mood. This was reported back to the unit manager who assured us this would be addressed.

Those people spoken with were very relaxed around staff and said they were listened to, so any concerns could be addressed. Observations at the time of our visit were that staff interacted with people living in the home in a positive and supportive manner. People, when asked, said that they felt ‘safe’ and they were confident any concerns would be listened to and addressed.

People told us that they are consulted about their care and about aspects of the running of the home. Interviews confirmed that the general running of the home is consistent. The people living at Fleetwood Hall told us they had a say in recent developments of the units as well as personalising their bedrooms and choosing décor. One person we spoke with said ‘’ I was able to choose the décor for my bedroom and also get some furniture which I liked.’’

People told us they were encouraged to express any views they had. They said their views were considered as part of the decision making process about the care and treatment they received.

Many expressed the view that they felt like they were treated with respect and dignity. Those spoken with said that the staff are both competent and respectful in terms of any privacy and dignity issues.

People confirmed their wishes were listened to. One person said they felt very free in terms of being able to come and go from the home and safe in the knowledge staff were available if necessary to assist them.

For a short period of time we observed staff interactions with residents who have dementia. We saw good examples of staff talking to and supporting residents but this was inconsistent. During the time of our observation, we saw one resident not supported appropriately by staff.

We discussed consent and people told us that the staff asked for their consent for care and treatment. Generally they spoke positively about how staff included them in the care and confirmed that staff asked for their consent to care and treatment as required. A relative spoken with said that they had been kept updated about recent changes in their relatives care and their views had been sought so that decisions could be made in the persons best interests. This helped confirm that the home was good at explaining and involving the person in any decisions made about planned treatment.

The dependency of people living in the home can be very high and care needs vary across the different units. Those people we spoke with said there was good communication and staff were very competent when carrying out care and using equipment.

Generally people were relaxed and talked freely. One person was clearly not well but was being monitored well by staff who had also called the GP to attend. Staff were knowledgeable regarding this persons care needs. We spoke with one person who said ‘The staff look after me very well. They are very kind’.

We spoke with a visitor who said that they are always kept informed about any changes in the care and any events such as a fall would be reported to them very quickly. This shows that the home is responsive to people’s care needs. Residents, when asked, said that they felt ‘safe’ and they were confident that any concerns would be listened to and addressed.

People told us that they are consulted about their care and about aspects of the running of the home. Interviews confirmed that the general running of the home is consistent. The people living at Fleetwood hall told us they had a say in recent developments of the units as well as personalising their bedrooms and choosing décor [for example].

.

This unannounced inspection of Fleetwood Hall care home took place on 25 June and 27 July 2015. The home was inspected in January 2015 and judged to ‘inadequate’ overall. We identified eight breaches to the regulations. The provider (owner) agreed not to admit any people to the home while the breaches in regulation were being addressed.

Fleetwood Hall is a large care home set in its own grounds on the outskirts of Southport. The home is registered to provide accommodation for up to 53 people across four units. The units include:

• Female unit that can accommodate 14 women with mental health needs
• Andrew Mason Unit - a male unit than can accommodate 14 men with mental health needs
• Dementia care unit that can accommodate six people
• A general nursing unit for up to 14 people.

At the time of the inspection 27 people were living at the home.

A registered manager was not 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 staff we spoke with could clearly describe how they would recognise abuse and the action they would take to ensure actual or potential abuse was reported. Staff we spoke with confirmed they had received adult safeguarding training. An adult safeguarding policy was in place for the home and the local area safeguarding procedure was also available for staff to access. A member of staff said to us, “It is my responsibility to ensure people are treated with dignity and respect. If they are not it is my job to report to the nurses and management on duty.”

The approach to recruitment of staff was not robust. There was no information in any of the personnel records we looked at to suggest the applicant’s competence, skills and experience for the role had been checked. There was no record maintained of how the applicants performed at interview. You can see what action we told the provider to take at the back of the full version of this report.

People living at the home, families and staff consistently told us there was sufficient numbers of staff on duty at all times.

Staff told us they were well supported through the induction process, regular supervision and appraisal. They said they were up-to-date with the training they were required by the organisation to undertake for the job. There were some gaps in the training records but we were provided with assurance that further training had been planned.

A range of risk assessments had been completed depending on people’s individual needs. Care plans were well completed and they reflected people’s current needs. Risk assessments and care plans were reviewed on a monthly basis or more frequently if needed.

Processes were in place to ensure medicines were managed in a safe way. We observed medicines being administered safely. Audits or checks were in place to check that medicines were managed safely.

An extensive refurbishment of the building had taken place. The building was clean, well-lit and clutter free. New fixtures, fittings and equipment had been purchased. People living at the home had been involved in choosing themes and colours for the different units. Measures were in place to routinely monitor the safety of the environment and equipment. The dementia care unit had been decorated and organised in accordance with the principles of a dementia-friendly environment.

People’s individual needs and preferences were respected by staff. They were supported to maintain optimum health and could access a range of external health care professionals when they needed to.

Staff worked closely with local primary care and specialist health care services, such as the GP and community mental health teams. People were supported at access health care services when they needed it.

People living at the home were satisfied with the food and choice of meals. Visitors too were pleased with the quality and choice of food. They said their relative or friend’s dietary needs were being met.

Applications to deprive people of their liberty under the Mental Capacity Act (2005) had been submitted to the Local Authority. Some people had a deprivation of liberty safeguard (DoLS) plan in place. Staff sought people’s consent before providing routine support or care. Consent for more complex decisions was not obtained in accordance with the principles of the Mental Capacity Act (2005). We made a recommendation regarding this.

Staff had a good understanding of people’s needs and their preferred routines. Overall, we observed positive and warm engagement between people living at the home and staff throughout the inspection. A full and varied programme of recreational activities was available for people to participate in.

The culture within the service was and open and transparent. Staff were pleased with the improvements that had been made. They said the service was well led and well managed.

Staff and visitors said the management was both approachable and supportive. Staff felt listened to and involved in the running of the home.

Staff were aware of the whistle blowing policy and said they would not hesitate to use it. Opportunities were in place to address lessons learnt from the outcome of incidents, complaints and other investigations.

A procedure was established for managing complaints and people living at the home and their families were aware of what to do should they have a concern or complaint.

Audits or checks to monitor the quality of care provided were in place and these were used to identify developments for the service.

While significant improvements had been made since the inspection in January 2015, we have not revised the ratings above ‘Requires improvement’. To improve the rating to ‘Good’ would require a longer term track record of consistent good practice.