Wirral Christian Centre Trust Limited

Wirral Christian Centre Trust Limited is a 'care home' otherwise known as Orton House. Orton House is registered to provide accommodation for up to 39 older people. At the time of our inspection, there were 22 people living in the home, some of whom were living with dementia.

People’s experience of using this service and what we found

We found medicines were not always managed safely. The temperature of the area the medicines were stored was not monitored and guidance regarding the covert administration of medicines was not always clearly recorded. Not all staff who administered medicines were fully aware of all procedures in place, such as homely remedies and guidance for medicines given as and when required. Staff had however undertaken medication training and had their competency assessed.

A range of new audits had been implemented to help monitor the quality and safety of the service.

They were completed regularly and when issues had been identified, they had been addressed. However, they did not highlight the medicine issues we found during the inspection.

People and their relatives told us Orton House was a safe place to live. There were enough staff available to support people in a timely way, who had been safely recruited and were knowledgeable about safeguarding procedures. One person told us, “I’m happy here. The staff are wonderful, they’re caring, they’re all lovely. I’m perfectly safe.”

Individual risks to people had been assessed and measures taken to reduce any identified risks. Most people’s records were up to date and guided staff on how best to support people. People’s temperatures were monitored to check for any potential early signs of COVID-19, but these checks needed to be increased to twice daily in line with government guidance.

Infection control arrangements were in place to prevent and mitigate the risk of COVID-19. Appropriate personal protective equipment (PPE) was available and staff were seen to use this appropriately. There was a COVID-19 testing schedule in place in line with government guidance. The provider had systems in place to ensure the vaccination as a condition of deployment regulation was met.

Feedback regarding the management and quality of service people received was extremely positive from staff, people living in the home and their relatives. Everybody described improvements that have been made within the home. One relative told us, “Since the new manager came it’s improved by leaps and bounds.” Staff said they enjoyed their jobs, were well supported and would recommend the home. The registered manager was very responsive to the feedback provided during the inspection.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 24 August 2021). Breaches of regulation were identified in relation to risk management, infection prevention and control, the management of medicines and the governance of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulation regarding the governance of the service, but further improvements were still required to ensure the safe management of medicines.

This service has been in Special Measures since 8 January 2021. During this inspection the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wirral Christian Centre Trust Limited on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of medicines at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will ask the provider to complete an action plan to inform us how they will make the necessary improvements and by when. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wirral Christian Centre is a 'care home' otherwise known as Orton House. 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 service.

People’s experience of using this service and what we found

At this inspection, we identified concerns with the management of risk, care planning, the delivery of care, medicines, infection control, record keeping and leadership and governance. Audits and checks were not always completed by the registered manager and provider. Those completed were not always effective at making improvements where actions were required. This posed potential risks within the service.

Staff did not always have sufficient or accurate information about people’s needs and lacked guidance on how to provide safe and appropriate care. Medication management was unsafe and placed people at risk of avoidable harm.

The service was clean, and staff used appropriate techniques to prevent the spread of infection. However, aspects of managing infection control lacked appropriate oversight to ensure the service had safe systems. The isolation procedures were not followed appropriately, staff had not all competed required training and oversight of the testing programme was not effectively taking place.

People told us they liked living at the service, but some relatives felt they needed more access to social support and activities.

Record keeping supporting people's needs were not always documented and up to date within care records. Some people’s clinical needs were not properly monitored to keep them safe and where professional advice had been given; this had not always been followed.

Accident and incidents and safeguarding events were recorded. However, some of these incidents had not been acted on appropriately.

The systems in place to monitor quality and safety were ineffective. Although new systems had been implemented, they were not reflecting the actions to improve the service provision and lacked oversight.

This is the second time, since 2020 that the service has been rated inadequate. It was clear that both the provider and registered manager lacked an understanding of regulatory requirements and how to ensure people received safe and appropriate care. This placed people at significant risk of avoidable harm.

There were enough staff on duty to support people. Staff were observed to be kind and caring and people told us they felt safe. People and relatives we spoke with were positive about the service however comments were made that there could be more staff.

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

The last rating for this service was inadequate (published 15 January 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found no improvements in breaches for regulation 12 and 17. Improvements had been made and the provider was no longer in breach of regulation 18.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. Also, a breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also looked at management of staffing levels and staff training. This was a breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have identified continuing breaches in relation to safe care and treatment and good governance.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wirral Christian Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Wirral Christian Centre is a 'care home' otherwise known as Orton House. Orton House is registered to provide accommodation for up to 39 older people. At the time of our inspection, there were 31 people living in the service.

People’s experience of using this service and what we found

Governance systems did not mitigate risk to the health and welfare of people living at the service. Audits and checks were not always completed by the manager and provider. Those completed were not always effective at making improvements. There was a lack of robust oversight with aspects of the service especially with managing fire procedures, medications, staffing levels, training, recruitment, infection control, health and safety and managing communications and feedback. This posed potential risks within the service.

Risks to people were not always assessed and in place to keep people safe. Care records were not always updated to reflect the care and risks to people. We found staff were aware of the care needs of people and told us these had taken place even when they were not fully recorded.

The service was clean and staff used appropriate techniques to prevent the spread of infection. However, aspects of managing infection control lacked appropriate oversight to ensure the service had safe systems. Hand washing audits had not been regularly carried out and highlighted potential risks amongst the staff team with management of infection control.

Staffing levels were insufficient especially in the afternoon and weekends.

People told us they liked living at the service but some relatives felt they needed more access to social support and activities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, record keeping supporting people's needs were not always documented and up to date within care records.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk by selecting the ‘all reports’ link for Wirral Christian Centre.

Rating at last inspection

The last rating for this service was good (published 23 May 2019).

Why we inspected

We received concerns in relation to the management arrangements at the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wirral Christian Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have identified breaches in relation to safe care and treatment, staffing and good governance.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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.

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, there were not policies in place to cover all required areas, such as mental capacity and Deprivation of Liberty Safeguards.

Staff told us that they received an induction when they started in post and shadowed other staff. A range of training was available to staff; however, they had not completed training in relation to MCA or DoLS. Staff were provided with an annual appraisal and regular supervision sessions.

People told us they felt safe living in Orton House. Staff were recruited safely and feedback regarding staffing levels was mixed. We found that people’s needs were met in a timely way during the inspection, as the management team supported care staff to achieve this.

Staff were knowledgeable about safeguarding procedures and how to report their concerns. We found that appropriate safeguarding referrals had been made.

Systems were in place to assess and meet people’s nutritional needs and preferences. People told us the food was satisfactory, that there was no choice of main meal, but that they could request an alternative if they did not like what was offered.

Staff reacted quickly and sought appropriate medical advice when people became unwell.

People told us staff were kind and caring and treated them with respect. People had only praise when talking about the staff that supported them, the care they received and how they liked living in the home. We observed people’s dignity and privacy being respected by staff throughout the inspection. Care files containing people’s private information were stored securely in an office.

People’s relatives were able to visit at any time and were made welcome.

There was a range of activities available to people within the home. Some trips were arranged outside of the home, but not all people were able to attend if they were unable to walk onto the bus.

People had access to a complaints procedure and told us they knew how to make a complaint if they needed to.

Staff told us they worked well together as a team and that they enjoyed working at the home.

The registered manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory requirements. Ratings from the last inspection were displayed within the home as required.

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.

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.

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 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.

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.