We carried out an unannounced inspection of Vancouver House on 8 and 9 January 2018.

Vancouver House 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.

Vancouver House accommodates 32 people in one adapted building. At the time of inspection there were 29 people living in the home. The home has three floors. Each bedroom is en-suite, incorporating toilet, wash hand basin and shower. There is a lift to the first floor. There are four units over the first two floors, each has its own dining and kitchen area with the manager’s office on the top floor.

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.

The care service has 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, Vancouver House had been registered since 2011 to provide a service to 32 people. However, we saw that the home itself was situated in a residential area and that people with learning disabilities who were using the service were encouraged to live as ordinary a life as any citizen despite the constraints of the size of their home and their living environment..

During our inspection, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulation 11 and 17 of the Health and Social Care Act 2014 Regulations. These breaches related to consent and to the quality processes.

Some best interest meetings had been held for people in regard to their daily living however there was no evidence of people’s consent to their care within their care files. We also identified that some aspects of the service had no auditing processes in place. Issues we identified during this inspection should have been actioned had audits been in place.

Care plans and risk assessments were person centred and they detailed how people wished and needed to be cared for. The care files records we looked at were at times confusing, however did contain the information needed about the support people required and recognised people's needs. All records we saw were up to date and regularly reviewed.

The environment was in places bare and unwelcoming, however the registered manager informed us that there were plans in place to improve this as it gave an impression of being institutionalised.

People had developed positive and friendly relationships with the staff. Staff could tell us about people’s likes, dislikes, interests and the support they needed. People’s different communication needs were considered and met in line with the Accessible Information Standard. This included people’s audial, visual and language support needs.

We reviewed the home’s complaints records and accident and incident records and found that these were appropriately recorded, action and/or responded to in a timely manner.

Policies and procedures were in place and updated, such as safeguarding, complaints, medication and other health and safety topics. infection control standards were monitored and managed appropriately. There was an infect

This inspection took place on 26 October 2016 and was an unannounced inspection.

Vancouver House is a purpose built building for up to 32 people who require nursing care. It is located in the Gateacre area of Liverpool. There are four separate units. There are communal lounges in each unit, a dining room, and bedrooms. All bedrooms have en-suite wet rooms incorporating toilet, wash hand basin and shower. There is a passenger lift for ease of access and the home is fully wheelchair accessible. There is also a shared games room with pool table. There is a large outdoor space and car parking available.

At the time of the inspection 32 people lived at the home. Three units were for people with learning disabilities, mental health difficulties and behaviour that challenged and one unit for people with acquired brain injury.

At the last inspection in November 2013. The service was meeting the requirements of the regulations that were inspected at that time.

There was a registered manager in place. 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.

Where possible we spoke with people about their experiences. However about a third of the 32 people who lived at Vancouver House had limited communication and were unable to converse with us. To understand their experience of Vancouver House we observed the care and interactions by staff.

People told us they felt safe living at Vancouver House nursing home. The management team had procedures in place and there was an open and transparent culture in the home. Risk assessments, guidance and management strategies were in place including those around behaviour that challenged. These reduced the risk of distress or injury. People we spoke with told us staff were good and helpful. We saw people’s health needs were met and any deterioration in health was managed promptly.

Staff had all received safeguarding training and knew what to do if they saw or suspected abuse. We saw care was usually good, with staff showing kindness, patience and consideration to people they supported.

We looked at how the home was being staffed. We saw there were enough staff on shifts to ensure safe care and to support in house and in the community.

Appropriate checks were made when recruiting prospective staff. This gave senior staff information about their employment history and character and reduced the risk of employing unsuitable people. Staff were trained and had the skills and knowledge to provide support to the people they cared for.

Staff managed medicines safely. Staff gave people their medicines correctly and when they needed them. We saw they were given as prescribed and stored and disposed of correctly.

The home was clean and hygienic when we visited. There were no unpleasant odours and staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Applications had been submitted where needed. This showed us staff were working within the law to support people who may lack capacity to make their own decisions.

Most people spoken with said they liked the meals. These were provided pre-cooked by a specialist food company. Staff made sure people’s dietary and fluid intake was sufficient for good nutrition.

We saw staff were familiar with people’s history and support needs. They encouraged people to make decisions and choices. Staff were respectful and usually considered people’s needs and wishes.

Care records were personalised but not always reviewed regularly.

Staff recognised the importance of social and leisure activities. People went

People living at Vancouver House told us they were happy with the service provided and they liked all of the staff. They offered various positive comments such as:

"It's good"; "I'm happy" and "I can speak to the staff they help me sort things."

People were encouraged to discuss anything important to them during meetings they had with staff and included topics such as: holidays, activities and the laundry. We looked at a sample of recent surveys completed by people living at the service. Their results were very positive regarding their opinions about the service.

The service has its own hairdressing and therapy room. People living at the service told us about how they liked this room and one person told us they liked the massages they received from the therapist. Staff told us this was a service provided by the company and offered to everyone including staff.

We found that the building was clean and tidy throughout our visit. The environment was a purpose built building and was highly maintained. The service had recorded checks carried out by the services maintenance person and contractors. These checks helped to ensure that the building was kept safe and was well maintained.

We spoke with service users, visiting professionals and people who have family members living at the service and the feedback from everybody we spoke with was positive. People made some of the following comments;

"They’re very good here"

“Money can't buy the care you get here”

People told us that they were happy with the care and support they/their relatives received and that they were involved making decisions about their relatives care and support. People said staff were respectful towards them and protected the privacy, dignity and independence of people living at the service.

People told us that they felt they could discuss any problems or concerns with staff or with the manager, and described staff as being caring and attentive.

We also spoke with a number of visiting professionals. They gave us good feedback about the service and said they felt the standards of care were very good. They told us they had never had reason to make a complaint and that they felt the atmosphere at the service was open and welcoming and that staff communicated well with them.