This inspection took place on 3 and 4 July 2018 and was unannounced.

Moss View 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. The home is situated in the Huyton area of Liverpool. It provides, residential, nursing and dementia care for up to 78 people and at the time of the inspection there were 71 people living in the home.

A registered manager was in post. 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. We asked people their views of how the home was managed and feedback was positive.

The environment was not always maintained safely. The home’s electrical system had been checked and found to be unsatisfactory and we saw a number of fire doors wedged open.

Risk to people was not always assessed and managed appropriately. Risk assessments had not all been accurately completed to ensure the level of risk people faced was known and actions could be taken to reduce that risk.

Although medicines were stored safely, we found that they were not always managed safely as directions were not always clear and guidance for safe administration was not always followed.

Some applications had been made to deprive people of their liberty lawfully, however the registered manager told us there were a number of applications still to be made. These were completed before the end of the inspection. Not all conditions on the authorisations in place had been met.

Consent was not always gained and recorded in line with the principles of the Mental Capacity Act 2005 (MCA). Not all staff had a good understanding of the MCA and how to record agreements to care when people were unable to provide their consent.

Care plans did not all contain sufficient detail to inform staff of people’s needs and how they should be met and did not all reflect the current support being provided to people.

We looked at the systems in place to monitor the quality and safety of the service and found that they were not always effective as they did not identify all of the issues highlighted during the inspection. When areas for improvement were identified, it was not always clear whether actions had been taken to address them.

People told us they felt safe living in Moss View. Staff were aware of safeguarding procedures and how to raise concerns and accidents were recorded and analysed. Feedback received regarding staffing levels was mixed. We saw that staff were busy during the inspection, but were able to meet people’s needs. Staff had been recruited safely to ensure they were suitable to work with vulnerable people.

Staff were supported in their roles through induction, supervision and regular training. Staff told us they felt were supported and were able to raise any concerns with the registered manager.

People told us they had enough to eat and that they always had a choice. People were provided with support when needed. Staff were aware of most people’s individual dietary requirements.

Some steps had been taken to ensure the environment was suitable for people, though some areas required further refurbishment. The registered manager told us they had plans in place to make the environment more dementia friendly.

People living in the home, their relatives and visiting health professionals told us staff were kind and caring and treated people well. Staff were aware of people’s needs and preferences and how they liked to spend their day. We saw staff provide support in ways that protected people’s dignity.

People agreed that staff supported them to remain as independent as t

The inspection was carried out on 10 October 2016 and was unannounced. Moss View is registered to provide accommodation and support for up to 78 people. The home supports people living with dementia, and people who have both nursing care needs and personal care needs. At the time of our inspection 72 people were living there.

A separate unit known as Dodd unit provided care without nursing for people living with dementia. This unit provided two lounges and a dining room for people to share. The rest of the home was for people who had nursing and non-nursing needs. The ground floor had three big lounges and a dining room, with a sitting area in the entrance. The first floor had a small lounge.

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. A manager had been appointed to manage the home and had applied to become the registered manager.

The manager was familiar with the home and how it operated and was enthusiastic about further developing the service provided.

During the inspection we spoke individually with eight of the people living at the home and with four of their relatives. We also spoke individually with eight members of staff who held different roles within the home. We examined a variety of records relating to people living at the home and the staff team. We also looked at systems for checking the quality and safety of the service.

People told us that they though Moss View was a safe place to live. Safeguarding policies and procedures were in place to provide guidance for staff and these had been followed when needed. People felt confident to raise concerns or complaints and systems were in place for dealing with them.

People’s legal rights were protected and they were supported make as many decisions for themselves as possible.

Medication was safely managed with systems in place for minimising the risks of errors occurring. People received their medication on time and as prescribed. Staff were aware of people’s health care needs and monitored their health, providing the support people needed.

People’s support needs were assessed and evaluated regularly. Care plans contained information about the person, how they communicated and decisions they could make. This meant staff had up to date guidance available on how to support people safely and in line with their wishes.

People were able to personalise their bedrooms if they chose to do so. The home provided equipment to support people with their mobility and health. A lift was available and corridors were wide enough for people using a wheelchair or mobility aid to get around easily. Externally a number of enclosed areas were available, not all were currently in use. .A full refurbishment of the home was planned by the provider to take place in 2017.

Staff knew people well and spent time talking with them and meeting or anticipating their support needs. Staff were busy but able to meet people’s care needs. Procedures were in place and followed for recruiting new staff. These were not always robustly recorded. Staff had a good understanding of their role in supporting people, received training and used this to suggest improvements to the service they provided.

People had plenty to eat and drink and could request an alternative at mealtimes. Staff monitored people’s food and drink intake and the quality of meals provided.

Systems were in place for auditing the quality of the service and were effective at identifying areas where improvements could be made.

We found that people who used the service were treated well and with dignity and respect. Care plans demonstrated people had been involved in discussions and reviews regarding their care and treatment plans.

People who used the service and their relatives told us they were very satisfied with the care and support given to them. They told us:

“It’s very good here, I feel at home”,

“It’s like home from home”

“It’s excellent”.

Care and support plans identified people’s needs and how their needs were to be met. Risk assessments and care plans were seen to be individualised and covered all aspects of a person’s needs including physical, behavioural, mental health and social. Risk assessments and care plans had been completed in full and reviewed every month.

People were protected from the risks of abuse as staff were trained and knowledgeable in safeguarding vulnerable adults. Appropriate guidance and support was available.

There were sufficient numbers of suitably qualified and experienced staff in order to care and support people. Records were found to be held securely, yet accessible and were accurate.

We spoke with three people who lived at Moss View and four relatives. Their comments included:

"Happy with the care provided"

"A caring, loving service, all the staff respect her (relatives comment)"

"I cannot fault any of them"

"Come here, it's very welcoming. The manager is very good"

We also met with several of the other people living there and observed the support provided to them. During our visit we observed a friendly relaxed atmosphere with positive interactions between staff and the people who lived at Moss View.

We saw evidence of robust care planning that had been personalised and addressed specific individual needs.

We were told that there was an activities coordinator within the home and we saw evidence of a wide programme of activities that had been provided.

We saw a complaints policy and information was displayed on notice boards on how to complain.