This unannounced inspection took place on 31 May 2018. Mother Red Caps 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 registered to accommodate up to 50 people in purpose-built three-storey premises and 50 people were living there at the time of this inspection.

The home 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.

At our last inspection of the home in March 2017 we found that the service overall required improvement, however there were no breaches of Regulations of the Health and Social Care Act 2008.

People we spoke with during the inspection believed the home was safe. Maintenance records showed that regular checks of services and equipment were carried out by the home’s maintenance person and testing, servicing and maintenance of utilities and equipment was carried out as required by external contractors.

There were enough qualified and experienced staff to meet people’s care and support needs. Recruitment records showed that robust procedures had been followed to ensure new staff were of good character.

Risk assessments were recorded in people’s care notes and plans put in place to reduce the risks identified. A log of accidents and incidents was maintained and the records showed that appropriate action had been taken when accidents occurred.

Staff received training about safeguarding as part of their induction, with updates periodically. The manager had reported safeguarding incidents as required and full records were kept of safeguarding referrals that had been made.

The service complied with the requirements of the Mental Capacity Act and appropriate Deprivation of Liberty Safeguard applications had been made to the local authority.

People told us they enjoyed their meals and had plenty to eat and drink.

There was a comprehensive programme of training for all staff to ensure that they knew how to support people safely.

People who lived at the home told us that the staff provided them with good care and support and we observed that staff treated people with kindness and respect. Everyone had their own bedroom and personal care was provided in a discreet way in the privacy of the person’s room.

The care files we looked at showed that people’s care and support needs were assessed covering all aspects of their health and personal care needs and personalised plans were written for the care and support people needed. These were kept up to date with monthly reviews.

There was a planned programme of regular social activities, including trips out.

Regular meetings were held for staff and for people living at the home and their families. The staff we spoke with told us they enjoyed working at the home and found the management very supportive.

People spoke highly of the home manager and described him as approachable and supportive.

There was a schedule of quality audits for the year and these had all been completed to date. They were accompanied by action plans for improvement as needed.

This unannounced inspection took place on 15 and 22 March 2017.

At our last inspection on 26 March 2015, we had found that there were breaches of regulations 11 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the need for consent and inadequate staffing levels.

At this inspection we found that the provider had made improvements in these areas.

Mother Redcaps Home is in a residential area of Wallasey, in Wirral, overlooking the Mersey estuary. The home has capacity for and is registered to provide accommodation and nursing for up to 51 people. At the time of our inspection, there were 49 people living in the home.

The home is a large building over three floors and all rooms are for single occupancy. There are communal lounge areas on each floor. The home was divided into three units. The lower floor accommodated 12 people who were living with dementia but did not require nursing care. The middle floor accommodated 16 people who required nursing care. The top floor accommodated 21 people who required personal care.

The home requires 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 registered manager had left the home several months prior to our inspection. The current home manager at the time of our inspection had been in post for four months and had applied for registration with the Care Quality Commission.

We looked at records relating to the safety of the premises and its equipment, which were correctly recorded. Records we looked at showed that the required safety checks for gas, electric and fire safety were carried out.

The home used safe systems for recruiting new staff. When we looked at staff recruitment files and we saw that staff had been recruited using safe recruitment methods. There had been appropriate application and interview process and before any staff member had started in employment there has been checks made on their previous employment history and any criminal records. These included using Disclosure and Barring Service (DBS) checks. References were available from at least two sources including applicants last employer.

A new training provider had been sourced who provided face to face training which staff enjoyed. Staff told us they felt supported by the deputy manager and the home manager.

Food menus were flexible and alternatives were provided for anyone who didn’t want to have the meal on the menu for that day. People we spoke with said they always had plenty to eat. However, some people complained about the quality of the food. We observed the lunch time meal where staff were observed to support people to eat and drink with dignity. However, some people who needed support were not given help due to a shortage of staff. People and some staff told us there were not enough staff, especially at peak times such as the morning or at mealtimes.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

We found that the care plans, risk assessments, staff files and other records were in the process of being reviewed and updated.

People told us they felt safe with staff and this was confirmed by people’s relatives who we spoke with. The home manager had a good understanding of safeguarding. The home manager had responded appropriately to allegations of abuse and had ensured reporting to t

This inspection took place on 26 March 2015 and was unannounced. The previous inspection took place in January 2015. The provider had met the standards that were inspected.

The service 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.

Mother Red Caps Home is in a residential area of Wallasey on the Wirral. It overlooks the Mersey estuary. The home has capacity for up to 51 people. At the time of our inspection, 28 people lived at the home. 10 of the people who lived there required nursing care. The home is a large building over three floors and all rooms are for single occupancy. At the time we visited, the lower floor unit was providing residential dementia care for 12 people; the ground floor unit was providing nursing and residential care for 14 people; and the first floor was providing residential care for two people. There were communal lounge areas on each floor. Plans were in place to re-locate people from the ground floor to the first floor in the week following our inspection.

People who used the service told us they felt safe when receiving care in their home. However, some people told us they had to wait for assistance as staff were often busy. We found that staffing numbers were insufficient and people’s personal care needs were not always met in a timely manner.

Recruitment processes were robust so that people were supported by staff of a suitable character.

Medicines were managed safely and people received their medicines as prescribed. Improvements had been sustained since our last inspection in January 2015.

The service was not effective in upholding the rights of people who lacked capacity. Decisions were made without informed consent being obtained.

People told us they enjoyed the food that was on offer and had plenty of choice. However, the arrangements for meal times were hap-hazard and people were unnecessarily made to wait to be assisted to eat.

People were cared for in an environment that was not dementia friendly. Even though some activities were seen to take place, people with dementia did not have access to any meaningful activities.

People who used the service and their relatives told us they had no complaints about the service. They told us they knew how to make a complaint and felt the manager was approachable.

The service was not always well managed because systems were not in place to ensure the rights of people who lacked capacity were upheld. People spoke highly of the management team that was in place. The registered manager was continually trying to improve the service and had plans in place to demonstrate how they were going to do this.

The inspection team was made up of one inspector and a pharmacist inspector. We set out to answer four questions where concerns had been identified at a previous inspection. These questions were; Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe. At this inspection we found that people were protected from harm as appropriate arrangements were in place for obtaining, recording, storing and handling medicines.

Is the service effective?

The service was effective. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements in respect of medicines that were to be given covertly.

Is the service responsive?

The service was responsive. We saw that people's medication was now obtained in a timely manner and adequate supplies were kept in the home.

Is the service well led?

The service was well-led. A new manager was now in place having been appointed following our last inspection. An application to register with the Commission was on-going during this inspection process.

We found that the manager carried out frequent medicine audits and monitored staff practice related to medicines in the home.

The inspection team was made up of two inspectors and a pharmacist inspector. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and there were enough staff to meet people's needs. Required recruitment checks into character, qualifications and experience were carried out to make sure that staff were suitable.

The arrangements for the management of medicines did not ensure that people were given their medicines at the times they needed them, which may have put them at risk of harm.

Is the service effective?

People’s care needs were assessed with them, and they were consulted about their care plans in relation to personal care. However, some people's medication was being disguised in food without their knowledge or consent. The provider did not have proper systems in place to ensure that this was in the best interests of the people concerned and that their rights were upheld.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us staff were polite and had always treated them well. Comments included: "The girls are great”; "The staff are very kind"; "They have a good attitude".

Is the service responsive?

Relatives of people who used the service told us they were involved in their relative's care and support. One person commented; “I'm very happy with my father's care, I'm kept involved and informed and there are no restrictions on visiting".

People were referred to relevant health care professionals such as their GP, a dietician or nurse specialist when necessary. However, changes to medication were not implemented in a timely manner.

Is the service well-led?

The home did not have a registered manager who had been assessed by the Care Quality Commission as fit to manage the service.

The service had a quality assurance system. People using the service and their relatives completed an annual satisfaction survey and were invited to meetings to discuss the care provision. There were checks in place to identify risks but these were not always managed effectively. Medicine audits seen by us showed that shortfalls identified had not been addressed.

We spoke with seven people who were residing in Mother Red Caps Home. All expressed satisfaction with the care and support provided by the home. Comments included: "I like it here"; "The food is good"; "Nothing is too much trouble".

We spoke to the relatives of three people residing in the home, who were also happy with the care provided. Comments from relatives included: "The care is outstanding"; "We honestly couldn't ask for anything more"; "My mother is really settled here".

We spent time observing staff interactions with people using the service. We saw that staff explained what they were doing, didn't rush people and were reassuring.

We examined the home's recruitment processes and found that the registered manager carried out the necessary checks to ensure that staff were appropriately qualified and physically and mentally fit for the job.

At previous inspections we had found that appropriate arrangements for safely handling medicines were not in place. At this inspection we found significant improvements had been made and overall we found medicines were being safely and appropriately managed.

At previous inspections we had found that there was inadequate control of water temperatures to reduce the risk of scalding. Since then the provider had made improvements to the heating and water systems and regular checks were carried out on the water temperatures to ensure they were not too hot.

The home was clean, warm and well furnished.

People told us that they were well cared for and staff were responsive to their needs. Comments included: "The staff are marvellous"; "I have no complaints"; "The staff are very friendly. I once had a minor concern but the staff sorted it out for me straightaway".

We spent time observing staff interactions with people using the service. We saw that staff explained what they were doing, didn't rush people and were reassuring.

The manager (not yet registered) had been in post for four months and had begun to implement systems to seek the views who used the service and identify and manage risks. Staff expressed confidence in the manager and felt that standards had improved since her appointment.

However, we found that people's safety was still at risk because there was inadequate control of hot water temperatures. We have referred this matter to the Health and Safety Executive.

We also found continued concerns with the management of medicines and are considering taking further action.

We spoke with four people living in the home and two relatives. People said they were happy with the care provided. Comments included: “They look after me”; “The staff are very understanding”; “They are caring and attentive”; “On the whole mum gets good support and staff treat her with dignity and respect”.

People told us that, on the whole, they enjoyed the food provided and they were offered choices. Comments included: "The food's not bad"; “The food’s very good”; "I can choose what I have and some days it’s very nice”.

We spent time observing staff interactions with people using the service. We saw that staff explained what they were doing, didn’t rush people and were reassuring. However we did find that, for two people, not all staff were aware of their current needs. Also people were not encouraged to eat at a dining table.

Since the last inspection there had been another change in manager. This was the fifth manager in two years.

Staff we spoke with said they were provided with training in how to carry out their role and that the current acting manager was supportive.

We found continued concerns with the management of medicines and are considering taking further action.

In addition we found that the registered provider did not have adequate systems in place to seek the views of people using the service or identify and manage risks.

We carried out an inspection on January 30th and 31st 2012 and found improvements needed to be made. Following this the previous manager had sent us an action plan telling us how they were going to meet and maintain compliance with the regulations by June 2012.

We carried out this inspection on the 7th June 2012 to check whether improvements had been made. The CQC had also received several safeguarding concerns since our last inspection therefore we also looked at other standards relating to these concerns.

On the day of our inspection there was a new manager in post who had only been there for three weeks and had not seen the action plan but was however, able to discuss details from it. We saw evidence that the previous manager had begun implementing the plan and that the new manager had also made additional plans to improve the service.

We spoke with eight residents and their relatives and friends. All of the residents we spoke with were happy with the home. One person told us “I am very lucky and fortunate to be in this home.” We spoke to two friends who told us they thought their friend and others were always treated kindly and respectfully. They also told us they did not have any concerns or issues about the care received.

One relative said staff were very caring and they had been involved in the care planning process. Another person said “the staff are excellent and treat me very well.”

At this visit an expert by experience (an independent person with personal experience of the provision of care the service is registered to provide) also attended. One resident told the expert by experience that staffing levels at night were inadequate and medication had been given out at the wrong time at night. We also saw one suggestion in the suggestions box that more staff were needed. They also said the food was good and that they were given a choice in what they wanted to eat. The expert by experience also noted a lack of dining tables and chairs for residents. Two residents told the expert by experience that they had not been involved in any surveys.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed staff provided care in a sensitive and caring way.

Prior this inspection we had received information from the Local Authority Commissioners who had undertaken a monitoring visit and evidenced improvements in the quality of the service.

We observed how people were supported during the visit. At this visit an expert by experience (an independent person with personal experience of the provision of care the service is registered to provide) attend this visit. The expert by experience saw that people who lived in the service had a degree of choice of when they got up and went to bed. One person wanted a lie in and was being provided with a late breakfast to support their choice.

People who lived in the service told us that they felt safe and well cared for and several of them made clear that they saw Mother Red Caps as their home and not an institution. The expert by experience observed that one person had misplaced their reading glasses and proudly told them that even though they kept losing their spectacles the care workers went to look for them.

We spoke to people living in the service who told us that they were

“Very happy”, living in the service.

Some told us that “it can take time for someone to come, but not often left for long and the staff are so nice”,

“It’s much nicer lately”,

“Would like more things to do during the day can get a bit dull”

“It’s my home I’m happy here”.

People living in the service were asked by the expert by experience had they became involved in their care plans. All those spoken with told them that they did not have any real ownership of their own care. The people spoken with did tell them that were quite confident that the care workers “would support them” appropriately”.

We contacted 16 relatives after our visit. They told us that

“It’s of a lot better in the last few months”

“There are still things to improve for my parent about some of things he does. I know he upsets some of the people who live there”,

“My relative had a sore bottom for months, I’m sure its getting better”

“They seem to be doing what they can to get my mother to eat and drink. “They called doctor as needed.””

Staff said she was eating and drinking, better”. .

“Like to see more activities, she sleeps all the time. There are days when she is alert but not much happens then”.

“I am made up, really nice and well looked after”,

“Staff spend loads of time with her”.

“They don’t do anything for him, put him in front of the telly and that’s it, I’d like it to be more active”.

The expert by experience observed that at times the approach from care workers gave little encouragement for people to support themselves. Staff confirmed to us that they often “managed” care and took “decisions” for people at times. The expert by experience observed that at lunchtime on the dementia care unit every person was served with the same main meal. The cook confirmed to us that he had not been asked for items such as “finger” foods which helped people less able to sit and enjoy a meal eat in a manner of their choosing.

One person told us they were comfortable and happy and enjoyed the food. Another person told us they were happy with the care and food provided. One person told us help is always there if you need it. A relative told us that they thought the staff were fantastic.

One person mentioned they would like assistance with dental care and help to keep their spectacles clean. Another person said they needed a more comfortable bed. One person told us that some of their clothes had gone missing.

We had mixed feedback from relatives about the quality of care provided by Mother

Redcaps. Some people said they did not feel that the home took individual needs and

personal choices into account in the way it provided and delivered care. Other relatives

said they thought the care was satisfactory. Residents told us their rooms were nice and

that they enjoyed the views.

Most relatives said they would like to see more support to help people maintain their

abilities and interests. A number of relatives said they were worried about staffing levels,

staff turnover and the use of temporary staff that were not familiar with the needs of people living in the home. The care and approach of a couple of staff was commended.

Other health and social care agencies also told us of concerns they had about the welfare

of people with high or complex needs living in the home. This included failure to consistently adhere to care and treatment plans or follow advice to effectively manage risk.

We had previously carried out an inspection on 7 June 2012 and found improvements needed to be made. We had received other concerns relating to people’s welfare since our last inspection therefore we looked at the standards relating to these concerns. We had also been made aware of ongoing investigations by other statutory bodies.

We carried out this inspection on the 14 September 2012 and also during the late evening of 17 September to check whether improvements had been made.

Some of the people at Mother Red Caps Home could not communicate verbally and we spent time observing the support they received. We found that staff were aware of the needs of the people who used the service. However, there were concerns identified during our visits regarding the lack of bathing opportunities and social activities.

At the last inspection we found continuing non compliance with the management of medicines and as a result we issued a warning notice. We found the provider had not complied with all aspects of the warning notice and as a result we are considering taking further action.

Satisfactory recruitment processes were in place but there were insufficient staff to meet people’s needs, in particular at night. We also identified safety concerns with fire doors and bed rails and we informed the Fire Safety Officer and Health and Safety Executive of our findings.