The inspection took place on 27 February 2018 and was unannounced. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question, is it safe? to at least good.”

Galtee More provides accommodation for people with a learning disability who require support with personal care. There were 11 people living in the home at the time of our 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.

Galtee More accommodates 15 people in one building. Due to its layout the building does not have a passenger lift. There is ramp access to the front of the home. Bedrooms are situated over four floors. Most bedrooms are of single occupancy, some with en-suite facilities. There is a walk in bath and a shower room available for use. The home is within walking distance of the town centre and just off the promenade. Transport links to nearby towns are within easy reach.

Galtee More 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.

“The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy. At Galtee More many of the people living in the home have lived there together for over 12 years, some as many as 30 years. Galtee More is their home. They access their community and its facilities through socialising, activities and work/volunteering opportunities. People are very much a part of the community. Some people have family members and friends who live locally and visit them.

Risk assessments had been undertaken to support people safely and in accordance with their individual needs. They were regularly updated to reflect any changes in people's needs.

Medicines were safely stored and administered in accordance with best practice. Staff were trained in the administration of medication. The records that we saw indicated that medicines were administered correctly and were subject to regular audit.

The registered provider had robust recruitment procedures in place to ensure staff were suitable to work with vulnerable adults. There were enough staff on duty to provide support to people living in the home.

Staff had completed training in safeguarding vulnerable adults and were aware of the action they would take to ensure actual or potential harm was reported.

Safety checks of the environment and equipment were completed regularly. The home was odour free, clean and hygienic.

Staff were trained and supported by the service to ensure that they had the right skills and knowledge. They had completed a range of training courses relevant to the needs of people living at the home. We saw that staff received training regularly and that this was up to date.

Staff spoke positively about support they received from the registered manager and the registered provider. Staff we spoke with confirmed they had completed a period of induction when they commenced their employment, which included a number of ‘shadow shifts’. This enabled them to familiarise themselves with the people who lived in the home and their support needs. From the records we looked at we saw that staff received regular supervision and annual appraisals.

The service operated

This inspection took place on 6 February 2017 and was unannounced.

Galtee More is a residential service which provides accommodation and personal care for a maximum of 15 people with learning and physical disabilities. At the time of the inspection 12 people were living at the service. The majority of the people living at the service at the time of the inspection were semi-independent and did not require intensive care and support. The service is based in a property near to the town centre of Southport.

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 registered manager was not available on the day of the inspection, but was contacted on their return to provide additional evidence.

Risk to the people living at the service was not always appropriately assessed and recorded in care records. Risk had not been consistently reviewed following significant incidents which placed people at unnecessary risk of harm. We found a breach of regulation in relation to this.

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

We spot-checked medicine administration records (MAR) for three people and saw that they had been completed correctly. We checked stock levels for three medicines and found that they were accurate. However, we saw that one person’s medicine had been relocated within their blister pack following a dispensing error. We made a recommendation regarding this.

The service was not assessing people’s capacity to make decisions about their care in accordance with the Mental Capacity Act 2005. People’s consent to various aspects of their care had been sought and recorded on their care files. However, capacity assessments recorded in care files were generic and did not take account of people’s capacity with regards to specific aspects of care. We made a recommendation regarding this.

The service had a set of policies and procedures which were used to inform staff of standards and expectations. Staff had signed to indicate their awareness and acceptance of the policies in August 2016. The policies had been reviewed in 2015. However, we saw that some policies required further development to ensure that they were complete and reflected best practice. We made a recommendation regarding this.

The registered manager completed their own regular audits which covered; care plans, reviews, complaints, medicines and rotas. However, they had not identified any deficits in the risk assessments or practice in relation to the MCA previously mentioned. We made a recommendation regarding this.

Accidents and incidents were recorded and assessed by the registered manager. However, there was no process in place to allow for effective evaluation and to look for patterns or triggers.

Staff were recruited subject to the completion of appropriate checks. This included a requirement for two references and a Disclosure and Barring Service (DBS) check. Staff were deployed in sufficient numbers to keep people safe and provide effective care and support.

The service had processes to monitor safety and employed external contractors to service and check; gas safety, electrical safety and fire equipment. We saw checks had been completed in each area within the previous 12 months. The service had a general evacuation plan in place and tests on emergency equipment were conducted and recorded regularly. People also had a personal emergency evacuation plan (PEEP).

Staff had the skills and knowledge to meet the needs of the people living at the service. Staff were required to complete a programme of training which included; administration of medicines, people handling and adult safeguardi

We found that people's views were taken into account in relation to the way the service was delivered. People we spoke to said "I love it here I am never moving again." and "all the staff here are friendly and help me". We observed good rapport between people and staff.

People were supported to be involved in the community and to enjoy hobbies that were important to them. Staff we spoke to had an in-depth knowledge of people's preferences and this was supported in conversations with people who used the service and in the documentation we viewed. People told us that there were a wide range of activities that they were able to participate in if they wanted to. On the day of our visit we observed people being able to participate in things that were important to them.

People using the service had received a thorough needs and staff were able to tell us what people's needs were. Documentation supported appropriate escalation of health needs to community services.

There were sufficient staff to support people with the activities that they wanted to undertake. Staff were trained appropriately and had opportunities to access further training.

People living in the home that we spoke with told us they were fully involved in deciding what care and support they required and how and when this would be provided. People spoke positively about the care they received. A person wrote in a recent survey, ’Staff help me to have a happy and comfortable life doing the things I want to do.’

We looked at four care records of people living in the home and saw that up to date person centred care plans were in place, which supported staff to be able to deliver the care required.

Staff we spoke with had an in-depth understanding of people’s needs and preferences. The atmosphere in the home was calm and relaxed. We spoke with relatives who told us that they were very satisfied with the care provided and that they had confidence in the home.

We looked at medication administration records for people living in the home and found that they were complete, signed and dated. Daily medication checks were carried out and stock was checked each month prior to ordering and on receipt of people’s medication.

People we spoke with told us they felt confident that the home listened and acted upon any concerns they had. We saw the home’s handbook for people which they signed to say they had read. This included information about how to raise any concerns and we saw that the home had used visual information to support people in understanding the process.

During our visit to this service we were able to talk with a good number of people living there. Everyone we spoke with told us they felt safe and gave us very positive comments about what it was like living at Galtee More.

People told us they were very happy with all aspects of the facilities and services provided, including the food served, care they received and attitude of all staff members. They said they were respected as human beings and their privacy and dignity was always promoted.

People living at the home told us their needs were being met by the staff team. They also explained how they were supported to maintain their independence and how medical assistance was always sought if they were not well.

Comments from people living at Galtee More included:

"I like everything about it here, the food, the staff, my room, the things I do, my pocket money. It's fantastic. I wouldn't want to be anywhere else."

"There is no place in the land like Galtee More. I will never move anywhere else again."

"It is just like a hotel living here."

An announced inspection took place on the 18 and 19 November 2014.

Galtee More Rest Home is a terraced property, situated in the town centre of Southport, Merseyside. It is located close to public transport links, leisure and shopping facilities. The service is owned by Mr John Campbell & Mrs Ellen Mary Campbell. The home provides accommodation for up to 15 people with a learning disability or autistic spectrum disorder who require support with personal care. During our visit there were 14 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.

People living at the home were kept safe from abuse because the staff understood what abuse was and the action they should take to ensure actual or potential abuse was reported. People told us they felt safe.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults.

Family members told us the home communicated well with them and they were kept informed of any changes regarding their relative’s care needs. People were able to see their families and friends when they wanted.

People were supported by external health and social care professionals to maintain their health and wellbeing. We saw referrals to external professionals had been made at the appropriate time. Health professionals we spoke with were complimentary regarding the care and support people received.

Health plans were in place and these included associated risks with people’s medical conditions and how to safely support them.

People told us they received their medication at a time when they needed it. We observed that medication was administered to people in a safe way. For people who administered their own medicines, this practice had been risk assessed to ensure people were able to undertake this practice safely.

Throughout the inspection we observed warm positive interactions between the staff and people they supported. There was a genuine sense of the staff caring about each person and this had a positive effect for people.

People were comfortable and relaxed with the staff. There was plenty of chatter and laughter and throughout our visit people were treated with respect. Staff supported people in a discreet and sensitive way, which ensured people’s safety whilst maintaining a good standard of dignity. People who lived at the home and their family members told us the staff were polite and caring.

People we spoke with told us the home offered them independence to carry on with their chosen social interests and activities.

We observed the lunch time meal. This we found to be a very pleasant experience. People required little support with their meals however staff made sure they had time to enjoy their lunch and they checked to make sure the meal was to their liking.

The menus were displayed and offered a good choice of hot and cold meals. The menus were also in pictorial format for people to see what the meals looked like. People told us they were able to choose what they wanted to eat.

At the time of our visit sufficient numbers of staff were available to support people. This was confirmed when talking with people. Staff were skilled and trained to provide care to people at the home. Staff told us they received good training and support from the registered manager. We saw staff were supported through induction, team meetings, supervision and appraisal.

The registered manger and staff had a good knowledge of the principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). 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 unless it is in their best interests.

People who lived at the home and their family members were able to give feedback about the home through meetings and day-to-day discussions.  Satisfaction surveys were also distributed to seek formal feedback from people and their family members. Positive comments had been received.

We looked at how the how the quality of the service was checked. We saw a number of weekly and monthly audits or checks on the service. These included health and safety checks of the environment. These checks helped monitor the service provision, identify potential risks and to drive forward improvements.

A service user guide provided information about the service. The registered manager sends statutory notifications to us to identify key events in the home.

The overall management of the service was effective and the registered manager demonstrated good leadership skills. It was evident that staff and home owner respected and valued the people they supported.

Staff told us there was an open culture and they would not hesitate to speak up if they thought any person was being placed at risk or if they required some further training to support people. A process was in place for managing complaints and the quality of care was monitored to ensure it was safe and in accordance with people’s individual care needs.