The inspection of Hoylake Cottage took place on 24 and 25 January and was announced on the first day.

During our last inspection of the service we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because people's medicines were not always managed safely. During this inspection we found that improvements had been made to the management of medication but there was room for further improvement.

Hoylake Cottage 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. Hoylake Cottage provides accommodation with nursing or personal care for up to 62 people in a purpose built facility.

The service is required to have 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 had a registered manager who was supported by a clinical nurse manager.

All of the people we spoke with said they felt safe at Hoylake Cottage. We observed that the premises were clean and people had spacious and well-appointed bedrooms with en-suite toilet and shower. Maintenance contracts were in place for premises and equipment and some regular safety checks were carried out, however there remained room for improvement in this area.

There were enough staff to meet people's needs and the staff we spoke with were friendly and helpful. We looked at the personnel files of three staff. All files had appropriate application forms with references and appropriate criminal record checks. This meant that the provider had ensured staff were safe and suitable to work with people at risk of abuse or neglect prior to employment. The files also showed that new staff had a robust programme of induction training. The service had an in-house trainer and an annual programme of staff training and development was in place.

Everyone said they got enough to eat and drink, and people were satisfied with the quality of the food. People received the support they needed to maintain their nutrition and hydration.

The service complied with the requirements of the Mental Capacity Act 2005 to ensure that people were protected when their capacity to make decisions was impaired.

People told us they could make choices about their daily routines and that their privacy and dignity were respected at all times. Everyone was very complimentary about the attitude of the staff and about the care provided. Visitors were made welcome at any time. A programme of stimulating social activities was in place.

The home's complaints procedure was displayed in the entrance area and records showed that complaints were responded to appropriately and constructively. The management style was open and inclusive and significant progress had been made in taking the service forward. The quality of the service was monitored continuously by means of quality audits, satisfaction questionnaires, and regular meetings of various groups.

The inspection took place on 6 and 7 December 2016 and was unannounced. Hoylake Cottage is a three storey, purpose-built care home that is registered to provide accommodation and nursing care for up to 62 people. The ground floor and first floor units each provided nursing care for up to 20 people, and the second floor unit provided nursing care for up to 22 people who were living with dementia.

The home did not have 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 previous manager had left the service in October 2016 and a new manager had submitted an application for registration with the CQC.

During our last inspection we found breaches of the regulations of the Health and Social Care Act Act 2008 relating to safeguarding arrangements; staff training and support; consent and capacity; and quality assurance processes. During this inspection we found that, in all of these areas, the new management team had taken action and there were robust plans in place for future development.

During this inspection, we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s medicines were not always managed safely. You can see what action we told the provider to take at the back of the full version of this report.

All of the people we spoke with said they felt safe at Hoylake Cottage. We observed that the premises were clean and people had spacious and well-appointed bedrooms with en-suite toilet and shower. Maintenance contracts were in place and the home’s maintenance team carried out some regular safety checks, however these were not comprehensive and the manager had arranged for a full health and safety audit to be carried out by an external company.

We saw that accident records were completed in full and were summarised monthly. Personal emergency plans were in place to advise how people should be evacuated safely in the event of an emergency situation.

There were enough staff to meet people’s needs and the staff we spoke with were friendly and helpful. We looked at the personnel files of eight staff. All files had appropriate application forms with references and appropriate criminal record checks. This meant that the provider had ensured staff were safe and suitable to work with vulnerable people prior to employment. Since our last inspection, the service had employed an in-house trainer.

Everyone said they got enough to eat and drink, and most people were satisfied with the quality of the food. We saw room for improvement in the dining experience.

The second floor unit included some aspects of a dementia friendly environment, for example low windows in the lounges enabled people sitting in chairs to see the garden and courtyard areas, however we observed that there was little stimulation for people in the environment.

People told us they could make choices about their daily routines and that their privacy and dignity were respected at all times. Everyone was very complimentary about the attitude of the staff and many said “They can’t do enough for you.” All of the visitors we met said they or another family member had been involved in care planning. Everyone said that visitors were welcome at any time, and there was a steady flow of visitors throughout the day. A variety of social activities was provided.

The home’s complaints procedure was displayed in the entrance area. It gave the names and contact details of people who could be contacted if someone wished to make a complaint or raise a concern. Everyone we spoke with knew how to complain, but nobody had. A frequent comment was “I’ve nothing to complain about.”

People we spok

The inspection took place on 27 October 2015 and was unannounced. Prior to the inspection we had been informed of a number concerns regarding the safe handling of medicines which were being investigated by the local authority.

The inspection was conducted by an inspector who is a pharmacist and only looked at how safely medicines were handled. We found that medicines were not being handled safely and found that they were in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Hoylake Cottage' on our website at www.cqc.org.uk’

We gathered evidence against the outcomes we inspected to help answer our five key questions.

Is the service safe?

People were protected against the risks associated with medicines because policies and procedures were in place to manage medicines and these were followed by the nurses. Medicines were stored safely and were audited monthly to identify any shortfalls.

Nurses, care staff and ancillary staff were provided in sufficient numbers to meet people’s needs. Domestic and maintenance staff ensured that the environment was kept in a clean and safe condition and this was audited monthly.

Is the service effective?

People experienced care, treatment and support that met their needs and protected their rights. People receiving intermediate care were supported by the home’s staff and by therapy staff employed by the NHS to enable them to regain their independence.

We observed that people received the support they required to maintain adequate nutrition and hydration.

Is the service caring?

We observed that people’s privacy, dignity and independence were respected. Staff were kind and patient to the people who lived at the home and we observed positive interactions between staff, visitors and people who lived at the home.

Is the service responsive?

People's needs were assessed before they moved into the home. Care plans recorded people's personal preferences and interests, and care was provided in accordance with people's wishes. People were given opportunities to express their views.

Is the service well led?

The service is a registered charity with a board of trustees and a management committee. The registered manager had been in post since the service opened and was supported by four team leaders and by administration staff.

We spoke to different people about this service to gain a balanced overview of what people experienced, what they thought and how they were cared for. We spoke to three people resident at the service, four relatives of people and five staff members. We spent time observing people using the service, to see how they were cared for and how staff interacted with them.

People said the home was, “wonderful” and that staff were always busy but cheerful. Relatives had discussed people’s preferences with staff and most thought that the care was good. No one that we spoke to had ever made a complaint but some had raised issues or concerns with staff and most were satisfied with the outcome. One person felt reluctant to discuss concerns with staff and said that some staff were more approachable than others.

We saw that while there were adequate numbers of staff most of the time, there were periods in the morning when some staff were on a scheduled break and a person using the service on one floor was not responded to promptly. Consequently they had become distressed due to the delay.

Staff said that they thought that issues or complaints were always addressed appropriately because the management “genuinely wanted the home to do well.”

Although we saw some minor inconsistencies in documentation about people, staff were able to describe the needs of different service users and we saw that they treated people with respect in a cheerful and caring way.

People who used the service and their relatives whom we spoke with told us they were happy living at the home, were well cared for and treated with dignity and respect. They told us:

“They do everything well”, “It’s excellent here”, “It couldn’t be better”.

People told us they were involved in their care and treatment and were able to make choices in every day living activities such as food choices and level of assistance needed with personal care.

We observed that people were well cared for and treated with dignity and respect. People’s needs were appropriately assessed, planned and reviewed. We found that the provider monitored the service and gained views on the service from staff and people who used the service.

Staff were appropriately trained, supported and appraised to care for people’s needs. They demonstrated an awareness and understanding of how to protect people from abuse.

We received concerning information from a relative of someone who had used the service. The concerns included not acting upon information received regarding specific dietary needs, communication between nursing staff and kitchen staff and poor satisfaction with the complaints process. This information fed into our assessment of the service provider at this review.

We visited the service on 6 July 2011. People who used the service and their families told us that overall they were very satisfied with the care and treatment given to them by the provider.

We were told that they were treated with dignity and respect, involved in their care and treatment options, were well cared for including having the opportunities of a wide range and number of activities delivered through a planned program.

We were told that mostly the food served was appropriate for them. It was of good quality and there was a good choice.

People who use the service and their families also told us that they were aware of how to complain or make comments if they needed to regarding the service and that on the occasion they needed to do this the issues had been dealt with appropriately.

The inspection took place on 13 and 24 August 2015 and was unannounced. Hoylake Cottage is a three storey, purpose-built care home that is registered to provide accommodation and nursing care for up to 62 people. The ground floor unit provided nursing care for up to 20 people; the first floor unit provided intermediate care for up to 20 people; and the second floor unit provided nursing care for up to 22 people who had dementia.

The home 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.

All of the people we spoke with said they felt safe at Hoylake Cottage. We observed that the premises were clean and people had spacious and well-appointed bedrooms with en-suite facilities. Records showed that services and equipment were maintained in safe condition. On the second floor, we found many aspects of a dementia friendly environment, for example low windows in the lounges enabled people sitting in chairs to see the garden and courtyard areas.

We found a number of breaches of the regulations relating to safeguarding arrangements, staff training and support, consent and capacity and quality assurance processes. You can see what action we told the provider to take at the back of the full version of this report.

We found that there were enough staff to meet people’s needs and the staff we spoke with were friendly and helpful. We looked at the personnel files of six staff. All except one of the files included evidence of a formal, fully completed application process and checks in relation to criminal convictions and previous employment. This meant that the provider had ensured staff were safe and suitable to work with vulnerable people prior to employment. One person did not have an employer reference and their previous employment history was unclear.

Training records showed that a number of staff had not completed training in a range of subjects to ensure that they knew how to keep people safe, and a number of other staff had not updated their training for several years. The home’s induction programme for new starters did not reflect the ‘Skills for Care’ Care Certificate programme for new staff. Staff did not have one to one supervision meetings with their line manager and had not had a recent appraisal of their work performance. This meant that their training and development needs had not been identified and planned for.

Where people were identified as being at risk of harm, assessments were in place and action had been taken to mitigate the risks. We saw where people were at high risk of falls, timely referrals were made to the Community Therapy and Falls Prevention Team. We saw that accident records were completed in full and were summarised monthly. Personal emergency plans were in place to advise how people should be evacuated safely in the event of an emergency situation.

We inspected medication storage and administration procedures in the home and found that people’s medication was being managed safely.

The care records we looked at indicated the actions to comply with the requirements of the Mental Capacity Act 2005 had not always been fully followed. Care staff had a good understanding of matters relating to restraint, but this was not under-pinned by a robust policy or staff guidance document.

We saw evidence in written records to show that staff worked with various agencies and made sure people accessed other services in cases of emergency, or when people's needs had changed. This included GPs, hospital consultants, community nurses, specialist nurses, physiotherapists, speech and language therapists, dieticians and dentists.

We observed staff interaction with people throughout the day. The staff were gentle, patient and respectful. All of the staff interactions with people that we observed were friendly and caring. We saw people who lived at the home and staff had developed positive relationships with each other, and staff had an understanding of people’s likes and dislikes. However, in one care plan we looked at we found some inappropriate language used. Also, we observed that the confidentiality of people’s records was not always maintained.

People we spoke with were able to name members of staff who would they would speak to if they had any concerns. The home’s complaints procedure was displayed in the entrance area. It did not give the name or contact details, for example telephone number or email address, of anyone within the organisation who people could contact if they wished to make a complaint or raise a concern.

Care plans we looked at on the dementia care unit contained information about the support people needed. On the ground floor, we found that the system in place was not person-centred, nor was it based on an assessment of people’s needs and preferences. There were no signatures to show who had made entries on the care notes and ensure accountability.

On the ground floor we looked at the plan of care for a person who had leg ulcers. We found that the knowledge, training and skills of the nurses were effective in the care and treatment of this person’s wound care needs.

All of the staff we spoke with said that they enjoyed working at Hoylake Cottage and some had been there for a number of years. They told us that the manager was very supportive and they could go and speak to her and she would listen, however staff meetings did not take place regularly. We looked at records of the quality assurance system and found that the audits lacked detail and evidence. At the end of our visits we discussed the issues we had found with the registered manager. We found that the manager was not open and receptive to our feedback or to suggestions made by the specialist professional advisor as to where the service could improve.