This inspection took place on 22 June and 6 July 2018. The first day of our inspection was unannounced.

Since 2014, Meols Drive Care Home provided nursing care and rehabilitation support for men who have learning difficulties or autism spectrum disorder. The home is in a modern spacious detached building in its own grounds on a residential street in Hoylake, Wirral. The home is registered to provide accommodation and nursing care for up to 12 people, at the time of our inspection 11 people were living at the home. Meols Drive is on a residential road, within five minutes’ walk of the facilities of Hoylake which include local train and bus transport, shopping, socialising and community venues.

The home required and 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.

The aim of the service is for people who had previously had more intensive care and support to learn the skills to help them live more independently. It is not intended that this is a home for long term, rather that people move on to more everyday living accommodation.

Many of the values that underpin Registering the Right Support and other best practice guidance were seen in practice at this service. There was overwhelming evidence that the core values of choice, promotion of independence and community inclusion; were at the centre of people’s day to day support.

However, the service was in a large home which was larger than most domestic style properties and was registered for the support of up to 12 people. This is larger than current best practice guidance. The size of the service having a negative impact on people had been mitigated in the following ways. The design of the building was such that it fit into its environment as it is in a residential road with other large domestic homes of a similar size. There were deliberately no signs, intercom, cameras, industrial bins or anything else outside the building that may indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people. People had a high level of autonomy over how they spent their time. People’s support was built around them and this enabled people to live individualised lifestyles. Inside the building the living accommodation was split into two self-contained parts. The main part was the ‘house’ for nine people and the ‘flat’ for three people who lived more independently. In the main building there were numerous rooms that people could use in addition to their private space. The building did not feel overly busy or institutionalised.

Some people at the home have been identified as being ready to increase their independence and move into their own home. It is not the intention that Meols Drive is a long-term home for people and the service had worked closely with commissioners to help people get ready to move out of the home. One service commissioner told us that the service, “Ensured independence in a very supportive environment whilst people build up healthy social relationships.”

During our previous inspection in March 2016 we had found a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the administration of people’s medications was not always safe. We asked the provider to complete an action plan to show what they would do and by when to improve the key question; ‘Is the service safe?’ to a rating of at least good.

At this inspection we saw that there had been improvements made in this area and the service was compliant with all the health and social care regulations. The breach we identified in March 2016 had been addressed

This inspection took place on 11 and 18 March 2016 and was unannounced. The first person moved into Meols Drive Care Home in November 2014. This was our first inspection of the home.

Meols Drive Care Home specialised in providing nursing care for people with mental health support needs, learning disabilities or autism.

Meols Drive Care Home is in a modern spacious detached building in its own grounds on a residential street in Hoylake, Wirral. The home is registered to provide accommodation and nursing care for up to 12 people, at the time of our inspection 8 people were living at the home.

People we spoke with told us they liked living at Meols Drive and had good relationships with the support staff. Our observations of the staff were that they were caring and treated people with dignity and respect. There was a relaxed and friendly atmosphere at the home, it was not clinical or regimented and people’s choices were respected.

The building was designed as a spacious, safe and well equipped environment for people with mental health support needs and or autism. All of the bedrooms at the home were en-suite. The bedrooms on the first and second floor were accessed by a lift. We found the home to be well decorated in a non-clinical and homely style, clean, fresh and well maintained. There had been attention given to the environment, usability of the space and adaptations made for the people living at the home. There were three different communal areas used by the people living at the home along with a computer and craft room and ‘skills kitchen’. People living at the home had access to two vehicles, a mini bus and a car. These were used for trips out, appointments and traveling to and from regular places.

There was a separate self-contained annex of the building called the ‘flat’, this contained three en suite bedrooms, a lounge and kitchen. The manager told us they provided a different type of support for people who are developing their skills and independence. People living in the ‘flat’ went food shopping and cooked their own food with support. It is planned that this support is a stepping stone for people to move onto more independent living.

We checked a sample of people’s medication. We found areas of improvement needed in the administration and documenting of medication, this was a breach of Regulation 12 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 the report.

The home environment was safe. The manager had arranged for risk assessments, regular audits and checks to take place of health and safety and the home environment. The senior staff had used the relevant professionals to service equipment at the home as necessary.

We found there to be adequate nursing and support staff working at the home. These staff had been safely recruited, inducted and trained. Longer standing staff had received refresher training. Staff were supported with regular supervisions and appraisals with a senior member of staff.

People living at the home were involved in their care planning each month and signed off their care plan if they were able to. The care plans were detailed, clear and written in a person centred way. They contained lots of information about people’s different communication styles, health needs and information for staff on how to support people safely and in the way the person preferred. ‘Resident’s meetings’ were held to gain feedback from people living at the home.

At times people did things that may be unsafe to themselves or others and may be seen as challenging to support safely. We found evidence that staff responded appropriately ensuring people were safe. There was also attention given to making sure that any physical intervention was caring in its approach and was the least restrictive method used for the least amount of time. Staff were trained in a recognised technique and recei