This unannounced comprehensive inspection took place on 26 and 28 February 2019. Waverley Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. At the time of our inspection 12 people were accommodated at the home, one of whom was currently in hospital.

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 last inspected Waverley Care Home on 12 and 13 February 2018 and gave it an overall rating of ‘requires improvement’. During that inspection we found that the home was in breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the home’s approach to assessing people’s mental capacity was poor and was not in line with the principles of the Mental Capacity Act 2005 (MCA) and the associated DoLS.

During this inspection we found breaches of Regulations 9, 11, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure that each person received appropriate person-centred care and treatment that was based on an assessment of their needs and preferences. Mental capacity assessments were not consistently recorded in people’s care plans and best interests meetings had not been held as needed. The provider did not have effective systems in place to monitor and improve the quality of the service. The provider had not carried out the required checks before new staff were employed.

During the inspection we found enough staff on duty to meet people’s needs and the staff we spoke with considered that staffing levels were adequate. We looked all around the home and found that it was clean and adequately maintained. Safety certificates demonstrated that utilities and services had been tested and maintained. People’s medication was stored and handled safely, however more detail was needed regarding the administration of medication prescribed to be given ‘as required’.

The registered manager introduced a new training system in 2017 but training records showed a poor level of take up of the new training packages. We saw records of regular individual staff supervisions and appraisals with the manager, but not always follow ups where improvements to practice had been identified. Monthly staff meetings were held.

People we spoke with told us they enjoyed their food and drinks at the home and we observed that drinks were offered regularly. Improvements were needed to the meals service to ensure that people received food at a safe temperature and at appropriate intervals.

One of the activities organisers brought in daily newspapers for people and supported people to go out regularly to local leisure activities, a gym, shops, cafes, and Sefton Park. Our observations in the lounge during the morning showed that people were able to express themselves and we saw friendly and cheerful interactions between people who lived at the home, and between them and the staff.

We saw that confidential information about people was stored securely in the nurses’ office which was locked when not in use.

Care plans did not adequately documents people's care and support needs or their personal choices and preferences.

Waverley Care Home is located in a period property near to Sefton Park, Liverpool, and is close to local amenities such as cafes, restaurants, shops and public transport links. There is on street parking and a garden to the rear of the property. The home provides residential and nursing care for up to 20 people, some with diagnoses of dementia or enduring mental health needs. At the time of our inspection 13 people were living there.

This unannounced comprehensive inspection took place on 12 and 13 February 2018.

We last inspected the home in March 2017 and gave it an overall rating of ‘requires improvement’. On that inspection we found breaches of regulations 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that people may have been deprived of their liberty unlawfully; there were poor recruitment checks, inadequate staffing levels and the premises were not kept safe; there was poor governance at the service to ensure safe and effective care was being delivered and not all staff were suitably trained to meet people’s needs.

During this inspection we found that the home remained in breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is because the home’s approach to assessing people’s mental capacity was poor and was not in line with the principles of the Mental Capacity Act 2005 (MCA) and the associated DoLS. However, we found that the home was no longer in breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as improvements had been made in these areas.

For services rated Requires Improvement on one or more occasions, we will take proportionate action to help encourage prompt improvement. Regulation 17(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires a provider to give us information – when we ask them to do so - about how they plan to improve the quality and safety of services and the experience of people using services. You can see what action we told the provider to take at the back of the full version of the report.

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 home lacked a clear and robust approach to meet the requirements of the MCA and the associated DoLS. The staff we spoke with demonstrated a basic understanding of the principles of the MCA and the associated DoLS and they had recently received training in this area. DoLS applications had been submitted to the local authority for authorisation and there was a system in place to monitor and renew them when needed. However, we saw that several of the mental capacity assessments in people’s care files were unsigned, undated, had no plan to review the assessment. These assessments did not involve the people being assessed, their families, any independent advocates or any relevant health professionals, nor were they supported with best interests decisions. This meant that the home was not acting in line with the principles of the MCA and people living there were not being supported to live their lives in the least restricted ways possible.

The home had introduced a new training system since our last inspection, which included improved records and monitoring of staff training. However, the home did not have a formal and consistent induction process for new staff.

The people we spoke with told us they enjoyed the food and drink at the home. However, we found that not everyone’s dietary preferences were catered for.

People living at the home had individual care plans and risk assessments. People’s risks were assessed and sta

This inspection took place on 01 and 08 March 2017 and was unannounced.

Waverley Care Home is located near to Sefton Park Liverpool and is close to local amenities such as cafes, restaurants, shops and public transport links. There is on street parking and a garden to the rear of the property. It provides residential and nursing care for up to 20 people; some people lived with dementia or enduring mental health needs. At the time of our inspection, there were 13 people living in the home.

At our inspection on 19 August 2015, we found that there were breaches of Regulations 11,12,15 and 17 of the Health and Social Care Act 20108. These related to consent, medication administration, premises and equipment and good governance. When we re-visited on 23 March 2016, we found that progress had been made and believed that this progress would continue. However, at this inspection we found that insufficient progress had been made and the provider was not meeting the requirements of the Regulations. You can see what action we told the provider to take at the back of the full version of the report.

The service required 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 home had a registered manager who had been in post for just over a year, at the time of our inspection.

Some people had not been appropriately assessed or regard taken of their cultural and language needs. This meant that the person was unable to communicate little with other people and had to conform to western styles of eating.

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. People were all registered with a local GP and records showed that people saw a GP, dentist, optician, and chiropodist as needed. Some information in the care plans however was not clear and the records were difficult to follow.

The provider had partly complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. This was because a person’s communication needs had not been met and therefore an assessment of their mental capacity or a best interest meeting might not be a fair representation of the person’s ability to make decisions. Staff we spoke with had minimal understanding of what this meant or what their obligations were in order to maintain people’s rights. Some people were deprived of their liberty unlawfully because they did not have free access to leave or re-enter the home.

People who used services were not protected from unsafe care because of poor staff recruitment checks, inadequate staffing levels, the lack of robust and regular risk assessments and inadequate checks related to the safety of the premise’s. People were not cared for by suitable and appropriately trained staff. People told us they felt safe with staff and this was confirmed by the relatives we spoke with

People received sufficient quantities of food and drink and had a choice in the meals that they received. Menus were flexible and alternatives were provided for anyone who didn’t want to have the meal on the menu for that day. People we spoke with said they always had plenty to eat. However, mealtimes were set and drinks available only at certain times in the day. This meant that they could not access food or drinks other than water, when they wanted to.

The staffing levels were seen to be insufficient at times to support people and meet their needs, especially in relation to activities during the day. We observed that some staff did not interact or talk with people through much of the time we were in the home.

Some risk assess

We carried out an unannounced, comprehensive inspection of this service on 19 and 20 August 2015. Breaches of legal requirements were found. We served warning notices relating to the premises and equipment and governance which told the provider what action to take to meet the legal requirements. We also served requirement actions for medicines management and consent.

After the inspection the provider wrote to us to say what they would do to meet the warning notices and the requirement actions.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Waverley Care Home on our website at www.cqc.org.uk

Waverley Care Home is located in a period property near to Sefton Park Liverpool and is close to local amenities such as cafes, restaurants, shops and public transport links. There is on street parking and a garden to the rear of the property. The service provides care over three floors. The service is registered to provide care and accommodation for up to 20 people. At the time of this inspection, there were 12 people living in the home.

The home required 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 found that the breaches we had identified in August 2015 had been met but that there still was further work needed to ensure a good standard in these the home.

At our last inspection there were concerns about the management of the home. The home had not had a registered manager for some time. The home had recently appointed a manager who told us they would apply for registration with the Care Quality Commission. They also told us they had set up processes and procedures, such as audits and would ensure that these happened in order to monitor the quality of the service. We saw that this had started to happen.

We saw that the medication administration had improved but that there were still some areas which required further work, such as the medication policy needed updating and that audits needed to be re-instated. However the medication was correctly counted and recorded and stored appropriately and securely.

The premises had been improved and were now safer, for example, window restrictors had been fitted and an electrical consumer box being had been safely concealed. Flooring and beds were being replaced and some area of the home had been re-decorated. Fire equipment had also been sited more securely. Further work was needed to continue these improvements throughout the home.

The manager showed us evidence that applications for a Deprivation of Liberty Safeguards had been made for some people living at Waverley Care Home but they also needed to update some capacity assessments.

We spoke to different people about this service to gain a balanced overview of what people experienced, what they thought and how they were cared for. We spoke to three people resident at the service, two relatives of people and four staff members. We spent time observing people using the service, to see how they were cared for and how staff interacted with them.

People said the home was "lovely" and that the staff were "great". We saw staff interact with service users throughout the day. Some people were able to leave the home independently to go to local shops and others needed more support and assistance.

People were able to chose which they activities they took part in. Relatives told us, and we saw, that they joined with people using the service going out for lunch locally. Some people said that they did not like to go out and that although staff encouraged them to do things, they were always free to choose.

We saw that risk assessments were carried out appropriately and care for people using the service was planned and agreed. Staff had received training about safeguarding vulnerable people from abuse and were able to discuss this.

The property was maintained adequately and was secure. Repairs were dealt with promptly. People said they felt safe during the day and at night.

We saw relevant policy and procedure documents which were up to date. We saw that regular surveys and audits took place to monitor the quality of the service provided at the home.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector, joined by a practising professional.

At the time of our visit,15 people lived in the home. We spoke with four people who lived in the home, one relative, a visiting friend, the nurse in charge, a care assistant, the cook and two activities co-ordinators. Limited information was obtained from some of the people using the service due to their dementia care needs or communication difficulties. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with four people living at the home who were positive about the staff and the support they provided them with. People told us they had chose how they had spent their time and they had enjoyed the activities and day trips the staff had arranged for them. A relative we spoke with told us “the staff are lovely – all the carers are ‘spot on’” and a visiting friend told us that the staff are “all friendly”.

This unannounced, comprehensive inspection took place on 19 and 20 August 2015 and was conducted following receipt of information of concern. The service was registered to provide care to people who may have nursing needs. The service was registered to provide accommodation for 20 people, there were 11 people living at Waverley Care Home at the time.

Waverley Care Home is located in a period property near to Sefton Park Liverpool and is close to local amenities such as cafes, restaurants, shops and public transport links. There is on street parking and a garden to the rear of the property. The service provides care over three floors.

The home required 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.’

Prior to the inspection three whistle blowers contacted CQC and raised a number of concerns about the home and the practices in it. They included medication issues pertaining to a particular member of staff and staffing levels. We looked into the concerns raised and found them to be unfounded, however other concerns raised were substantiated.

We found breaches of The Health and Social Care Act 2008 relating to safe premises, the administration of medication, consent and capacity and how the home was managed. You can see what action we told the provider to take at the back of the report.

We saw that 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.

We found a number of breaches related to medicines management and made a referral to the local authority medicines management team. Medicines were not always managed safely because the administration recording sheets did not always record the number of tablets administered. We also found that some medication was not accounted for.

Concerns had also been raised with us in relation to the application of the Mental Capacity Act.

We found that correct consideration had not been given to support people under the Mental Capacity Act 2005 (MCA). We did not see any documentation confirming if people using the service had capacity to consent.

We found breaches of The Health and Social Care Act 2008, regarding good governance in the service, the home is without a registered manager and we had a number of concerns about the lack of quality assurance processes in the home to monitor the service provision.

We found that not all areas of the home were 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.

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 care plans that we reviewed showed that preadmission assessments had been conducted and

people’s individual preferences were recorded in their care files.