The inspection was carried out on 26 June 2018 and was unannounced.

St Martins Residential Home 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 provide support for up to 16 people. At the time of our inspection 15 people were living there.

St Martins is a three-storey property in a residential area of Wallasey close to the town centre. There are 14 bedrooms, in the home two of which offered shared accommodation. The registered manager explained that two people chose to share and they do not use shared rooms unless people actively request to do so. The building contains a shared lounge, conservatory used by people who smoke, a dining room and bathrooms and toilets throughout the building. Externally there is some parking to the front of the building and an enclosed back garden to the rear.

The home has a registered manager who has been in post for eleven years. 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 last inspection of the service was carried out in January 2017 and the service was rated ‘requires improvement.’ At that inspection we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the fire risk assessment, the testing of the water for presence of legionella and some concerns with medication administration. After that inspection the provider wrote to us to say what they would do to meet its legal requirements. At this inspection we identified that improvements had been made and the provider was no longer in breach of these regulations.

During this inspection we found breaches in relation to Regulations 15, and 17 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014. This was because the home did not meet standards for infection control and prevention and parts of the building, decoration and furnishings were not of a suitable standard. Quality assurance systems, although in place were not robust enough to identify and improve areas of the service that required improving.

We also found a breach in relation to Regulation 18 of the Care Quality Commission (registration) Regulations 2009. This was because the provider had not notified the commission of a notifiable incident as required by law so that we can effectively monitor the service provided.

The registered provider met the requirements of the Mental Capacity Act 2005 and people had choices in their everyday lives. The home did not have an ethos of offering people support to improve or maintain their everyday living skills. Although people were able to make choices in their everyday lives there were few opportunities for people to take responsibility for meals, food shopping or managing parts of their medication.

Posters and notices were prolific throughout the home and detracted from creating a homely environment. They were also instructive and not in keeping with an ethos of working in partnership with people.

Systems were in place for safeguarding people from the risk of abuse and reporting concerns that arose. People felt safe living there and staff knew what action to take if they felt people were at risk of abuse. A system was also in place for raising concerns or complaints and people living at the home told us they would feel confident to raise a concern.

People’s medication was safely managed and they received it on time and as prescribed. Staff provided people with the support they needed to manage their physical and mental health c

This inspection was carried out on 07January 2017 and was unannounced. St Martins is a three storey property in a residential area of Wallasey close to the town centre. The home is registered to accommodate up to 16 people requiring personal care. At the time of inspection 15 people were living at the home.

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 inspection the service had a manager in post who was registered with Care Quality Commission since July 2011.

During our inspection, we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

These breaches related to the safety of the premises and the management of medicines. You can see what action we told the provider to take at the back of the full version of the report.

The service had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults and staff spoken with were knowledgeable with regards to safeguarding and whistleblowing.

During our visit we found that the water systems for legionella had not been tested and the service had not had an official fire risk assessment for a number of years. This meant we could not be certain the building was safe.

We checked the medication management arrangements at the home. We found that the balance of medication stock that we sampled did not match what had been administered. This indicated that medication had not been given correctly.

Risk assessments and care plans were in place for people living in the home, however the risk assessments documentation were not always used appropriately this meant if there were significant changes to a person’s risk assessment then this information would not be readily available to inform staff practice.

We identified that the reviewing systems of care plans and risk assessments had not been carried out according to the homes own policies and quality assurance processes that had been put into such as audits were not always effective.

We found that people had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime, these options had been chosen by the people who lived at St Martins Residential Home, however not all staff had knowledge of the dietary requirements of people living in the home. This meant that people could have been at risk of receiving inappropriate diets.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. We checked whether people’s legal consent to the care they were provided with, had been sought and we found that it had. The registered manager told us people at the home had capacity and were able to keep themselves safe outside of the home,. This meant that no one at the home required a deprivation of liberty safeguarding to keep them safe. The registered manager however was able to tell us of actions that could be taken regarding depriving someone of their liberty if this became necessary.

Staff were recruited safely and there were sufficient staff working at the home to support the people living there. Staff had received training and were supervised regularly. Part of this training was mental capacity act training and staff are able to tell us about the Mental Capacity Act and the deprivation of liberty safeguards.

People who lived at the home were able to tell us who the registered manager and their keyworker was and said they felt comfortable approaching any staff if they felt the need to complain. We saw that the register

The inspection took place on 1 December 2015 and was unannounced. The home is a four-storey property set in a residential area close to Liscard town centre. There were bedrooms on three floors with communal areas on the ground and the lower ground floors.

The service is registered to provide accommodation and personal care for up to 16 people and 15 people were living there when we visited. The people accommodated were adults of various ages who required 24 hour support from staff due to mental health conditions.

The home had a manager who was registered 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.

During the inspection we found breaches of the Health and Social Care Act 2008 and the Care Quality Commission (Registration) Regulations. You can see what action we asked the provider to take at the end of this report.

All staff had received training about safeguarding and this was updated every three years. Safeguarding incidents had not been reported to CQC in accordance with legal requirements. There were enough experienced staff to meet people’s needs and keep them safe. The required checks had been carried out when new staff were recruited to ensure person employed were suitable and safe to work with vulnerable people.

The members of staff we spoke with had a good knowledge of the support needs of the people who lived at the home and had attended relevant training. The staff we met had a cheerful and caring manner and they treated people with respect.

We found that the home was adequately maintained in most areas and records we looked at showed that health and safety checks were carried out. However, we found that a number of doors, including the kitchen door, the laundry door, and the door leading to the conservatory which is the area where people were permitted to smoke, did not close fully which meant that people were not adequately protected from the risk of fire.

People were potentially at risk as smoking was not managed safely in the home as people were not adhering to the smoking policy.

We found that medicines were managed safely and records confirmed that people always received the medication prescribed by their doctor.

People were registered with local GP practices and had visits from health practitioners as needed. The care plans we looked at gave details of people’s care needs and how their needs were met.

There were no restrictions on people’s movements and no Deprivation of Liberty Safeguards had been applied for.

There was an open and inclusive culture in the home and regular house meetings were held. The manager carried out various checks and audits to monitor the quality of the service.

One inspector carried out this inspection. 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?

People who lived at the home required support due to long-standing mental health needs and their care needs were reviewed regularly by mental health professionals.

People were protected against the risks associated with medicines because appropriate arrangements in place to manage medicines and we saw that these were followed.

Regular safety checks were carried out by the home’s maintenance person. These included the fire alarm and emergency lighting systems. Portable appliance testing was carried out annually and current certificates were in place for the electrical wiring and the gas boiler. Regular fire drills were held and recorded and these included the people who lived at the home.

Is the service effective?

People were registered with a local GP practice and the care plans recorded that people had a full health check at least once a year. People we spoke with were very satisfied with arrangements for their health and welfare and confirmed that there were no restrictions on their movements.

Is the service caring?

Staff provided encouragement to people to maintain an acceptable standard of personal care and to look after their health. They were available to accompany people to appointments if they wished.

People were able to pursue their hobbies and interests and to go out with their families. The manager told us that she was trying to encourage people to go out more often. Transport was available twice a week to take people for a trip out.

Is the service responsive?

People who lived at the home had a monthly meeting and the minutes of the meetings showed that they were well-attended and that people were able to raise any issues that they wished to discuss. Safeguarding was a standing item on the agenda.

People were able to help themselves to hot and cold drinks throughout the day. A choice of meals was always available and at the monthly residents meetings, people were able to make suggestions about dishes they would like to be included on the menu.

Is the service well led?

The manager had been in post for five years and was registered with CQC. She was working towards a management and leadership qualification. Two senior care staff had been appointed since our last visit which meant that the manager had been able to delegate some management tasks. Each of the senior care staff had specific responsibilities and shared on-call duties with the manager.

Monthly health and safety checks of bedrooms were recorded and monthly medicines, accidents and care plans audits were carried out and recorded.

People who lived at the home told us that they were able to decide their own daily routines and to come and go as they pleased. People told us that they got plenty to eat and there was always a choice available. There were regular meetings for staff and for the people who lived at the home and the records showed that people were able to raise any issues they wished to discuss.

All of the people who lived at the home had mental health needs and were supported by a community mental health team. They were also registered with a local GP and had regular health checks. Staff we spoke with had a good knowledge of people’s individual needs.

Since our last visit to St Martins some of the furniture which was shabby and/or broken had been replaced. Stained carpets had been removed and laminate flooring fitted.

Robust recruitment practices were followed and new staff received induction training. Most of the staff had achieved a national vocational qualification in care.

Records were accurate, up to date and readily available for inspection.

People who lived at the home told us that they were happy there. Some people said that they had lived at other care homes but they preferred this one. There was no shouting or bullying and they felt safe at St Martin’s. People were able to decide their own daily routines and to come and go as they pleased. People told us that they got plenty to eat and there was always a choice available.

All of the people living at the home had mental health needs and were supported by a community mental health team. Their care needs were reviewed by mental health professionals every ten months. Each person had a key worker and the staff we spoke with had a good knowledge of people’s individual needs.

Some of the furniture in the bedrooms was broken and other items were shabby. Some of the carpets in the bedrooms were badly stained and in poor condition. There was an adequate number of bath or shower rooms and toilets but some of these were in need of upgrading.

The staff we spoke with said that they worked well together as a team and covered both care and domestic work. Staff were always willing to work an extra shift when needed to cover for holiday or sickness. Twelve of the staff had achieved an NVQ in care at level 2 and five others were working towards this.

There were regular meetings for staff and for the people who lived at the home and the records showed that people were able to raise any issues they wished to discuss.

The following comments were gained through discussion with the people living at the home and the local authority contracts and commissioning team.

People using the service are happy with the way they are looked after. They can make their views known through regular meeting and they are consulted and involved. They get to see their social worker, GP or CPN when necessary. They confirmed they always get their medication on time. They said staff are always available and they are kind and friendly and listen to whet they say. They said they know how to make a complaint and have never been spoken or treated badly. They all said they enjoy the food and have plenty to eat. Comments made by the people living at the home include:

'The staff are all lovely; they are always around to help'.

'I'm happy with the way the staff look after me'.

'I know I have a care plan and staff talk to me about it'.

'The food is lovely, I always have plenty to eat'

'I have never been spoken to or treated badly'.

'I always get my medication on time and the staff never run out'.

'If I had a complaint I would speak to the manager or to the owner'.

Wirral local authority contracts and commissioning team told us they had not current concerns about the care and support being offered at this service.