About the service:

Wirral Christian Centre is a ‘care home’ otherwise known as Orton House. 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. Orton House is registered to provide accommodation for up to 39 older people. At the time of our inspection, there were 25 people living in the home.

People’s experience of using this service:

People told us they felt safe living in the home. They were supported by sufficient numbers of staff who had undergone most safe recruitment checks. Procedures were in place to support people in the event of an emergency, although not all staff had yet completed safeguarding or fire safety training. People’s medications were managed safely.

People’s needs were assessed, and person-centred plans of care developed to meet their identified needs. People’s consent to their care and treatment was sought and recorded in line with the principles of the Mental Capacity Act 2005. Nutritional needs were assessed, and individual dietary needs catered for. Staff were well supported through induction and regular supervisions.

Staff treated people with kindness and compassion and provided support that protected people’s dignity and privacy and promoted their independence. Staff knew the people they supported well, including their needs and preferences. People were given information and support to make decisions about their care and treatment and their feedback regarding care was sought regularly.

Plans of care were detailed and person-centred and reflected people’s needs and how they wanted them to be met. People had been involved in the development of the plans and regular reviews. Staff were responsive to people’s individual needs. People were supported to participate in activities that interested them. There was a procedure in place to manage complaints and people knew how to raise any concerns they had.

The service was led by a registered manager who was aware of their responsibilities and completed regular checks to monitor the quality and safety of the service. CQC had been notified of incidents that had occurred within the home and the previous rating was displayed as required. The registered manager had forged effective working relationships with other agencies to help ensure high quality care for people living in the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (Last report published 22 November 2018).

Why we inspected:

This was a planned comprehensive inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 16 and 17 October 2018 and was unannounced.

Wirral Christian Centre Trust Limited is a ‘care home’ which is otherwise known as Orton House. 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 care home provides residential care for up to 39 people. At the time of the inspection, there were 29 people living in the home, including one person who was in hospital.

At the last inspection in March 2017, we found the registered provider to be in breach of Regulations 12, regarding safe care and treatment and 17, as systems in place to monitor the service were not effective. The service was rated as requires improvement for the second time. We asked the registered provider to provide an action plan to tell us how they would meet the breach of Regulation 12 and we issued a warning notice regarding the breach of Regulation 17. During this inspection we looked to see if the necessary improvements had been made.

We found that risk was still not always assessed or managed appropriately. We also found that the environment was not always maintained to ensure people's safety. We saw a broken window that posed risk of significant injury and the passenger lift provided unobstructed access to the basement which contained the laundry, high risk machinery, chemicals and the maintenance room with tools within it. These risks were addressed during the inspection.

Medicines were not always managed safely. There were no protocols in place to guide staff when to administer medicines prescribed as and when required. There were gaps in the recording of medicines administered and we found that medicines had not always been administered as prescribed.

Applications to deprive people of their liberty had not been submitted for all people who required them. The conditions attached to authorised applications had not been met. Records showed that consent was not always sought and recorded appropriately in line with the principles of the Mental Capacity Act 2005 (MCA).

Care plans were not in place to cover all of people’s identified needs or medical conditions, to ensure staff had guidance on how best to support people. Care plans were not always reviewed regularly.

There was a registered manager in post since the last inspection and they registered with CQC in August 2017. 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. Feedback regarding the registered manager was very positive. The registered manager was aware that improvements were required within the service, however they had been prioritising people’s care needs over their managerial role and hoped that when additional staff were recruited, they would be able to focus on making the necessary improvements.

Systems in place to monitor the quality and safety of the service were not effective. Audits did not cover all areas of the service and those completed did not highlight the issues we identified during the inspection. There was no system in place to ensure required maintenance work was completed. Records showed that repairs reported in July 2018 had not been completed.

The action plan provided to CQC following the last inspection had not all been achieved. The registered manager told us they had to increase the timescales for completion due to low staffing levels. Many points identified on the warning notice issued after the last inspection had been met, but not all of them.

A range of policies and procedures were available to staff and we saw that these were in the process of being updated. However

Wirral Christian Centre Ltd is a care home known as Orton House. It is registered to provide accommodation for people who require nursing or personal care to a maximum of 39 people. It is situated in Birkenhead, Wirral, close to the town centre and local amenities. At the time of our inspection 22 people were receiving care at the home.

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. The service had not had a registered manager since June 2015. On the day of inspection the manager applied to the Care Quality Commission for registration and the provider and deputy manager were in attendence.

During our inspection, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulation 10 dignity and respect, Regulation 12 safe care and treatment and Regulation 17 good governance. You can see what action we told the provider to take at the back of the full version of the report.

The service had not had a registered manager since June 2015 and had not submitted statutory notifications to the Care Quality Commission regarding incidents that had happened at the service.

Quality assurance systems such as audits were in place but did not operate effectively and had not embedded into the culture of the service enough to ensure people received a safe, effective, caring, responsive and well led service. The policies the service had in place had not been signed or dated and so we could not determine how old they were.

We reviewed people’s care plans and risk assessments as well as monitoring information. Not all of these were clear or legible regarding people’s needs and not all care plans had been updated. Some monitoring information and risk assessments were also misleading and gave little guidance to staff on how to meet people’s needs.

We received feedback from both staff, families and people using the service regarding low staffing levels. This meant there was a risk that there was not sufficient staff to ensure people received a safe, effective, caring, responsive and well led service.

We observed mealtimes that were task orientated and menus were not displayed. We were told that people were asked for their meal choices a week in advance. This meant that there was confusion about what choices had been made and what was available. We received a mixed response from the people living in the home regarding the food provided.

Suitable processes were in place to deal with complaints however there was some confusion in the records as to whether issues were complaints, incidents or safeguarding concerns.

Staff were recruited safely and had received suitable training to do their job role effectively. The majority of staff had been supervised and appraised.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been followed by the home. The deputy manager told us about people in the home who lacked capacity and that the appropriate number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority.

Medication records were completed legibly and properly signed for. All staff giving out medication had been trained in medication administration and medicines were stored safely.

We looked at the premises and saw that they were clean and well maintained we saw evidence of cleaning rotas for each room in the home. There were records of cleaning slings, hoists, wheelchairs and other mobility aids.

We carried out an unannounced comprehensive inspection of Wirral Christian Centre Trust Limited on 17 and 19 February 2016.

Wirral Christian Centre Ltd is a nursing and care home known as Orton House. It is registered to provide services to a maximum of 39 people. It is situated in Birkenhead, Wirral, close to the town centre and local amenities. At the time of our visit 37 people were living at 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.

There was currently a temporary manager in post as there was no permanent manager employed at the time of inspection. The provider was taking steps to address this.

We spoke with the general manager and the temporary manager who was very transparent and told us that they recognised that the home needed to improve and that they were committed to the work required.

People we spoke with told us they felt safe in the home. They had no worries or concerns other than staffing levels. People’s relatives and friends also told us they felt people were safe but also mentioned the low staffing levels. During our visit, however we identified concerns with the service.

We found breaches in relation to Regulations 12 and 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We observed that staffing levels were a concern as shown by several call bells that were not answered for a considerable period of time. Feedback from staff people who use the service and relatives/visitors also confirmed that they felt there was a problem.

We saw that mealtimes were disorganised and afternoon meals were prepared by care staff at weekends as there were no cooks available.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had not always been adhered to in the home. Not all the people at the home who lacked capacity had been assessed or all of Deprivation of Liberty Safeguard (DoLS) applications been submitted to the Local Authority in relation to people’s care.

Infection control standards at the home were not monitored or managed and there was no permanent maintenance person employed.

The provider was in the process of working through action plans so the organisation could be reassessed for legionella and electrical safety.

Staff were recruited safely and there was sufficient evidence that staff had received a proper induction and suitable training to do their job role effectively. The majority of staff had been supervised and appraised.

The registered nurses had not had appropriate PIN checks, these checks shows that a person has completed the training and registered to practise with the Nursing & Midwifery Council (UK). This meant the service could not be confident they were currently registered.

We spent two days visiting The Wirral Christian Centre 21 May 2014 and the 23 July 2014. We considered all of the evidence we have gathered under the outcomes we had inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

On the days of our visits we found the environment clean and fresh.

We saw adequate staffing on duty to meet the needs of the people living at the home and were told that a senior staff member or the manager was always available either working in the home or on call in case of emergencies.

A safeguarding policy and procedure was in place to advise staff what they should do if they suspect abuse and staff received regular training in safeguarding. We spoke to six staff members who all demonstrated a good understanding of types of abuse and how to protect the welfare of vulnerable people.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. Proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with their care. We spoke with staff and found that they knew the people living in the home well. One person told us that they had decided to move to the home permanently as they felt that living there met their needs.

The people who lived at the home and a relative we spoke with told us they were given a choice as to how they lived their lives at the home. They told us staff always sought their consent before support was provided. People's comments included, "Staff always ask if I want some privacy when doing personal care for me", "Staff are really helpful" and "Very nice staff". A relative said, "This is a great place here, the staff are lovely. They do anything they can do to help".

Care records showed evidence that people and/or their relatives were involved in regular discussions about their care and that they had received the care and support outlined in their support plan.

We saw training records which identified that staff received training relevant to the needs of the people who lived in the home.

Is the service caring?

We spent time in all areas of the home and saw and heard staff to be kind and patient to the people who lived there. We saw that the people who lived in the home were comfortable in the company of staff and the manager and happy to have a chat with them. One person told us, “I’m happy here and feel safe".

We saw that workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us about the staff, "They treat me well and are kind".

Is the service responsive?

People's needs had been assessed before they moved into the home and were frequently reassessed whilst they lived there.

Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided that met their needs and wishes. Other professionals, such as speech and language therapists, continuing care and district nurses were involved in peoples care when necessary. We saw that relevant referrals were made to other professionals as and when required.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. The Wirral Christian Centre has direct links with the church and the majority of people living there are practicing Christians and attend church services regularly. Other people were supported to practice their religious observances. All of the people we saw appeared happy and content in the home and communicated well with staff.

People who lived in the home told us that they were happy with their care. We looked at care plans and saw that they were person centred and updated to reflect the changing needs of people.

Is the service well led?

The home had a registered manager in post which indicated that the person had undergone the relevant checks. This meant that they were of good character, is physically and mentally fit and has the necessary qualifications, skills and experience. A relative said, "The manager is very good, if there is any issues she will phone me".

Staff told us that the management supported them to attend training. Staff had a good understanding of the ethos of the organisation and quality assurance processes were in place. The manager and senior staff undertook a range of quality audits to ensure risks to people's health, safety and welfare were identified and managed.

Regular resident meetings took place and the minutes of the meetings showed people's views and opinions were sought and acted upon by the provider. The people living at the home, staff and relatives were asked for their feedback on the service on an annual basis.

We were told that the members of the board of the service spend a lot of time in the home. People who lived in the home told us that they are always available for a chat.

We were able to speak with 13 people during our inspection of Wirral Christian Centre Trust Limited and were told by each of them that overall they were very satisfied with the care provided at the home. They said the staff were respectful and friendly and their dignity was maintained.

We received comments such as "I've lived here a long time and it is like home"; "I go out to Church when I please and I know that the staff will support me"; "The food is good and there is plenty of choice".

During this inspection we followed up a compliance action relating to records. We reviewed seven care records and found that assessments and care plans were person centred and informative. Detailed individualised risk assessments and detailed care needs were clearly identified and recorded and there was clear instruction to staff about how those needs should be managed. We saw that people's consent had been obtained and they had been involved in their care planning process. Information was shared with all health and social care professionals involved in people's care.

Staff we spoke with were able to explain how people were safeguarded against abuse and knew how to access local policies and procedures which were provided by the home. Staff also told us how they had come through a difficult period of change when nursing care had been added to the home's regulated activity. They said they now felt well supported by the new deputy manager.

Prior to our visit we had received concerns about the care of people who used the service and about care records held at the home.

We found that people who used the service and relatives whom we spoke with told us they were treated very well and with dignity and respect. People told us they were spoken to with respect; staff listened to them and acted upon their choices. They told us they were happy living at this home. They said:

“They look after me well”, “It’s wonderful, they treat us very well”,

We observed that staff treated people well and in a caring manner. They understood people’s different behaviours and responded accordingly, adjusting their manner and how they cared for them to the person’s needs.

We found that care records contained relevant information in relation to personal details, assessment of care needs, risk assessments and care plans. We found that records identified people’s needs and how their needs were to be met. Risk assessments were in place and were individualised. However we found that risk assessments and care plan reviews had not been undertaken regularly on a monthly basis. We found that care records were not stored safely.

We found that staff training, supervision and appraisal took place, training plans demonstrated further training sessions booked for the forthcoming months and statistics demonstrated most staff had regular supervision.

We spoke to four people who use the service and their relatives when we visited. People were generally very satisfied with the care received at the home. They said they were treated with dignity and respect, however all those we spoke to were unaware of their care plan and told us they had not been involved in discussions regarding how they wished to be cared for. They were unaware of how to pass comment or complain about the service provided but felt they would be able to speak to the manager if needed. None of the people we spoke to had any cause to complain about the service.

People we spoke to told us the care was “Good”, “Very good” and “Absolutely brilliant”. They all said they were well cared for and looked after. One person said “It’s ten out of ten, they are absolutely brilliant”. Others we spoke to said “Everyone is friendly”, they look after me well”, “It’s always very clean”.

During our visit we saw that the people who are able can choose how they spend their time and who they spend it with. Some of the people who live at the home join in activities that are provided in the day care centre. There is a choice of several comfortable sitting areas for people to use. One person we spoke with told us that she looks after her own medicines and she receives the support she needs to do this. We observed another person who was able to use the passenger lift independently, and someone else was going out for the day with her family.

We spoke with relatives of people who live at the home and they all expressed their satisfaction with the service provided. One person told us that her Aunt has lived here since September 2010. She has settled well and her health has 'improved no end'. Nothing is too much trouble and they have gone out of their way to meet her needs. Another person was visiting her mother who is now very frail. She told us that she has been very happy with the care that her mother received over the last two years.

We saw that the people who were frail and being looked after in bed had been provided with pressure relieving mattresses. The care they received was recorded on a chart in their bedroom. We saw that moving and handling equipment was provided for people who have mobility needs. During our visit we saw that a district nurse was visiting one of the residents to provide wound care treatment.

During our visit, people who live at the home and people who use the day centre were having lunch in the dining room on the ground floor. It is a light and spacious room and there was a lively atmosphere with plenty of conversations going on. People said that they were enjoying their meal.

We spoke to a person who had chosen to have her meal in her own room and she considered that the meals could be better although she had no specific complaints. We observed another person who was having her meal in her room and she had slumped over to one side in her chair and needed assistance. This was brought to the attention of a senior member of staff who then provided the assistance that the resident needed.

We saw copies of the menu choice forms that showed what each person had chosen to have for lunch and tea each day.

The people we spoke with said that they feel safe at Wirral Christian Centre and staff always treat them kindly.

One of the people who lives at the home told us that it is always kept clean and there are never any unpleasant smells.

One of the people we spoke with said that she is very happy with her large bedroom and she has been able to bring some furniture and other belongings from her home to make it more comfortable and homely. She particularly appreciates having en-suite facilities.

The staff we spoke with considered that there are enough staff on duty to meet the needs of the people currently living at the home. One person told us that if he rings his call bell the staff are 'there like a flash'. Another person said that she never has to wait for attention during the day or night.

The people who we met spoke very highly of the staff. They described them as kind and caring and considered that they were 'in safe hands'.

The people we spoke with said that they go to the residents meetings but one person thought that they were a waste of time.

The people we spoke with said that they would feel comfortable to speak to the manager if there was anything they weren't happy with. One person said that she would tell her relative if she had any complaints.