This inspection was carried out on 11 and 15 October 2018. The first day of the inspection was unannounced.

Hilbre Manor EMI has accommodation for people over four floors. It provides accommodation and support for up to 15 older people who live with dementia. The house has a large garden and a passenger lift. It is on a main road in Prenton and has good access to public transport and other community facilities. At the time of inspection, the home had 14 people living there.

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 the time of inspection the service had a manager in post who was going through the registration process with the Care Quality Commission.

Hilbre Manor EMI 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.

We last inspected this home in July 2017. During this inspection we found the service was in breach of regulations 12, 18 and 17 of the health and social care Act 2008 (Regulated Activities) Regulations 2014.

Following this inspection the registered provider sent us an action plan which described how they were going to meet these breaches and we checked this during this inspection.

At this inspection, we found that significant improvements had been made, and the registered provider was no longer in breach of regulations 12 and 18. However the registered provider remained in breach of Regulation 17 as there were continued concerns around consistency of paperwork and quality assurance systems and processes.

Despite some improvements being made to the audit and checking systems that were in place, there were still come inconsistencies in the recording of information which had not been highlighted by the current checking regime. We did feed this back during our inspection process and the manager accepted and took our feedback on board.

The registered provider had ensured regular checks were carried out and the premises were safely maintained. We also saw that risk assessments for people were completed and risks were adequately assessed. We did highlight some recording issues which were recertified during our inspection.

The registered provider had enrolled all staff on training which was appropriate to their roles. This information was recorded in the training matrix and we saw evidence this had took place by looking at certificates in staff files. Staff had also engaged in regular supervisions.

We checked records in relation to the Mental Capacity Act 2005 and whether people were being lawfully deprived of their liberty following a capacity assessment. We saw that Deprivation of Liberty (DoLs) were suitably applied for and people’s capacity was assessed. We did see however that some of the information in relation to people’s capacity required further clarification. We made a recommendation regarding this.

There was information recorded in people’s care plans which specified how they required their support to be delivered. There was also detailed information regarding people’s likes, dislikes and backgrounds. We did see however, that the level of this information differed from care plan to care plan, and some more information would have been beneficial.

Everyone was complimentary about the home and the staff. People told us they felt safe and well supported.

Medication was managed well and stored correctly. Medication was only administered by staff who had the correct training to do so.

Staff recruitment was safe. Appropriate checks had been carried out on staff before they started working at the home, and most staf

This inspection was carried out on 13 and 19 July 2017, the first day of the inspection was unannounced. This period property has accommodation for people on the lower ground, the ground, first and second floors. It provides accommodation and support for up to 15 older people who live with dementia. The house has a large garden, a passenger lift and has been recently refurbished (2015). It is on a main road in Prenton and has good access to public transport and other community facilities. At the time of inspection the home had 12 people living there.

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 the time of inspection the service had a manager in post who was going through the registration process with the Care Quality Commission.

During our inspection we found breaches of Regulations 12, 17 and 18 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. These breaches related to the safety of the premises, risk assessments, governance of the service and staffing.

During our visit we found that care plans and risk assessments were mostly in place for people living in the home, however some risk assessments were not always in place or had contradictory information in them. The personal evacuation plans for people did not always match the risk assessments contained in their care files. The provider informed us on the second day of inspection that this was being actioned. These files and people’s needs should be regularly checked and updated, not as a consequence of a CQC inspection.

There were some quality assurance systems in place but these did not operate effectively enough to ensure people received a safe, effective, caring, responsive and well led service. Staff did not receive the training and supervision they needed to support people with dementia. This placed people at risk of receiving inappropriate and unsafe care.

The service had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults. However most staff had not received any up to date training surrounding safeguarding.

We saw that the home did not have records of any reassessment of people’s capacity before deprivation of liberty safeguards were applied for. The acting manager told us of the people at the home who lacked capacity and that the appropriate number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care. We identified one was out of date and this was reapplied for during the inspection.

People told us they felt safe at the home and had no worries or concerns. From our observations it was clear that staff cared for the people they looked after and knew them well. Relatives we spoke with said they would know how to make a complaint. No-one we spoke with had any complaints.

People had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime. All medication records were completely legibly and properly signed for. All staff giving out medication had been appropriately trained.

Staff had been recruited safely with appropriate criminal records checks, however some checks required under legislation had not been completed.

The home had recently undergone an infection control audit and we saw that the findings had been actioned and completed. The home was clean, safe and well maintained. We saw that the provider had an infection control policy in place to minimise the sp

We had previously carried out an unannounced comprehensive inspection of this service on 5, 12, 14 and 15 April 2016. Since that inspection we received concerns regarding lack of care and risk assessments, safe recruitment of new staff members, inadequate bathing facilities, the security of people’s monies and inadequate staffing numbers at the home. As a result we undertook this focused inspection on 21, 22 and 23 September 2016 to look into those concerns. This report only covers our findings in relation to those concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hilbre Manor EMI Residential Care Home on our website at www.cqc.org.uk .

We found that there was evidence to show some of the allegations would have been substantiated without any intervention. However, in the short time since the allegations had been made, when we visited the home in September 2016, the new nominated individual and the new manager for the service had made good progress with respect to the areas of concerns. They were positive about the future progress of the service.

Hilbre Manor EMI Residential Care Home has accommodation for people on the lower ground, the ground, first and second floors. It is registered to provide accommodation and support for up to 15 older people who live with dementia. There are 12 rooms, three of which are able to be double. The house has a large garden, a passenger lift and the home was refurbished in 2015. It is on a main road in Prenton and has good access to public transport and other community facilities. At the time of our inspection, there were eight people living in the home and all were accommodated in single rooms.

We saw that staff recruitment had not been carried out in a safe way, as recently recruited staff were found to be working without the required checks.

This is a breach of Regulation 19 of the Health and Social Care Act 2008, which states that fit and proper persons are employed. Recruitment procedures were not operated effectively to ensure that persons employed were suitable to work in health and social care. You can see what action we have taken, at the bottom of the full report.

Care and risk assessment had been completed for a new person living in the home and we saw that the records showed that assessments had been updated for most of the people living in the home. The remainder were in the process of being completed and updated.

The home requires 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. The home did not have a registered manager and had not since September 2015.

However, we noted that the provider had been actively recruiting for a new manager over this period. The previous manager had left the home unexpectedly two weeks before this inspection. A new manager had been appointed and was in post and present at this inspection. At the time of writing this report, an application by the current home manager for registration by CQC has been received by us.

The nominated individual had applied for Deprivation of Liberty Safeguards for people living at the home who had been assessed as lacking the capacity to consent to their care and accommodation. This complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA) for people who had been assessed as lacking mental capacity in aspects of their lives. We saw however, that people who were deemed to have capacity were not supported to have maximum choice and control of their lives an

We carried out an unannounced, comprehensive inspection of this service on 29 September and 01 October 2015. Breaches of legal requirements were found. After the inspection the provider wrote to us to say what they would do to meet legal requirements in relation to safe care and treatment, peoples’ consent, safeguarding people from abuse, the management of the service and submission of statutory notifications.

This inspection took place on 05, 12, 14 and 15 April 2016 and was unannounced. There were several visits because there was no manager present and the provider was unavailable for much of our inspection. We needed them to respond to requests for information about people being supported by the service or about the way the service was run and managed.

We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hilbre Manor EMI Residential care Home on our website at www.cqc.org.uk

In addition, we had recently received two pieces of information of concern.

After our visit and in response to The Care Quality Commission raising several areas of concern with them, the provider told us that improvements had taken place and we re-visited the home to check these on 12 May and 29 June 2016. We found that improvements had been made to a number of safety factors that had previously given the Commission cause for concern on the lower ground floor.

The home required 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. The home did not have a registered manager and had no dedicated manager to lead it.

During the inspection we found breaches of Regulations 10, 11, 12, 13, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to dignity and privacy, consent, safe care and treatment, safeguarding and governance.

The home had CCTV installed but we did not see evidence that people, their relatives or staff had been consulted or had given their consent to this.

We also saw that people were not referred to specialist teams when aspects of their needs indicated they would benefit from such a referral.

People’s care records were improved since our inspection in October 2015 and most were person-centred. However reviews did not accurately reflect peoples changing needs.

The home did not have a registered manager as required. We were concerned about the inconsistent management of the home.

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

Staff were recruited appropriately and knew about abuse and how to report it. Staffing levels were appropriate to the numbers and dependency of people living in the home at the time of our inspection.

Staff were trained to do their job and we found them to be caring and kind.

People enjoyed a range of activities and told us they had no complaints, but knew what to do if they did.

During our inspection the provider brought in a team of managers to begin to check on the home and to complete audits and action plans.

This inspection took place on the 29 September and 1 October 2015 and was unannounced. The inspection was the first since the service had been registered in July 2015.

Hilbre Manor EMI Residential Home was a large, Victorian building which had recently been refurbished.

The home was registered to provide care and accommodation for up to 12 people. At the time of our inspection, there were eight people living in the home. One person was currently being supported by District Nurses as the home did not provide nursing care. Most people at the home had some confusion or dementia type conditions.

The home required a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

There had been two registered managers and both had resigned and left their post, the previous week. Management of the home was being done by the provider, who had recently appointed another manager. This person was present in the home during our inspection, having had all the required checks, although they had yet to formally take up the post. However, they too left the service shortly after our inspection, we were later told.

Medication administration was poor. The refurbishment in some areas of the home was incomplete. Subsequently, there were concerns over medicines and food storage, infection control and fire safety. Care records had been completed erratically, the appropriate assessments for capacity and best interests had not been done or the appropriate applications for Deprivation of Liberty, made to the local authority. Safeguarding concerns had not been forwarded to the local authority in a timely manner, nor statutory notifications made to CQC. The management of the home was chaotic.

We made a recommendation about appropriate physical environments for people living with dementia.

We identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 and the Care Quality Commission (Registration) Regulations 2009. These were in relation to medicines management, care records, safeguarding, the need for consent, for failure to notify CQC of certain events and the governance and management of the service.

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