This inspection took place on 23 and 28 August 2018 and was unannounced.

Hilbre House 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. Hilbre House is registered to provide accommodation and personal care for up to 22 people. At the time of the inspection there were 20 people living in the home.

The last registered manager had left the service in January 2018. 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. A new manager had been in post since January 2018 and was present on the second day of the inspection. They had begun the process to apply to the Commission to become registered. Feedback regarding the management of the service was positive. Staff told us they could go to the manager at any time and relatives described the manager as, “Great” and told us they had, “A very caring attitude.”

At the last comprehensive inspection in December 2017, the registered provider was found to be in breach of Regulations 12 (safe care and treatment), 17 (good governance) and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated as inadequate and placed in special measures. We completed a focused inspection in February 2018 to check whether the significant risks identified at the last inspection had been addressed and found that they had. The overall rating was changed to requires improvement.

During this inspection we found that not all of the improvements had been sustained and the provider was in breach of Regulations 11 (consent), 12 (safe care and treatment) and 17 (governance).

At the last comprehensive inspection, we identified that the fire risk assessment needed to be updated and were informed a contractor had been commissioned to complete this. At this inspection however, we saw that it had not yet been updated. Systems were in place to monitor the environment, however it was not always safely maintained. We observed a broken dado rail that posed a risk of injury and cleaning chemicals were not always stored securely. This meant that vulnerable people had access to these chemicals which could cause them harm.

Most medicines were stored safely; however, we saw boxes of medicines left out in one person’s bedroom and medicines that required storage in the fridge were not kept at the correct temperatures. When people were prescribed medicines as and when they needed them (PRN), there were not always protocols in place to inform staff when to administer them.

We found that DoLS applications had been made appropriately. However, records regarding applications, when they were authorised and were due to expire, were not always clearly recorded, or known by staff. Records showed that consent was not always gained and recorded in line with the principles of the Mental Capacity Act.

Systems in place to monitor the quality and safety of the service were not robust or effective. They did not include all areas of the service provided and those audits that had been completed, did not identify all of the issues raised during the inspection. Meetings took place to enable the registered provider to be kept informed of what was happening within the service.

The Commission had not been made aware of all notifiable incidents, such as those relating to pressure sores of grade three and above.

Staff were supported through an induction when they started in post. Supervisions had taken place this year, however annual appraisals had not been completed. Staff had access to training to support them in their role, alth

This inspection took place on 6 February 2018 and was unannounced.

Hilbre House 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. Hilbre House is registered to provide accommodation and personal care for up to 22 people. At the time of the inspection there were 15 people living in the home.

We carried out an unannounced comprehensive inspection of this service on 12 and 15 December 2017. Breaches of legal requirements were found in relation to the safety of the environment, management of medicines, risk management, staffing and the management of the service. The service was rated as inadequate and placed in ‘special measures.’ Following the inspection, CQC used its urgent powers to keep people safe. The provider made an appeal against this action which was upheld as we found that action had been taken to minimise the risks identified at the last inspection.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the identified breaches of regulations. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hilbre House on our website at www.cqc.org.uk.

The previous registered manager had recently left the service. A new manager had been appointed and was in the process of registering with CQC. 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.

In December 2017 we found that medicines were not managed safely as they were not stored safely. During this inspection we saw that improvements had been made and medicines were now stored securely. The provider was no longer in breach of regulation regarding this.

During this inspection we found that actions had been taken and risks regarding the environment had been resolved. New window restrictors had been fitted as required to most windows, the linen cupboard had been de-cluttered and chemicals were stored securely.

A new call bell system had been fitted and was available in each person’s bedroom and en-suite bathroom. This meant that people living in the home had a means of calling staff if they required support. The provider had made improvement to the safety of the environment and was no longer in breach of regulation regarding this.

During this inspection we found that steps had been taken to begin addressing all concerns regarding risk management that we identified at our last inspection and some had been fully completed. New evacuation equipment was available and this was reflected within people’s personal emergency evacuation plans. However, the new fire risk assessment and emergency evacuation procedure were not yet available.

During the last inspection concerns were raised that people had been admitted to the home with assessed nursing needs, which the provider is not registered to provide. During this inspection we found that a new admission procedure had been put into place to help ensure all people who moved into the home had their needs assessed to ensure they could be met. The provider was no longer in breach of regulation regarding this.

A staffing analysis system had been implemented to help establish how many staff were required to be on duty. As a new call bell system had also been installed, this reduced the risk of people not having their needs met in a timely

This inspection took place on 12 and 15 December 2017 and was unannounced.

Hilbre House 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. Hilbre House is registered to provide accommodation and personal care for up to 22 people. At the time of the inspection there were 21 people living in the home.

A registered manager was in post, but was not available during the inspection as they were on a period of leave. 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 this inspection we found that the provider was in breach of regulations and was not meeting legal requirements. The breaches of regulation were in relation to risk management, medicines management, staff support systems and the leadership and running of the service.

People we spoke with told us they felt safe living in Hilbre House. We found however, that adequate systems were not in place to ensure the safety of all people living in the home, such as call bells in all rooms. We also found that the environment was not always safe for all people as not all windows were restricted as required and chemicals were not stored safely. This could pose risks to vulnerable people.

Emergency evacuation procedures did not provide information as to how all people would be supported to leave the home in the event of an emergency and not all people had a personal evacuation plan in place.

Risk was not always assessed accurately and people did not always receive safe care and treatment. The service accepted people into the homes with assessed needs that they were not registered to provide. The service did not adhere to agreed changes regarding pre admission procedures to help ensure people’s needs could be effectively met from the day they were admitted to the home.

Medicines were not always managed safely within the home as they were not stored securely and not all medicines were administered as prescribed.

The provider did not always demonstrate a caring approach as identified risks were not always addressed to ensure people would receive safe care and treatment.

Audits completed within the service did not highlight all of the concerns raised during the inspection. When actions were identified, we found that not all had been addressed in a timely way, including those raised from audits completed by external professionals.

There was no evidence that the provider maintained full oversight of the service and in the absence of the registered manager, the leadership of the service was unclear.

Not all statutory notifications had been submitted to the Commission as required by law.

There were a range of policies and procedures in place to help guide staff in their practice, however not all were up to date and not all were followed in practice, such as the pre admission procedure.

There was a safeguarding policy in place, however not all staff we spoke with were knowledgeable about safeguarding processes and how to raise concerns. A whistleblowing policy was in place which encouraged staff to raise any concerns without fear of repercussions.

Staff were supported in their role through induction and regular supervisions, however they did not receive an annual appraisal and not all staff had completed training necessary to enable them to meet people’s needs effectively.

We looked at how staff were recruited to the home and saw that most safe recruitment practices were adhered to. However, we found that there was not always sufficient staff on duty to meet people’s needs in a timely way, specifically o

We carried out an unannounced inspection of Hilbre House on 31 January 2017 and 2nd February 2017. Hilbre House is a large old style property owned by Hilbre Care Limited. The home is registered to provide accommodation for up to 20 people who require personal care. At the time of our visit the service was providing support for 18 people.

The service had 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. There was a registered manager in post, they had been registered since October 2016.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. The provider told us that some people at the home lacked capacity and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care. The service had accessed support from the local authority to ensure processes were appropriately followed. We found that in applying for these safeguards, peoples’ legal right to consent to and be involved in any decision making had been respected.

People told us they felt safe and we saw that staff knew how to ensure they were safe. From our observations it was clear that staff cared for the people they looked after and knew them well.

Staff told us that they felt well supported by the manager in their job roles. We saw that the manager was a visible presence in and about the home and it was obvious that they knew the people who lived in the home extremely well and the people knew who the manager was, often using their name.

Staff were recruited safely and there was evidence that staff had received a proper induction and suitable training to do their job role effectively and the staff had been supervised regularly.

Each person living in the home had a plan of care and risk assessments in place. These were specific to them and were regularly reviewed.

People had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime. The cook had a good knowledge of the dietary requirements, likes and dislikes of the people living in the home.

People's medicines were handled safely and were given to them in accordance with their prescriptions. Other healthcare professionals were contacted for advice about people’s health needs whenever necessary.

The home was clean, safe and well maintained. We saw that the provider had an infection control policy in place to minimise the spread of infection and a good supply of personal and protective equipment. For example, hand gels, disposable aprons and gloves. We also saw the home was in the process of being updated with adaptions being carried out on bathrooms and the emergency call bell system.

We carried out an unannounced comprehensive inspection of Hilbre House on 19 May 2016. Hilbre House is registered to provide accommodation and personal care for up to 20 people. At the time of our inspection there were 14 people living at the home.

The service had a registered manager. 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 the inspection we found breaches of Regulations 11 and 17 of the Health and Social Care Act 2008. You can see what action we asked the provider to take at the end of this report.

Some of the people who used the service had a diagnosis of dementia which had an impact on their ability to consent to decisions about their care. People’s mental capacity had not been assessed in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had not been applied for.

There were enough staff to meet people’s needs and staff received training to enable them to provide care to people safely, however we did not see evidence that every member of staff who worked in the home had completed all of the training.

We observed staff supporting people at the service and saw that they were warm, patient and caring in their interactions with people. People were seen to be relaxed and comfortable in the company of staff. People who used the service and their relatives told us they were happy with the service provided.

The premises were clean and bedrooms were appropriately decorated and furnished. Regular health and safety checks of the environment were not clearly recorded and some people did not have a call bell available to use when they were in bed.

The registered manager did not engage with us during the inspection and there were no other management staff identified on the staff rota. Some quality audits had been carried out but these were not comprehensive. We found no evidence that people had been asked for their views of the service during recent months.