We carried out an unannounced inspection of Oxton Manor on 12 June 2018. Oxton Manor is a detached house providing care for up to 15 people with complex learning disabilities. The home is situated in Oxton on the Wirral. At the time of inspection there were 12 people living in the home and two people who were respite.

Oxton Manor is a ‘care home’ for people with learning disabilities. 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 care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

Registering the Right Support gives guidance surrounding the maximum amount of people a home providing support to people with learning disabilities should have. Guidance states this should be six however Oxton Manor had been registered since 2014 to provide a service to 15 people. We saw that the home itself was situated in a residential area and that people with learning disabilities who were using the service were able to live as ordinary a life as any citizen.

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 service had a registered manager in place.

We previously inspected Oxton Manor in October 2016. We found the home was Inadequate and enforcement action was taken by CQC. This was followed by an inspection carried out in April 2017 where we found improvements had been made and so we cancelled the proposed enforcement action. During this inspection we found that Oxton Manor continued to improve however we identified that further improvements were needed.

For services rated Requires Improvement on one or more occasions, we will take proportionate action to help encourage prompt improvement. Regulation 17(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires a provider to give us information – when we ask them to do so - about how they plan to improve the quality and safety of services and the experience of people using services.

We found that risk assessments were not always fully completed and did not give full information about the level of risk. However, staff monitored people regularly.

We found that recruitment processes continued to improve. However, we found that although the culture of the service had significantly improved with changes that had occurred to staffing, the recruitment process needed to be more robust to show the registered manager had followed procedures appropriately to ensure the safety of the people living in the home.

We saw that the environment continued to improve with clean, open and cheerful areas. However, we identified that some fire doors were wedged open and that this had not been reported for the maintenance person to fix. We identified that other doors had been reported and fixed.

Care plans did not always reflect the needs of the people living in the home. We saw improvements continued to be made in people’s care plans and the registered manager was in the process of reviewing all care files. There were varying levels of information held in each care plan and staff gave differing examples of how to support a person in certain situations.

Staff received training appropriate to their role. They told us that they felt well supported and effective in their roles. We saw that trained

This inspection was carried out on 06 April 2017and was unannounced. Our previous comprehensive inspection of the home in October 2016 had placed the home in special measures and had rated the service as ‘inadequate’. We carried out this inspection as we needed to check that improvements had been made to the quality and safety of the service.

Oxton Manor is a detached house providing care for up to 15 people with complex learning disabilities. The home is situated in Oxton, in Wirral, Merseyside. All the bedrooms have en-suite facilities and there are gardens to the front and back of the property.

The home has a manager who had applied for registration 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 2008 and associated Regulations about how the service is run.

At our last comprehensive inspection of the home in October 2016 we found a number of breaches of regulations. As a result we served a Notice of Proposal to close the home due to breaches of the Health and Social Care Act 2008, which were related to person centred care, safe care and treatment, premises staff recruitment, training, supervision and the management of the service. We found that improvements had been made in all of these areas but minor further improvements were required. However, in response to the improvements that had been made we took the home out of special measures.

We had previously found that parts of the environment were dirty, shabby and unsuitable for the people living there. Infection control standards at the home required improvement. At this inspection we found the building and equipment had improved and it provided a safe environment for people to live in.

During our last inspection we had found care plans and risk assessments were difficult to navigate and did not provide up to date information to inform staff about people’s support needs. Where people's needs had changed, their care plan and therefore guidance to staff had not been updated. When other health professionals had been accessed this was not appropriately logged and information was difficult to find. This had placed people at risk of receiving unsafe care. During this inspection we found that this had improved and the provider had implemented new procedures that were adhered to by all staff.

During our last inspection we had found that there were few quality assurance systems in place and we had found the management of the home inadequate. During this inspection we found that this had improved, there was a new manager in post and they had implemented new quality assurance processes that were being followed by staff.

We had previously found staff did not receive the training, support and supervision they needed to support people with complex needs. During this inspection we found that this had improved and the new management had implemented supervision and training for staff.

People we spoke to were happy with the food provided and we saw that people were able to choose their meals and received support if it was needed.

There were sufficient staff working at the home to meet people’s care needs and staff were friendly, welcoming and were observed to have good relationships with people living in the home and a kind and respectful approach to people’s care.

We found that the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS), had been adhered to in the home. The registered manager told us of the people at the home who lacked capacity and that the appropriate Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority.

The manager was a visible presence in and about the home and it was obvious that they knew the people who lived in the home well.

Oxton Manor is a detached house providing care for up to 15 people with complex learning disabilities. The home is situated in Oxton on the Wirral.

This was an unannounced inspection carried out on 10 and 11 October 2016. These visits formed part of this inspection. We began this inspection due to information we had received from the local authority. Concerns we had received included the management style at the home and cleanliness of the building.

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.

During our inspection, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulation 9, 10, 12, 15, 17, and 18 of the Health and Social Care Act 2014 Regulations. These breaches related to person centred care, safe care and treatment, premises staff recruitment, training, supervision and the management of the service.

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

Parts of the environment were dirty, shabby and unsuitable for the people living there. Infection control standards at the home required improvement.

Care plans and risk assessments were difficult to navigate and did not provide up to date information to inform staff about people’s support needs. Where people's needs had changed their care plan and therefore guidance to staff had not been updated. When other health professionals had been accessed this was not appropriately logged and this information was difficult to find. This placed people at risk of receiving unsafe care.

There were a few quality assurance systems in place but they did not operate effectively enough to ensure people received a safe, effective caring, responsive and well led service. Overall we found the management of the home inadequate.

Staff did not receive the training, support and supervision they needed to support people with complex needs. This placed people at risk of receiving inappropriate and unsafe care.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system

to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their

registration.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location from the providers registration.

We carried out an unannounced inspection of Oxton Manor on 2 March 2016. Oxton Manor is a detached house providing care for up to 15 people with complex learning disabilities. The home is situated in Oxton on The Wirral. At the time of our visit the service was providing support for 15 people.

The home comprised of 4 floors, two of which are split level. Each bedroom is ensuite with showers and there are communal bathrooms available. The two lower floors have communal areas and dining areas.

The service had a registered manager 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.

People who lived in the home told us they felt safe at the home and had no worries or concerns. From our observations it was clear that staff cared for the people they looked after and knew them well.

All medication records were completely legibly and properly signed for. All staff administering medication had been trained in medication administration.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been followed. The provider told us that DoLS applications had been submitted to the Local Authority for some people

People and relatives we spoke with said they would know how to make a complaint, none of the people or their relatives we spoke with had any complaints.

We saw that some of the communal areas in the home looked tired and shabby and would benefit from re-decoration.

We noted that the manager was in the process of implementing improvements needed in the home and we saw an improvement in the systems that had been prioritised.

Staff were recruited safely and there was evidence that staff had received a proper induction or suitable training to do their job role effectively. The majority of staff had been supervised regularly and appraised annually.

People and staff told us that the home was well led and the staff told us that they felt well supported in their roles. We saw that the managers were a visible presence in and about the home and it was obvious that they knew the people who lived in the home well and that the staff were well supported to carry out their duties

We previously carried out an inspection of Oxton Manor on 29 April 2013. We found concerns relating to consent to care, care and welfare, safeguarding and staff training. The provider sent us an action plan to say how they would become compliant with the Health and Social Care Act (2008) (Regulated Activities) Regulations 2010. The purpose of this inspection was to check the home was now compliant with the regulations.

At this inspection, we found that the home had fully implemented their action plan.

We had previously spoken with relatives at our last inspection who were happy with the care provided. At this inspection we observed the care given and found that people who lived at the home appeared happy and relaxed. We found people’s care plans had been improved to incorporate guidelines to help staff when people became distressed.

We found the home advertised the services of an independent advocate who had visited the home and that people’s care files now contained consent forms. Staff had received refresher training about the Mental Capacity Act 2005. We spoke with two members of staff who were aware about the issues of consent.

We found the home had implemented a new monitoring system for incidents and had updated their safeguarding training.

We will continue to monitor the home to make sure that improvements are built on and sustained.

At a previous inspection on the 29 April 2013, we identified concerns regarding the lack of systems in place for monitoring the quality of service and managing risks. We issued a warning notice to both the provider and the manager of the home asking them to be compliant with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 by August 2013. We also identified other concerns which we will follow up at a future inspection.

The purpose of this inspection was to check if the provider and manager were compliant with the warning notice. We spoke with two relatives of people who lived at the home who told us they were happy with the quality of care received. One person told us that their relative “considers it to be their home” and another said “We are quite satisfied with the home.”

We spoke with the manager and two members of staff who told us about the improvements that had been made. We found some improvements in the monitoring of quality of service, such as improvements in the complaints procedures. We also found some improvements in systems in place to manage risks, such as monitoring any incidents.

We will continue to monitor the home to make sure that improvements are built on and sustained.

People who lived at the home did not always have the mental capacity to make certain decisions. We could find no evidence of any ‘best interests’ meetings being held for any major decision affecting any individual regarding their welfare and financial interests.

We found staff did not understand the Mental Capacity Act (2005), Deprivation of Liberty Safeguards and the issues of consent. We spoke with the senior operations manager after our inspection who told us training was being organised for all staff.

Relatives spoken with were happy with the care provided. One relative said “The staff are always very welcoming and chat with us” and another said "They keep me updated." However, we found care plans lacked specific guidance for staff on how to look after people. In particular there was no guidance for staff regarding the use of de-escalation techniques needed for individuals who could present with challenging behaviour.

We found safeguarding issues were not reported to us or the local authority. Staff did not understand safeguarding and the manager did not how to report safeguarding issues to us.

We found there were inadequate quality assurance systems in place to regularly identify, assess and manage risks to the health and welfare of people who lived at the home.

Oxton Manor is a detached house providing care for up to 15 people with complex learning disabilities. The home is situated in Oxton on the Wirral.

At the time of our inspection there was no registered manager in place at the home. The last registered manager had applied to have their registration removed in August 2013. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. It is a condition of Oxton Manor’s registration with the CQC that a registered manager is in place.

We found that people liked living at Oxton Manor and felt safe there. They liked the staff and got on well with them. They took part in a number of activities but these were sometimes limited because of the staffing levels at Oxton Manor. Activities were not always tailored to the individual needs and preferences of the people who lived at Oxton Manor.

People who lived at Oxton Manor had contact with community health professionals who either visited them at Oxton Manor or who saw them at their local surgery. There had been recent developments with regard to health promotion. Staff had received training in the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) associated with it. There were no people in the home who were subject to DoLS at the time of our inspection.

We could not see evidence that people who lived in the home had been involved in deciding on their care. Records at Oxton Manor were not always complete and up to date. This meant that people might not receive care that was appropriate. The home did not comply with the relevant regulation concerning this. You can see what action we told the provider to take at the back of the full version of the report.