This inspection was carried out on 31 May 2017 and 01 June 2017, the first day of the inspection was unannounced. Redholme Memory Care provides personal and nursing care for up to 55 people with dementia. The home is divided into three units over three floors. Parking is available directly in front of the home and there is a large garden with lawns and seating at the back of the property.

Redholme Memory Care 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 at the home were protected from the risk of potential abuse because staff had undertaken safeguarding training to recognise and respond to potential signs of abuse. Staff showed that they had a good understanding of what safeguarding meant and how to report it. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults.

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 Authorities for some people

Staff were recruited safely and the staff had been supervised and appraised. The registered nurses had the appropriate checks regarding their registration with the Nursing and Midwifery Council. We found that staff were appropriately skilled and trained to meet people’s needs effectively. We found that staff completed an induction prior to starting work in the service.

Redholme Memory Care offered a wide range of both group and individual activities that were seen to be meaningful to the people who lived in the home and which had a positive impact on their lives. They were taken to activities outside the home and encouraged to keep family connections with open visiting, relatives felt they could visit at any time.

The staff in the home knew the people they were supporting and the care they needed. We observed staff to be kind and respectful. Staff told us that the home was well led and staff told us that they felt well supported in their roles. The registered manager had a visible presence in and about the home and it was obvious that they knew the people who lived in the home extremely well. Learning was shared from within and outside the organisation and community contacts had been established.

People had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime and the feedback received throughout the inspection was all positive.

Care records, risk assessments, staff records and other documents relating to the running of the home, were well-kept and up-to-date. Each person living at the home had a personalised care plan and risk assessment. However, the care plans were going through an auditing process at the time of inspection and so there was some recording issues identified.

The registered manager regularly checked the quality of care at the home through audits and we saw that infection control standards in the home were monitored and managed appropriately.

This inspection was carried out on18 December 2015 and was unannounced.

Redholme Memory Care is registered to provide a service for 55 people. The home is split into three units. These are Baker unit which provides a service for up to 13 women, the Linden unit which provides a service for up to 12 men and the John McCann unit which provides a service for both men and women. The home provides care with nursing for people living with dementia. At the time of this inspection there were 52 people living there. Parking is available within the grounds of the home and a large enclosed garden is available for people to use.

At our last comprehensive inspection of the home in June 2015 we had found a number of breaches of regulations. As a result we served a warning notice on the home for lack of good governance. This was because we found there were no effective, consistent processes in place for monitoring the quality of the service provided; we had also found that training records were poor and polices and procedures out of date. At this inspection we found improvements had been made in these areas and the provider had met the warning notice.

Following the inspection in June 2015 we had also given the home a number of requirement actions. We had required them to make improvements to regulations covering the premises and equipment, obtaining consent from people and providing safe care and treatment. At this inspection we found that the provider had made improvements in these areas and were meeting the relevant regulations.

The home 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.

We saw that improvements had been made to the storage of medication. This meant it was stored safely and in line with good practice guidance. Action had also been taken to improve the safety of the premises. This lessened the risks for people living there.

Systems had been introduced to monitor the quality of the service and plan future improvements.

Policies and procedures were up to date and relevant to the home.  Improvements had also been made to the assessing and recording of people’s consent to important decisions.

We met many of the people who used the service. However, on this occasion we were only able to attain feedback about the service from a small number of people. This was as a result of the complex needs of the people who used the service. We used other means to assess people’s experiences of living at the service. These included observing the care and support provided to people, speaking with visiting relatives, speaking with staff and looking at records.

People who used the service and relatives told us they felt the care provided at the home was of a good standard. People felt confident to approach staff or the manager if they had any concerns and they felt their concerns would be listened to and addressed.

The manager and staff were aware of their roles and responsibilities to safeguard people who used the service against abuse. Systems were in place to report safeguarding concerns and these had been used appropriately.

Staff did not start working at the home until all pre-employment checks had been carried out. This was aimed to ensure people who used the service received care and support from people who were appropriately skilled and experienced.

Staff were well supported in their roles and responsibilities. Staff had undergone regular training and supervision and they felt well supported by their colleagues and the manager of the service.

People who used services at Redholme had complex needs and the majority were unable to share their experience with us. However we did observe people were happy and staff members engaged with them at every opportunity. People`s independence was promoted but when necessary, they were asked for their consent before help was given. We noted people received comprehensive assessments of needs which were reviewed every month and updated if a person`s needs changed. These were routinely attended by family members and when possible, the person using services.

We observed that medication was stored appropriately and securely and that processes were in place to identify who was responsible for administering medication at any given time. Medication management is monitored regularly by a local pharmacist and safe procedures were in place for disposal of medication no longer required. All actions were recorded. People were supported and cared for by staff who had been recruited through a rigorous process to ensure they were suitable for the role. Staff underwent a thorough induction process and attended annual staff development reviews which ensured people received safe and appropriate care. Redholme Memory Care had systems in place which ensured that any complaints were both listened to and acted upon within a given time-scale. We observed within company policies that a formal complaints procedure was in place to handle any complaints that were received.

We used a number of different methods to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

However two people did comment that they liked the staff and they were kind.

We spoke to the relatives of six people, who told us staff were polite and respectful and that the care they provided was good. They also told us that they knew what to do if they were woriied about how their relative was treated.

Relative’s comments included:

“The staff are really patient, polite and caring”.

“They keep me up to date about my wife”.

“They are respectful towards my relative, take their time and never rush”.

"I know my wife is safe, I have no worries about leaving her here".

This unannounced, comprehensive inspection took place on 25, 26 June and 07July 2015 and was conducted following receipt of information of concern. The service was registered to provide accommodation for 55 people, there were 52 people living at Redholme Memory Care at the time.

Redholme Memory Care provides personal and nursing care over three floors for people living with dementia and the building is divided into three units. The service is situated in the Mossley Hill area of Liverpool. Parking is available directly in front of the home and there is a large garden with lawns and seating at the back of the property. At the time of the inspection there were builders on site as improvements were being made to some areas of the ground floor of the building.

The home was registered to provide accommodation and care to people who may have nursing needs and 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.

The home was free from odours. In relation to orientation we found that there was little signage around the service to identify different areas, especially to support people living with dementia.

We found the safety of the premises and equipment, which was being used, put people using the service, staff and visitors at risk. We made referrals to the local authority infection control department and the fire service. They also conducted inspections as a result and have issued the provider with action plans.

We were concerned at the cleanliness and temperatures of the clinical room in which medicines were stored. We made a referral to the local authority medicines management team who also conducted an inspection and as a result have issued the provider with an action plan.

We found there were not acceptable recordings in relation to the Mental Capacity Act 2005, meaning it was not being applied lawfully and peoples rights were not always being respected.

We found that people’s personal information had been dealt with improperly, which demonstrated that the provider had not always taken proper steps to ensure people’s privacy.

We found that proper steps had not always been taken to ensure that the dietary and fluid needs of people using the service had always been properly monitored. This meant that there was the possibility of deterioration in people’s health not being detected.

We found that person centred care for people using the service was not always evidenced. We have referred one situation to the local safeguarding team.

We found breaches of The Health and Care Act 2008, regarding good governance in the service and had a number of concerns about the lack of quality assurance processes in the home to monitor the service provision. Most of the policies that we looked at were out of date and contained information that was no longer relevant.

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

People living at the service, some staff, relatives and professionals that we spoke with were all positive about the service provided. Relatives of people using the service told us they felt that people were kept safe.

We saw that there were satisfactory recruitment procedures in place people we spoke with knew how to make a complaint and we found that complaints were dealt with effectively.

The staff in the home knew the people they were supporting and the care they needed and a wide range of activities were available to suit the varied interests of the people using the service. The staff had been trained to provide the support which individual people required.

The care plans that we reviewed showed that preadmission assessments had been conducted and people’s individual preferences were recorded in their care files.

Several staff had worked at the care home for many years and when we spoke with them they were able to verbally demonstrate they had a good understanding of their roles and responsibilities towards people using the service.