The inspection was carried out on 21 June 2018 and was unannounced.

Merseyview Residential Home 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.

Merseyview Residential Home is registered to provide support for up to 12 people. At the time of our inspection 9 people were living there.

The home is a four storey property with accommodation provided on the ground and first floor. A stair lift is available to help people access the first floor. Six of the bedrooms have en-suite toilets, with shared bathrooms available throughout the home. People share a dining room, lounge and enclosed back garden.

The home has a registered manager who has managed the home for over 20 years. 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 registered manager is also the provider of this service.

At our last inspection of the home in March 2017 the service was rated Requires Improvement overall. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 12 and17.

This was because there were no systems in place to assess, detect and control the risk of Legionella infection and there were no effective systems in place to assess, monitor and mitigate the risks to the health, safety and welfare of people who used the service.

After that inspection the provider wrote to us to say what they would do to meet its legal requirements. At this inspection we identified that improvements had been made and the provider was no longer in breach of regulation 12. We found that although the provider had made improvements they remained in breach of regulation 17 because systems and records were not always in place or consistently followed to audit the safety and quality of the service provided.

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

The environment and building at Merseyview were regularly checked and audited. This included regular maintenance checks and checks of fire, water and electrical systems. Other records and systems for checking the quality and safety of the service were not robust or consistently followed.

Training records were patchy and relied on either the knowledge of the registered manager or the time to scrutinise individual staff files. This meant that it was difficult to establish if training provided and planned was suitable to equip staff with the knowledge they needed to support people safely and well.

Similarly, systems for auditing medication were time consuming and findings were not always recorded. No clear system for auditing care plan information was in place. This meant that information staff held about people was not always recorded. Although the registered manager had a good knowledge of people and there was a stable staff team the lack of clear systems meant it was not always possible to audit the service and plan future improvements.

People were very positive about living at Merseyview and about the staff who supported them. Comments we received from people included, “I am in luxury,” “It’s very good, they look after me,” and “So friendly, they are like my on family.” This was echoed by a visitor who told us, “Fantastic care, owners fantastic, staff are brilliant they will do anything for you. [my relative] seems happy.”

People felt safe living at Merseyview and staff knew what action to take if they felt people were at risk of abuse. A system was in place for raising concerns or complaints and people living at the home

This inspection took place on the 23 March 2017 and was unannounced. Merseyview Residential Home provides accommodation and personal care for up to 12 people. The home is a four storey property. Accommodation is on the ground and first floors and there is a stair lift to assist people to get to the upper floor. At the time of our visit, 11 people lived at the home.

The home has 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 registered manager is also the owner (provider) of the home.

During our visit, we found breaches of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014. These breaches related to the provision of safe care and the 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.

We observed that the practical administration of medication was not always safe. We also found that not all of the medicines at the home could be accounted for. Checks on the competency of staff to administer medication safely were not undertaken and staff were last trained in medication administration in 2015. This meant there was a risk this training was out of date. This placed people at risk of harm.

The home was well maintained and the home’s gas, electric and fire alarm systems were regularly inspected and were safe to use. A bath chair used by staff to lower people into the bath had not been checked in accordance with the Lifting Operations and Lifting Equipment Regulations 1998. (LOLER). This meant the manager and staff could not be sure it was safe to use.

The home’s fire risk assessment was out of date and had not been reviewed annually as recommended by Merseyside Fire and Rescue Service and there was a lack of suitable personal emergency evacuation plans in place for people who lived at the home. This meant staff and emergency personnel did not have important information on people’s needs and risks to assist them to evacuate people safely in an emergency.

Staffing levels were sufficient on the day of our inspection but some staff had not been recruited robustly. This was because information on the staff member’s skills and abilities had not been properly gathered or assessed prior to employment. These staff did not have contracts of employment in place and there was no evidence that one staff member had received an induction into their job role. Checks to ensure staff were safe to work with vulnerable people were made, previous employer references and information relating to the staff member’s identify were also obtained.

There was no system in place to assess, monitor and manage the risk of Legionella bacteria occurring in the home’s water supply. We spoke with the manager about this and they said they would address this without delay.

People’s care plans contained person centred information to enable staff to understand their needs and respect their wishes. Risks associated with people’s care were assessed and staff had guidance on how to manage these risks. For some risks, this guidance was brief and required further detail to ensure that staff had sufficient information. We saw people had access to support from a range of healthcare professionals where specific risks were identified. Some records relating to the repositioning of one person had not been kept in accordance with professional advice. We spoke with the manager about this. They told us they would commence this immediately.

Staff received training and support to do their job role. Our observations of care were positive. The manager and staff had a good knowledge of people’s needs and were kind, cari

We found that people who used the service were happy living at this home. They told us they were well cared for and felt it was like a family home. They told us:

“They look after me very well”,

“I love it here, everyone is friendly, it’s like a family”,

“I am happy here, it is my home”.

We found that people were asked their permission and consent gained to undertake care. People told us and we observed that they were treated well and with respect. People's choices were respected and they felt listened to.

Care needs were assessed, risks identified and care planned in order to meet people's needs. Staff were trained in emergency life support and were able to tell us what they would do in the event of an emergency.

People were cared for by staff who were suitably qualified and experienced and had the relevant checks undertaken for working at the home.

We found that there was not an effective complaint system in place. The complaints policy and procedure were out of date and inaccurate. The policy and procedure had not been brought to the attention of people who used the service or others, information was not available on the process and it was not publicised.

People told us they were generally satisfied and were happy living at the home. They all felt they were well cared for and treated respectfully. They told us:

“It’s good here”,

“They look after me well”,

“The carers are very good and help with everything, I couldn’t ask for anything more”.

We found that improvements had been made since our last inspection. We found new care documentation was in place and generally reflected the identified risks and needs of the people who used the service. We noted that improvements were needed to ensure that written agreement to people's wishes and consent to care and treatment was recorded.

People told us that the food was very good at the home. We found that a nutritional risk assessment tool had been implemented and that dietary care was planned and delivered according to need.

Improvements had been made with respect to staff training, we found evidence that all staff had been trained within the last year in relevant core topics. However we found that staff records did not contain the relevant information required of them in respect of their recruitment and the appropriate checks required to be undertaken.

There had been improvements in quality monitoring and we saw that the provider had gained people's views on the service in the form of a quality questionnaire. Formal checks of environment and risk assessments had been undertaken. However there was no formal audit plan in place.

We asked commissioners of the service for their views; they did not have any relevant or concerning information regarding this provider.

We spoke to some people who use the service when we visited on 17 July 2012. People we spoke to said they felt well involved with their care however were not familiar with their care plans. People who use the service told us they felt staff listened to them and would respect their wishes where possible when being cared for. We were told staff were approachable and felt they would be able to contribute views and suggestions regarding care and that this would be listened to. People told us the food was very good. There was one choice on the menu at mealtimes however we were told that they could request an alternative if they wanted to and this was respected.

All the people we spoke to told us they were treated well and with dignity and respect. People said “It’s excellent here”, “They do everything well” “It feels like home”.

We visited the home on 14 July 2011 and spoke to some people who use the service. Those people we spoke to were very satisfied with the care and treatment given at the home. They made comments such as “I am very happy here” and agreed that they were well cared for and looked after. They told us that they were involved in decisions regarding their care. They also told us of the activities and outings that they enjoyed and they spoke highly of the staff at the home. They felt well cared for and said that staff treated them with dignity and respect.

We were told by the people who use the service that the food is good at the home. They said that there was always plenty of it and good choices. They told us they were flexible with choices and were asked their preferences. They were able to have alternate choices if they did not like something.

A favourite meal of those we spoke to was the Friday night fish supper. Occasionally the manager and cook would order take away fish and chips from the local chip shop on a Friday. All those we spoke to mentioned this and how much they enjoyed it.

Merseyview Residential Home provides accommodation and personal care for up to 12 people. The home is a four storey converted period property. Accommodation is on the ground and first floors and there is a stair lift to assist people to get to the upper floor.

This was an unannounced inspection carried out over two days on 22 December 2014 and 2 January 2015. The inspection was carried out by one Adult Social Care inspector.

We last inspected Merseyview on 1 October 2013. At that inspection we found the service was meeting all the essential standards that we assessed except for one. We found there was an out of date complaints policy and procedure in place. Following this the provider sent us evidence that the issue had been addressed.

We observed care and support in communal areas, spoke to people in private, and looked at care and management records. There were eight people living at the home on the first day we visited, and nine on the second day.

People told us that they felt safe in the home and the staff knew how to recognise and report abuse. We found that the premises were clean, safe and well-maintained. Staff were recruited safely and there were enough staff to provide the support people needed. People’s medicines were handled safely.

The staff were trained and competent to provide the support individuals required. People received enough to eat and drink and choices were always available. People received the support they needed to see their doctor. Where people had health care needs, appropriate specialist health care services were included in planning and providing their care.

People were supported to maintain their independence and control over their lives. People were treated with kindness, compassion and respect. Relatives of people who lived at the home told us that they were very happy with the care their loved ones received.

People’s needs were assessed and provided as agreed in their care plans. People made choices about their lives in the home and were provided with a range of activities. There was a system to receive and handle complaints or concerns.

The provider was also the registered manager and worked full-time at the home. Staff told us that they were well supported by the manager and there were good communication systems in place.