Gordon House is a purpose built residential care service providing accommodation and nursing care for 20 people. The service provides rehabilitative care for people with severe and enduring mental health illnesses. At the time of our inspection there were 17 people using the service. The service was situated near to local amenities and had a well-maintained enclosed garden to the rear.

Gordon House is a ‘care home’. People in ‘care homes’ receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

This was an unannounced inspection which took place on 9 July 2018. The last inspection was in June 2015 when the service was rated as ‘Good’.

The service had a manager in post who had made an application to CQC to become registered. A registered manager is a person who has registered with CQC 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 we rated the service ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We found that staff’s suitability to work with vulnerable adults at the service had been checked prior to employment. For instance, previous employer references had been sought and a criminal conviction check undertaken.

Staff had received training which equipped them with the knowledge and skills to ensure people received adequate care. Staff had also received more specific training to meet the needs of people living with mental health illnesses.

Medication was managed safely and was administered by staff who were adequately trained. People who wished to self-medicate were supported by staff to do so safely, this helped to promote their independence.

Appropriate arrangements were in place for checking the environment was safe. For example, health and safety audits were completed on a regular basis and accidents and incidents were reported and recorded appropriately.

Care records contained detailed information to identify people’s requirements and preferences in relation to their care. People we spoke with told us that they had a choice in how they lived their lives at the service.

Quality assurance processes were in place to seek the views of people using the service and their relatives.

Staff sought consent from people before providing support. Staff we spoke with understood the principles of the Mental Capacity Act 2005 (MCA) to ensure people consented to the care they received. The MCA is legislation which protects the powers of people to make their own decisions.

People were involved in their care and there was evidence in their care records to show that they had been consulted about decisions. People’s hobbies and interests were recorded and catered for. For example, one person enjoyed horse riding and the home had supported him with visits to the stables.

A ‘community connections worker’ was employed by the service to support people take part in activities in the local community. For example, people were supported with attending health care appointments, this helped to promote people’s wellbeing. Some people were also supported with further education and attended computer courses.

We asked people about how they thought the service was managed and their feedback was positive.

This unannounced inspection was conducted on 16 May 2016.

Situated in North Liverpool and located close to public transport links, leisure and shopping facilities, Gordon House is registered to provide accommodation for up to 20 younger adults with severe or enduring mental health conditions. At the time of the inspection 18 people were living at the home. The location is a purpose-built, single storey property with single bedrooms and shared bathroom facilities.

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; however operational management responsibilities were shared with a colleague who was available throughout.

All of the people that we spoke with told us that they felt safe living at Gordon House. We saw that people were kept safe because staff were vigilant in monitoring behaviours and indicators of abuse.

People living at the home had detailed care plans which included an assessment of risk. These were subject to regular review and contained sufficient detail to inform staff of risk factors and appropriate responses. In the care records that we looked at risk had been recently reviewed.

Throughout the inspection we saw that, in accordance with their care plans, people were free to leave the building and return as they chose. There was no requirement for people to sign in or out of the building or inform a member of staff. This meant that staff could not be certain who was in the building at any given time.

The home had conducted regular fire drills and testing of fire alarms and other emergency equipment. Emergency equipment was serviced annually in accordance with requirements. The fire risk assessment had been reviewed annually. Safety checks were also completed regularly on water temperatures, legionella and gas and electrical safety.

Staffing were recruited safely and deployed in numbers which were generally adequate to meet the care needs of people living at the home. However it was apparent that people were left without obvious access to staff support at various points throughout the inspection.

People’s medication was stored and administered in accordance with good practice. We spot-checked medicines administration records and stock levels for each of the people living at the home. We saw that records were complete and that stock levels were accurate.

Staff were suitably trained and skilled to meet the needs of people living at the home. The staff we spoke with confirmed that they felt equipped for their role. The training matrix and staff certificates showed that training was in date.

The records that we saw showed that the home was operating in accordance with the principles of the MCA. Capacity assessments were decision-specific and were focused on the needs of each individual. None of the people living at the home at the time of the inspection was being deprived of their liberty although staff demonstrated that they understood the MCA and DoLS well.

Food was prepared from fresh ingredients, well presented and nutritionally balanced. People’s preferences, allergies and health needs were recorded and used in the preparation of meals, snacks and drinks.

The people that we spoke had a good understanding of their healthcare needs and were able to contribute to care planning in this area. All staff spoke of having good links with community mental health teams, crisis services and psychiatrists and there was evidence seen in the care records of regular meetings taking place with the views of the person clearly recorded.

Throughout the inspection we saw staff engaging with people in a positive and caring manner. Staff

During our inspection visit we spoke with three people who used the service. We also spoke with three members of staff who held various roles within the service. We looked at care files belonging to two people who used the service and we viewed the smoking policy and procedure. People told us they were aware of the smoking policy and that information had been given to them both verbally and in the form of a letter. We observed the smoking policy being followed.

People told us they were happy at Gordon House and were very positive about the support provided by staff. Comments included, "Staff listen to you and will acknowledge the difficulties you are having" and "You can relax here, I feel safe and trust the staff." People told us that staff were responsive to changes in their health and that staff supported them to be as independent as possible.

During our inspection we observed care plans for all people using services were present which ensured care and treatment was delivered in line with their assessed needs. We observed consent being sought on a continual basis around Gordon House particularly when medication was being administered. Continual engagement between staff members and people using services was observed, one of whom commented "it`s good here, the staff are really nice". Medication was stored securely and appropriately with all records up to date and was always administered safely by trained senior staff who always sought consent from people using services. Our inspection at Gordon House in October 2013 identified several people who, despite being told repeatedly by staff members to stop, continued to smoke in their rooms. It was reported by a member of staff that one person had been observed smoking in the dining room. We have taken action against the provider for failing to meet this essential standard which would have protected the health, safety and welfare of all people using services.

The staff members on duty during our visit had many years experience between them which provided them with the right competencies, skills and knowledge to meet the needs of people at the care home. Although the complaints log could have been organised better, people using services and staff were well aware of the process for making and recording complaints and how to escalate unresolved issues.

We spoke with many of the people who were living at the home and their feedback was positive in all aspects of their support. People's comments included;

"I like it here, I feel safe"

“It’s really good here, everybody is nice and there’s a relaxed atmosphere”

“It’s a great place”

People described staff as being supportive and they told us they felt confident that staff would get them the support they needed if they were feeling unwell or they needed medical attention.

People told us they felt confident to talk to staff if they had any concerns about their care and they told us they felt safe living at the home. People told us that they go out on a regular basis.

People told us they felt well supported by staff and that they were respectful towards them. One person commented "The staff would do anything for you’" and another person said "Staff are great here".

We asked people if they had any complaints about the service and people told us that they didn't. People told us they would feel confident to raise a complaint if they had reason to.

People told us they were happy with the home environment and the quality of furnishings provided in their own rooms and in communal areas.