The inspection took place on 7 December 2017 and was unannounced.

Paisley Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Paisley Court is a purpose built fully adapted service registered to accommodate up to 60 people who require nursing or personal care. The service specialises in providing nursing care to older people with age related conditions including dementia. The service is divided into four units spread over two floors, with access to the upper floor via stairs and a lift. There is a car park to the front of the building and gardens to the rear.

At the last inspection on 11 November 201610 the service was rated Good. At this inspection we found the service remained Good.

At the last inspection we identified a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because appropriately trained staff were not always deployed in sufficient numbers to meet people’s needs. At this inspection we found improvements had been made and the breach was met.

There were enough trained and experienced staff on duty at all times to care for people.

The service was relaxed and homely and people could move freely around the service as they chose. People were supported to have maximum choice and control over their lives and encouraged to remain independent.

People’s individual needs had been assessed and used to develop care plans. These provided staff with guidance about the care and support people needed and how they wanted this to be provided.

People and their relatives were consulted about their care to ensure wishes and preferences were met. People chose how to spend their day and they took part in a wide range of activities they enjoyed. Visitors were welcomed at any time.

People received a varied and nutritional diet that met their preferences and dietary needs.

People were supported by a kind, caring and consistent staff team who knew them well. Staff had been recruited safely and had the skills and experience to meet people’s needs and provide effective care.

People received their medicine safely and were supported to access the support of health care professionals when needed. People were protected from the risk of abuse because staff understood how to identify and report it.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

The management team were approachable and they and the staff team worked in collaboration with external agencies to provide good outcomes for people. Relatives felt concerns would be taken seriously and acted on. Processes were in place to assess and monitor the quality of the service provided and drive improvement.

The inspection was carried out on 11 November 2016 and was unannounced.

Paisley Court is registered to provided support for 60 people. At the time of this inspection 56 people were living there. The home was split into four units, Newsham, Woolton, Sefton and Jubilee. At the time of this inspection Newsham provided support to men only.

Situated in the Dovecot area of Liverpool the home is near to local amenities and bus routes. All of the bedrooms are single and provide en-suite toilet and basin facilities. Accommodation is over two floors with a passenger lift available for people to use.

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.

During the inspection we spoke individually with four of the people living at the home and with five of their relatives. We also spent time observing the care and support provided to people.

We spoke individually with eight members of staff who held different roles within the home and held a meeting attended by 18 members of staff. We examined a variety of records relating to people living at the home and the staff team including care plans, health and safety records and training and recruitment records.

At this inspection we found a breach of regulations. This was because there was not always sufficient numbers of competent staff working in the home who had received sufficient training and support to carry out their duties.

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

Staff sickness and a shortage of staff impacted on planned staffing levels on occasions. This meant that staff sometimes felt under pressure and unsupported. It also meant that newer staff or agency staff did not always have the information or support available to support people as well as possible.

Relatives told us that they thought Paisley Court 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 knew how to raise concerns or complaints and systems were in place for dealing with them.

People’s medication was safely managed with systems in place to ensure they received medication as prescribed and minimise the risk of errors occurring. Staff were aware of people’s health care needs and monitored their health, providing the support people needed. Permanent staff were also aware of the support people needed to manage the effects of their dementia and ensured this was provided.

Individual care plans were in place for everybody living at the home. These contained guidance for staff to follow to monitor the person’s care needs and ensure they were met.

People received the support they needed to eat their meals and were offered a choice of meals and drinks. Staff monitored people’s food and drink intake when required.

The building was clean and tidy with sufficient space for people to use mobility aids. Equipment and aids and adaptations were in place to support people with their mobility, health and personal care needs. Systems were in place and followed to ensure the building and environment were safely managed.

Permanent staff knew people well and spent time interacting with them as well as meeting their care needs. Permanent staff received training that helped them to carry out their role effectively and to understand and support people living with dementia.

The home had a registered manager who was knowledgeable and enthusiastic about the service provided and in planning further improvements.

Systems were in place for auditing the quality of the service and were effective at identifying and planning future improvements to the service peopl

We spoke with a range of people about the home. They included the manager, staff members, residents and visitors to the home. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at Paisley Court.

We used a number of different methods to help us understand the experiences of people who lived at the home. This was because the residents had complex needs and were not able to tell us about their experiences. People were encouraged to express their views and to be involved, where possible, in making decisions about their care and support. Relatives we spoke with told us they could express their views. They told us they felt listened to when discussing their relative’s care needs. Staff confirmed to us they involved relatives, where possible to ensure people received the right care and support.

We spent time in all areas of the home, including the lounge and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to the relatives of six people, who were very happy with the care their relatives received and told us “It is a great place, people here are treated as if they were at home with family” and that “you couldn’t have better staff”. One visiting healthcare professional told us they were “very pleased with the quality of the care in the home”.