The inspection took place on 12 and 13 October 2016 and was unannounced. Mariners’ Park is located in the Egremont area of Wallasey on the banks of the River Mersey. The care home is part of a range of housing and care services provided for former seafarers and their families by the charity Nautilus Care. The home is registered to provide accommodation and nursing or personal care for up to 32 people. Some of the people supported at Mariners’ Park were living with dementia.

At the time of the inspection, the home had a manager who was registered 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 and associated Regulations about how the service is run.

The manager and staff had knowledge of the Mental Capacity Act (2015), and Deprivation of Liberty Safeguards (DoLS) had been applied for appropriately. People were supported to make everyday choices within their capacity to do so.

Staff we spoke with had a good understanding and knowledge of people`s individual care needs. We observed that people were treated with dignity and respect and support was provided in a kind and caring manner. Family members and friends visited during the day with no restrictions.

The home was purpose built and provided a spacious, comfortable and safe environment. All parts of the premises were clean and tidy. People’s medicines were managed safely.

We observed that there were enough staff on duty and people did not have to wait for staff to attend to them. The rotas we looked at confirmed that these staffing levels were maintained by some use of agency staff. People had a choice of meals and received the support they needed to eat and drink.

The home employed a social activities organiser and a dementia support worker who provided support for people both in the home and in the community.

Care records we looked at showed that people's care and support needs were assessed before they moved into the home. Plans were in place for meeting people’s needs and managing risks. These were reviewed regularly.

We saw evidence of regular staff meetings and meetings for people who lived at the home and their families. People were also invited to give their views in an annual satisfaction survey. A series of quality monitoring audits was carried out.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with two people who lived at the home, one relative, the registered manager, the deputy manager, one member of the care team and a member of the nursing team. We also reviewed records relating to the management of the home which included three care records, daily written records, three staff files, training records, audit and complaint records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. The home had recently undergone a refurbishment and offered a pleasant, homely environment for people to live in.

During our inspection of the home in October 2013 we found that people’s care records did not contain clear or sufficient information on people’s needs, risks or care. Records associated with people’s care were also not stored securely to protect people’s confidential information. We asked the provider to make improvements in the way in which care was planned and delivered and the recording and safe storage of people’s information. At this inspection, we found that improvements had been made.

Records showed that people’s needs and care were now appropriately risk assessed and care plans regularly reviewed to ensure they remained effective and safe. Care plans were person centred and gave clear guidance to staff on how to care for people. Where people’s needs had changed, care plans had been kept up to date so that the care provided continued to meet their needs. Daily written records showed that people had received the care outlined in their care plans and that prompt access to medical support was organised in the event of people’s ill health.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. People we spoke with said “I’m very well looked after. From the very first day, it’s been very accommodating” and “All (staff) that I’ve met are pretty good”. The relative we spoke with said staff looked after their relative very well. They said “It’s great. The staff are great” and they “Always have time for a chat about them”.

During our inspection of the home in October 2013, we found that training and support for some staff was not adequate. We asked the provider to make improvements to the support and training arrangements in place for staff. At this inspection, we found that improvements had been made.

Staff told us they now received regular support and training to enable them to provide care and treatment safely and to an appropriate standard. Staff we spoke with said the management of the home had improved and that the manager and the deputy manager were approachable and supportive.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and supported people at their own pace. People told us they were treated with dignity and respect and that staff were nice. People said “It’s the best that can be expected" and “I’m very satisfied”.

Relatives we spoke with said they felt involved in people’s care and that staff kept them fully informed. Comments included “. They came and assessed them. We can talk to all of them without exception. All compassionate and understood our needs as a family”.

People were given appropriate information in relation to their care and regular opportunities to express what was important them in terms of their life at the home. This showed us that the home valued people’s views and opinions in the delivery of their care.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes.

The service worked well with other healthcare professionals to ensure that people received the health and social care support they required. For example, we saw evidence that GPs, dieticians, chiropodists, physiotherapists, district nurse, and dentists were all involved in people’s care and that their professional advice was followed by the home.

Is the service well-led?

People we spoke with said the service was well managed. One person said “It’s very well run”. They told us the manager and staff were approachable and easy to talk to. They said if they had any concerns they would feel comfortable talking to them. We saw that an easy to understand complaint procedure was in place and any complaints received had been appropriately investigated and responded to.

People’s and/ or relative feedback on the quality of the service provided was regularly sought through quarterly residents/relatives meetings and an annual satisfaction questionnaire. Records confirmed that people’s views and suggestions had been taken on board where possible.

The provider conducted a range of monthly checks on the quality and safety of the service which included care plans, environmental and infection control audits. Where improvements were required these had been acted upon.

We found that the service was well led. Staff had a good understanding of the ethos of the home and were positive about working for the provider.

At our last inspection in October 2013, we found the provider had not followed local safeguarding protocols to respond appropriately to allegations of abuse. Arrangements in place for storing and administering medication safely were inadequate and the number of staff on duty was insufficient to meet people’s needs. We spoke to the manager about this and an action plan was put into place to ensure compliance with the regulations was reached. We reviewed the provider's quality monitoring systems and found there were no systems in place to monitor the quality of the service, the risks in the delivery of care or people's views on the service provided. We issued a warning notice in response to this. A warning notice is a written notice that requires providers to become compliant with the regulation within a set timeframe.

We checked the provider’s progress at this visit and found that sufficient improvements had been made.

We saw that one safeguarding incident has been reported since our last visit. Records showed an appropriate investigation was conducted and the appropriate authorities notified. This indicated that there were now suitable arrangements in place respond appropriately to allegations of abuse.

We reviewed the administration of medication and found that medicines were now stored securely and safely administered. Staff administering medication had received refresher training and their competency was checked. This meant there were checks in place to ensure staff had the skills and knowledge to safely administer medication.

The provider had developed a staffing tool that enabled them to assess safe staffing levels based on the needs of the people who lived at the home. Staffing levels had been increased and new staff were appointed. We observed that the number of staff on duty on the day of our visit was sufficient.

A system was in place that enabled the quality of care plans, medication administration, staffing levels, accidents and incidents and the environment to be regularly monitored. This meant effective systems were in place to identify and manage the risks to people’s health, safety and welfare.

People and/or relatives at the home had received a satisfaction survey that checked they were satisfied with the service provided. We reviewed the survey results and saw that people’s feedback was positive.

We spoke with two people who lived at the home and one relative. People and the relative we spoke with said staff sought their consent prior to care or treatment being provided.

We saw people's needs were assessed and care planned. There was however a lack of accurate information about peoples needs and we saw that the planning and delivery of care did not ensure people's welfare and safety needs were fully met.

During our visit the manager told us about a number of safeguarding allegations. We found the provider had not followed local safeguarding protocols to respond appropriately to the allegations of abuse and had failed to safeguard people from further risk.

We examined the arrangements in place for the administration of medication. We found that medication was not stored, administered or managed appropriately.

We reviewed three staff records. We saw the necessary checks to ensure staff were suitable to work with vulnerable people had been undertaken but there was inconsistent evidence of appropriate staff support and training. We looked at staffing levels at the home due to concerns raised during our visit. We found the number of staff on duty was insufficient to meet people’s needs.

We reviewed the provider’s quality monitoring systems. We found there were no systems in place to monitor the quality of the service, the risks in the delivery of care or people's views on the service provided.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

During our visit we spoke with a volunteer who was working at the home and she told us about a respite stay she had there following surgery. She said that it was “brilliant”. The staff consulted with her about the treatment she needed and respected her wishes about how she would like the care to be delivered.

People we spoke with said that they enjoyed their meals at Mariners Park, the food was excellent and they could ask for more if they wanted to.

One person told us that the activities organiser was “worth her weight in gold”.

We looked at some letters that had been received recently at the home. One person had written:

‘Thank you for all the kindness and compassion you showed towards R and myself during his stay with you. I valued so much your friendship and support during a most difficult time for us.’

Another person had written:

‘Thank you so much for all you have done both caring and enabling D to stay with you. We all appreciate very much the level of hard work and care given by yourself and your wonderful staff.’

People we spoke with told us that the staff were very kind and they had never heard staff shouting or treating people in an unpleasant way.