About the service:

Halton View Care Home is a purpose-built residential care home providing personal care and accommodation for 64 older people. At the time of the inspection 49 people resided in the home.

People’s experience of using this service:

People were positive about living at Halton View Care Home and were complimentary about the staff who cared for them.

There were sufficient staff to meet people’s needs. Staffing levels had improved since our last visit and there was less dependency on agency staff. Which meant that people were supported by staff known to them.

Relatives told us that they were satisfied with the care their loved ones received.

Care and support was not always tailored to each person's needs and preferences, specifically around activities.

Appropriate recruitment checks were carried out to ensure staff were suitable to work in the care environment.

Improvements were evident that medicines were managed better in the home.

Risks were identified and managed to minimise harm.

Staff had not received regular training and improvement was needed to ensure that staff were working in line with current guidance and best practice.

The home complied with the principals of Mental Capacity Act 2005 (MCA), measures were in place to ensure consent to care and treatment.

People were satisfied with the food available. Menus offered choice on a daily basis.

People were well cared for by staff who treated them with respect and dignity. People were supported by staff who knew them well.

Systems were in place for people to raise complaints and concerns. People told us they knew how and to whom they should complain.

Overall we received positive comments to the recent changes in the management structure at the home from residents, staff and relatives.

More information is in the full report.

Rating at last inspection:

Requires Improvement (report published 24 May 2018) This is the second time the service has been rated Requires Improvement.

Why we inspected:

This inspection was brought forward due to information of risk or concern. The rating remains requires improvement.

Follow up:

We will continue to monitor any intelligence we receive about the service until we return to visit in accordance with our inspection schedule. If any concerning information is received we may inspect sooner.

This comprehensive inspection took place on the 22, 23 January and 13 March 2018.The first and third days were unannounced, the second was announced.

Halton View Care Home is a purpose-built residential care home providing personal care and accommodation for 64 older people. It is a two storey building comprising of 64 single bedrooms located within three separate units, all having en-suite toilet and shower facilities. There is a range of communal spaces including lounges, dining and sitting areas. Toilet and bathroom facilities are dispersed throughout the building.

At the time of the inspection there were 62 people living at Halton View. The accommodation was split into a residential unit on the ground floor and male and mixed units accommodating people living with dementia on the first floor. There were twenty eight people living in the residential unit, 23 living in the mixed unit and 13 living in the male unit.

The service did not have 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. Previous registered managers had not completed the process of de-registration however were no longer employed by the service. A new home manager had recently been appointed but had yet to begin their application to become the next registered manager.

We identified three breaches of relevant legislation, in respect of safe care and treatment, staffing and governance.

Overall people and relatives we spoke with were positive about the care and support they received at Halton View and spoke favourably about the staff. We observed many caring interactions although we saw one member of staff supporting a person whilst using their mobile phone. This was brought to the attention of the regional manager who advised they would address this with the staff member concerned.

We found that sufficient numbers of staff had not been deployed by the registered provider, particularly in one area of the home. This impacted upon the care that people received and the level of supervision and monitoring of support needs that staff were able to achieve. Although a dependency tool was used to determine staffing needs, we saw that this did not take into account the level of supervision that was needed and therefore, we queried the accuracy of the outcome.

We found shortfalls in the safe management of medicines. We saw that there were occasions when stocks had been allowed to run out or staff could not locate them, which meant that people did not receive their medicines as prescribed.

Although the home was visibly clean and tidy some areas were malodourous. This had improved on the final day of inspection but remained an issue. The service was working with the local infection prevention and control team to manage this issue who made a recommendation to install impermeable flooring had been made.

We saw that staff did not always follow guidance given by external professionals and risk assessments to mitigate risks, for example for a person who was at risk of choking.

The registered provider followed safe recruitment procedures to ensure that people employed were suitable to work with adults at risk of harm or abuse. Staff had received training and demonstrated an understanding of their responsibilities with regard to reporting abuse and whistle-blowing.

Arrangements were in place for checking the environment at Halton View to ensure it was a safe place for people to live. We spot checked safety certificates and found these were up to date.

People, visitors and staff felt that staff had received the training needed to deliver care that was effective. Communication, staff supervision, appraisal and meetings had improved since the appointment of

This inspection of Halton View took place on 1 and 3 August 2017 and was unannounced.

There was no registered manager at the time of our inspection. The service employed a manager who had applied for registration with the Care Quality Commission. 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.

Halton View Care Home is a purpose-built residential care home providing personal care and accommodation for 64 people. At the time of our inspection there were 63 people living at the home. It is a two-storey property comprising of 64 single bedrooms located within four separate units, all having en-suite toilet and shower facilities. There is a range of communal spaces including: lounges; dining rooms and sitting areas. Toilet and bathroom facilities are dispersed throughout the building. There is a car park provided for visitors and staff.

We last inspected Halton View in January 2016 and rated the service ‘good’ in all domains and ‘good’ overall.

We received some information of concern from the Local Authority with regards to a serious incident at the home where a person fell and passed away a short time later in hospital. The feedback we received from the Local Authority and our own requests for information indicated that we would need to go and inspect to ensure other people living at the home were not at risk. We wanted to examine what strategies were in place to monitor and supervise people who were at risk of falling to ensure that other people living at the home were kept safe. We also wanted to check whether the staff numbers were sufficient to support people and whether staff had received the necessary induction to enable them to fulfil their roles effectively.

This inspection was 'focused' in response to concerns in that we only looked at two domains; Safe and Well-led. The domains ‘Effective’, 'Caring' and 'Responsive' were not assessed at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Halton View Care Home’ on our website at www.cqc.org.uk.

During this inspection we found that the service was meeting the needs of people and was keeping people safe from harm specifically in relation to falls prevention although record keeping did not always reflect this. The service had taken positive steps to improve their risk management practices following the above serious incident.

On this inspection, we saw that many people living at Halton View were mobile with the assistance of an aid and therefore we considered that they were more susceptible to accidental falls. We found that the service had taken appropriate measures to mitigate this risk as far as possible and that people who were in danger of falling had the necessary risk assessments in place. However, we found that records were not always accurate and meant that the level of risk was not always captured correctly. We have made a recommendation about this.

People we spoke with told us they felt safe living at Halton View. People told us and our observations confirmed, that there were sufficient numbers of staff on duty to meet people's needs.

We saw evidence of good quality assurance procedures which had been developed to meet the needs of the service. The service was able to evidence a series of robust audits carried out by the area manager to monitor and improve standards in the home.

The manager had notified the Care Quality Commission (CQC) of events and incidents that occurred within the home in accordance with our statutory requirements.

The inspection took place on 13 and 14 January 2016. This inspection was unannounced. The last inspection of this home was carried out on 7 May 2014 when it was found to be meeting all the regulations we inspected.

Halton View Care Home is a purpose-built residential care home providing personal care and accommodation for 64 older people. It is a two-storey property comprising of 64 single bedrooms

located within three separate units, all having en-suite toilet and shower facilities. There is a range of communal space's including: lounges; dining rooms and sitting areas. Toilet and bathroom facilities are dispersed throughout the building. There is a car park provided for visitors and staff.

The home was divided into three units. The ground floor unit accommodated 28 people. The upper unit had two separate units; a male only unit which was equipped to accommodate 13 people and a further unit which accommodated up to 23 people who were living with dementia. At the time of the inspection there were 61 people using the service.

There is a registered manager at Halton View. 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 saw that care records contained care plans and assessments pertaining to health and well-being, these were individualised depending on need.

People were actively supported to access the community. The home arranged for people to be involved with community activities as part of their daily living skills.

Staff understood the Mental Capacity Act 2005 (MCA) regarding people who lacked capacity to make a decision. They also understood the Deprivation of Liberty Safeguards (DoLS) to make sure people were not restricted unnecessarily.

We saw that staff supported people and we saw caring interventions. Staff told us that they observed people’s body language and facial expressions to support their communication.

Staff told us that management was approachable and would listen to the concerns of staff and take necessary action if required.

One visiting heath care professional told us that staff contacted them when they had any concerns about people’s health. They said that staff took notice of any advice given and acted on it with immediate effect.

Recruitment practices were thorough, appropriate and safe. Rigorous pre- employment checks ensured that only suitable people were employed. Staff training was up to date and staff received supervision and appraisals.

Relatives told us that their family members had the correct level of well trained staff supporting them. We reviewed the most recent staffing rotas. There were sufficient staff on duty to meet the assessed needs of the people who currently lived in the home.

We saw that the service assessed peoples’ nutritional needs and had developed a varied menu. People told us that the food was good, not too fancy- but very tasty.

The registered manager had robust systems in place to monitor the quality of the staff and the services provided.

We undertook an inspection of Halton View care home on 7th May 2014.

During the inspection we spoke with the registered manager, twelve staff, seven relatives and a health care professional. We also spoke with fifteen of the people who used the service and encouraged each individual to communicate using their preferred method of communication. We observed people using a system called a Short Observational Framework of Inspection (SOFI). This process helps us gather information where people using services cannot verbally communicate with us.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

Policies and procedures had been developed by the registered provider to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). We were informed that a small number of people using the service had been assessed as lacking capacity to make decisions although no applications had needed to be submitted to ensure that people's rights were protected. Training records highlighted that the majority of staff had completed Mental Capacity Act training. They had also been provided with Deprivation of Liberty Safeguards training. This has been a useful way to increase staff knowledge and understanding of these issues. Examination of records and discussion with staff confirmed staff had been provided with lots of training and support to enable them to provide safe needs led care.

Is the service effective?

Feedback received from people using the service was generally positive and confirmed people were happy with the standard of care provided. Comments included: "Staff ask us what we want and take notice of our comments"; "I am very happy here, it's almost as good as my home and I know exactly what my care involves". We spoke with several relatives of people who lived at Halton View and they told us that they had been involved in the assessment process and had been able to influence, via discussion and sharing of information, how people received their care and support. Three people told us they had visited four care homes before making the decision to "choose Halton View". They told us that they had been given lots of information about the home; the staff and services provided and felt the home had "a very nice atmosphere".

Is the service caring?

We spoke with fifteen people who lived in Halton View and asked them what they thought about the staff and services provided. Comments were positive and included; "Staff are wonderful and treat us well"; "Staff make me feel very much at home here" and "The care and support we get is second to none". We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. People looked clean and well cared for. We saw care staff interacted well with people, were warm, supportive and sat and talked with people, when possible.

Members of the staff team spoken with demonstrated a clear understanding of people's care needs and their role and responsibility to maintain their safety. People we spoke with during our inspection told us that communication with staff at the home was "very good" and the care and treatment for people living at Halton View was carried out promptly and efficiently. We observed staff providing care and support to people in a caring and dignified manner.

Is the service responsive?

Staff meetings were held on a regular basis and staff were encouraged to speak their mind about any issues or areas of concern.

Each care plan we looked at was reviewed every month and provided people or their relatives with the opportunity to make comments or suggest changes about how their care was provided. This showed us the provider consulted with people at regular intervals to ensure the service was responsive to any concerns or changing needs.

Is the service well- led?

We noted that a number of audits were carried out on a regular basis. We looked at the audits file and saw that they included checks on cleaning, infection control, fire safety, water temperature and wheelchair safety and were being carried out on a regular basis, issues had been recorded that were then addressed and actioned.

We noted good interactions between staff during the inspection and were told that the manager was very good and led by mutual consent. The provider informed us that they had worked hard to establish a well-managed service and although it had taken some time the home now had a very good reputation. Feedback from local contracts and commissioning officers confirmed this and they also made positive comments about the robust management of the service.

This report shows that Halton View Care Home is registered as a nursing home when in fact it is a care home only. This is an administrative error which is being addressed as a separate issue..It has no impact on the service being provided at the home.

to alWe saw that all of the people living at the service were clean and well presented.

There were no malodours, bedrooms were decorated with each individuals personal effects and the furnishings and decor were to a good standard. The paved garden areas provided areas of shade and colourful flower displays that people who lived at the service helped to look after.

We spoke with people who lived at the service, family members and staff. Most people that we spoke with were positive about the provider, the care provided and the staff. Comments from the people we spoke to included, ''The staff are very good and they fit in with my relatives routines and wishes'' and ''The staff have supported me through a family bereavement and are very understanding.'' We saw that staff interacted well and supported people living at the service with dignity and that they interacted well with visitors and each other.

Two people living at the service told us that it was often noisy during the night. We passed this comment to the provider who told us that they would look into the matter.

Staff members told us they received training and support low them to provide a good quality of care for the people living at the service.

We carried out this inspection with the assistance of an ‘Expert by experience’. Experts work for voluntary organisations and may have direct experiences of the services we regulate. They talked to people living at the service and their families to gain their opinions of what Halton View was like.

People living at the service and their relatives made overall positive comments. They used words to describe the service such as:

“Its top class, they can’t do enough for you”;” It's really very good"; " We visited this and other homes which were also very good, but this one had the edge as its closer for us all” and “My relative really loves it here and joins in the activities”. One relative was very complementary of the activities officer.

The service had developed areas within the environment to support people with dementia. They had introduced specialised picture signs as a way of advising people regarding daily services like activities and were facilities are, such as were toilets and bathrooms were located. These tools for communication help people with dementia to be orientated and reminded about their surroundings and living space.

We had also contacted the local authority contracts and monitoring team for Halton Social services before we visited the service. They shared a detailed report from their recent reviews of the service.

The 3 people using the service who were spoken with were happy with the care they receive at the home. Some comments made were;

"The staff are very good, we have a good joke and they look after me well."

"This is a nice place with nice staff."

"The staff look after us all well."

Relatives spoken with said that people have their needs met by caring and attentive staff. They described the staff as polite and respectful. Some comments made were;

"I've been coming here regularly and I am very happy with the service. The staff give good care, they are nice people."

"A very good service is provided."

"The home is marvellous. It is very good for my relative. I have seen my relative get back to their old self here. There is a nice atmosphere at the home."

The people using the service enjoy the meals provided. They said the home is kept clean. Relatives spoken with agreed with these observations.

The report of a visit by Halton LINk on 14th February 2011 summarised their visit as follows "Halton View Care Home is a friendly and welcoming purpose-built care home. It is decorated to a high standard and well maintained. The staff at the home appeared friendly and considerate yet maintained a good professional attitude. Residents appeared to be happy and were cared for with dignity and respect. We felt that a lot of thought and effort had been put in to improving the environment for residents with dementia and the dementia unit was excellent and very worthy of praise. It should be considered as an example of best practice."

The last monitoring visit by Halton Borough Councils Quality Assurance team was undertaken in November 2010. They summarised their findings as follows; "The home was very clean and tidy with a very homely feel. A refurbishment programme had taken place and there was a grand piano in the reception area, with seating for visitors and tea/coffee/biscuits available. The refurbishment of the dementia unit was excellent and contained lots of memorabilia from years gone by. The food served at lunchtime was of a good standard and the home has received an Excellent Award from Halton Borough Council for Hygiene. There has been big improvements in the home since the last monitoring visit and these are continuing. The staff were very motivated, enthusiastic and very caring towards the residents."