The inspection was carried out on 17 and 23 July 2018. The first day of the inspection was unannounced.

7-9 Park Road South 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. It is registered to provide support for up to 21 people. At the time of our inspection 17 people were living there.

7-9 Park Road South provides support to people who have a learning disability, some of whom also require support with their mental health. Situated close to Birkenhead town centre the home appears externally as a domestic property on a residential street. Originally a pair of semi-detached houses the building has been converted to make one larger house.

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 has been in post since 2015.

The last inspection of the service was carried out in April 2016 and the service was rated good in all areas. During this inspection we found breaches in relation to Regulations 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014.

This was because the provider had not ensured care and treatment was provided with the consent of the relevant person. It was not clear from records whether people’s capacity to make important decisions had been assessed and what if any support they had received to make the decision and review it afterwards.

Although systems were in place for monitoring the effectiveness and quality of the service provided these were not always effective. For example, medication audits highlighted a concern with recording of medication and records showed that this did not improve following the audit process. Systems had also failed to note that not all care plan information was up to date or reviewed. In addition, audit systems had failed to identify that the home was not operating in line with current best practice guidance for supporting people with a learning disability. This includes Registering the Right Support.

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

In June 2017 CQC published Registering the Right Support. This along with associated good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability. At this inspection we assessed the service in line with this guidance.

7-9 Park Road South did not meet the values and principles of Registering the Right Support and associated guidance. Current good practice guidance encompasses the values of choice, independence, inclusion and living as ordinary a life as any citizen. The size, layout, staffing arrangements at 7-9 Park Road South meant that it does not feel or operate as people’s home. Certain physical aspects to the building and staff practices felt institutional and detracted from a homely atmosphere. This included staff wearing disposable gloves for no identifiable reason and wearing bunches of keys around their neck. We also saw that the office was a hub within the home with staff and people living there spending a significant part of their time in or near to it. People who required support to learn or retain everyday living skills were not routinely provided with this support.

The registered manager had a good understanding of Deprivation of Liberty Safeguards and had applied for these were an assessment indicated it was in the person’s best interests.

Polices were in place for safeguarding people from the risk of abuse and reporting any co

The inspection took place on 25 February and 1 March 2016 and was unannounced on the first day. The service is a care home which is registered to provide accommodation and personal care for up to 21 people who have a learning disability and/or other mental health needs. It is part of the range of services provided by the Wirral-based company Potensial Limited. The manager told us that due to changes made to the property, a maximum of 17 people could now be accommodated at the home.

At the time of our visit, 16 people were living at 7-9 Park Road South and all were accommodated in single bedrooms. Three of these people were having a short stay at the home and one person who usually lived there had been admitted to hospital.

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.

At the time of our visit the service had a registered manager, two senior support workers, nine regular support staff and two bank support staff, and a housekeeper.

We last inspected 7-9 Park Road South on 13 August 2014 when we found that the service was compliant in all of the areas we looked at.

During the first day of our visit we were concerned that there were not enough staff to fully meet people’s support needs. The manager told us this was due to a combination of some staff being on leave and others being off sick with a viral infection, which some of the people who lived at the home also had. On the second day we visited, there appeared to be enough staff.

The staff we spoke with had good knowledge of the support needs of the people who lived at the home. All staff had received training about safeguarding and this was updated every year. We saw evidence that regular environmental health and safety checks were carried out. We found that medicines were managed safely and records confirmed that people always received the medication prescribed by their doctor.

People had choices in all aspects of daily living. Menus were planned weekly to suit the preferences of the people who lived at the home and alternatives were always available.

People were all registered with local GP practices and had an annual health check. The care plans we looked at gave details of people’s medical history and medication, and information about the person’s life and their preferences. A 'health action plan' was in place for each person and there was a record of medical appointments people had attended.

The home implemented various methods of monitoring the quality of the service including daily checks, monthly audits, and satisfaction surveys. A monthly key worker summary was written for each of the people who lived at the home and a monthly meeting was held for people who used the service.

One inspector carried out this inspection, supported by an expert by experience. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

Two people who spoke to the expert by experience said :

“No, I don’t feel safe here, there are one or two of the residents that can be rather violent.”

“Yes, I feel safe. The staff here are superb.”

The two staff who spoke to the expert by experience said:

“I think people are safe living here, we do everything in our power to keep people safe.”

“I feel that they are very safe.”

We saw that people’s support needs were assessed and plans were in place for meeting their needs and keeping them safe. Staff had received additional training to enable them to keep people safe. A second member of staff was present in the home at night to provide support when needed for the support worker on night duty.

Regular health and safety checks were carried out and recorded to ensure that people had a safe environment.

Is the service effective?

People we spoke with considered that their needs were met at the home. They told us that they were supported to participate in community activities of their choice, to follow their hobbies and interests, and to attend medical appointments as needed. People’s individual needs were recorded in their care files and a ‘Key Worker Review’ was written monthly to record how people’s needs had been met. One person told the expert by experience:

“The staff encourage me to learn things. I make my bed and wash and iron my clothes.”

The expert by experience wrote:

‘It appeared quite clean and homely and the residents appeared quite free to move around the house as they pleased, they appeared to have good communication with the staff and all seemed very much at ease. There was no planned activity taking place during my visit although all the residents seemed quite content to do their own thing, one resident was writing up what looked like part of a life story and what had happened to them in the past, encouragement was being given by a staff member.’

Is the service caring?

People we spoke with said that they felt supported by the staff. They told the expert by experience:

“I get on with the staff.”

“The staff treat me with respect. If you talk to them nice they talk to you nice.”

“I’m OK with the staff.”

“Yes the staff are kind, caring people or they would not be working here.”

During our visit we observed that people who visited the office for support were treated with patience and respect and were encouraged to make their own decisions.

Is the service responsive?

We saw that people who lived at the home, visitors and staff were encouraged to express their views in monthly meetings and in satisfaction questionnaires. An appropriate complaints procedure was in place for people to use and an external advocacy service was available.

We saw that improvements to the environment had continued to ensure that people had a safe and pleasant home to live in and facilities were available to meet their needs, for example a small kitchen on the first floor for people to use.

Is the service well led?

The home had a registered manager who was supported by a senior support worker. An area manager was responsible for overseeing this and other services and visited regularly. We saw that all of the staff were involved in carrying out and recording regular checks and audits.

Senior staff who spoke with the expert by experience said:

“We have a staff meeting and we get our policies out and discuss how we conduct ourselves to respect service users.”

“If any service user wanted to complain, I would listen and write down their complaint, if it was about me or the manager I would speak to the area manager.”

“I have complaints forms at the front door and service users have their own service user guide and we have an easy read complaints form. Service users can come to the office any time they want.”

During our visit we were able to meet, and speak with, most of the people who lived at the home. There was a calm and relaxed atmosphere and people had freedom of movement around the home. People decided their own daily routines and most had one to one time during which they were supported to pursue their chosen leisure activities in the community. One person told us that they were excited about a forthcoming holiday to Blackpool. One person had a family member who was closely involved in their care and they stayed overnight once a week with their relative.

All medicines were kept in locked storage. A weekly medicines audit was carried out by senior staff and a quarterly medicines audit was carried out by NHS staff.

People had single bedrooms and had keys to their bedrooms. The home had a comfortable lounge, a conservatory and a dining room, so people had a choice of places to spend their time. There was an adequate number of WC’s and bath/shower rooms. At the back of the house there was an enclosed garden with table and chairs, and a smoking shelter. At the time of our visit a major refurbishment of the premises was taking place.

Rotas showed that there were usually three support staff on duty during the day, and one at night. Staff hours were calculated around the hours that people who lived at the home were allocated for one to one support.

We saw that records kept within the service were kept up to date, stored securely, and easily accessible.

People who lived at the home had opportunities to put forward their views of the service at regular house meetings and at care plan reviews. We observed that staff spoke to people in a respectful and polite manner and were aware of the need to protect people’s privacy and dignity. People's health and personal care needs were met with support from staff and this was recorded in detail in their care plans. The staff we spoke with told us that they had an established team with a low turnover which meant that they all understood people’s needs well. We saw records to show that the home implemented various methods of monitoring the quality of the service.

The people using the service said they liked living at the home. They said the staff are nice and they are always available when they want someone to talk to. They said the staff take them out and support them with different things in the home. The people using the service said they always receive their medication on time and they have never been spoken to or treated badly in any way. They said they enjoy the food and always have a choice. The people using the service said they know who to speak to if they want to make a complaint.