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Inspection carried out on 27 November 2018

During a routine inspection

The inspection took place on the 27 & 28 November 2018 and was unannounced.

James Page provides residential and nursing care for 36 people in single en-suite rooms.

James Page is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The James Page nursing home is part of Parkhaven Trust, a registered charity providing a range of services for older people and people with dementia. James Page accommodates 36 people in one single storey adapted building. At the time of the inspection 26 people were living at the home.

There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Everyone who lived in the home said they felt safe. There were robust measures in place to ensure people were safe. Risk assessments were in place for areas such as pressure care, falls, use of bedrails and mobility, and nutrition and hydration.

There were sufficient staff on duty to meet people's needs. Staff rotas showed a consistent number of staff were on duty each day. People told us call bells were answered within a reasonable time.

Medicines were managed safely and people received their medicines as prescribed. Staff had been trained to administer medicines to ensure errors were kept to a minimum.

The home was very clean and there were no odours. The home was well maintained and in good decorative order. People's bedrooms were personalised and were decorated and furnished to a high standard.

Regular checks and tests, such as gas, electricity, water safety, fire drills, fire alarm tests and external checks of firefighting equipment, were completed to maintain safety in the home.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. We found that staff had the skills, knowledge and experience to support people effectively and safely. Staff were supported by the manager through regular supervisions, annual appraisal and regular training. Staff had attended training in subjects such as first aid, fire safety, food safety, safeguarding and medication. New staff were required to complete an induction. Staff meetings were held regularly.

People's needs were assessed and reviewed regularly to reflect their current health and support needs. People were supported to maintain healthy lives.

The service was working within the principles of the Mental Capacity Act 2005. Mental capacity assessments had been completed to demonstrate people's ability to understand and consent to care.

People were supported to eat and drink enough to maintain a balanced diet and meet their dietary requirements. Drinks were offered at various times throughout the day to ensure people's hydration needs were met. Staff understood people's individual nutrition and hydration needs and we saw that meals and staff support were provided accordingly.

Everyone living in the home was very complementary about the attitude of the staff and the way they were treated. We observed staff speaking to people respectfully and in a caring way.

Staff knew people and understood their different communicati

Inspection carried out on 1 August 2017

During an inspection looking at part of the service

The James Page nursing home provides nursing care for up to 36 older people in a single storey building in Maghull. The James Page nursing home is part of Parkhaven Trust, a registered charity providing a range of services for older people and people with dementia.

This was an unannounced inspection which took place on 1 August 2017.

We carried out an unannounced comprehensive inspection of this service in April 2016. We found the home to be rated ‘Good’ overall but we found one breach of regulations regarding the way medicines were managed in the home.

We asked the provider to take action to address these concerns. After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had they now met legal requirements. This report only covers our findings in relation to the specific area / breach of regulation. This report only covers two of the questions we normally asked of services; ‘Is the service safe?’ and ‘Is the service Well led. The other three questions; whether the service is ‘effective’, ‘caring’, and ‘responsive’ were not looked at on this inspection.

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

There was a registered manager in post. 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 the service had made improvements to the way medicines were administered and managed. We found the breach had now been met.

At the last inspection in April 2016 we found concerns because some medicines given ‘when required’ lacked supporting protocols and external medicines [creams] were not being recorded appropriately.

These failings had been addressed and people were receiving there medicines safely.

We found good supporting governance [management] arrangements to support safe medication administration.

Inspection carried out on 21 April 2016

During a routine inspection

The James Page nursing home provides nursing care for up to 36 older people in a single storey building in Maghull. The James Page nursing home is part of Parkhaven Trust, a registered charity providing a range of services for older people and people with dementia.

This was an unannounced inspection which took place on 21, 22 April 2016. The service was last inspected in April 2014 and at that time was found to be meeting standards.

There was a registered manager in post. 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 reviewed the way people’s medication was managed. We saw there were systems in place to monitor medication so that people received their medicines safely. We found some medicines given ‘when required’ lacked supporting protocols and external medicines [creams] were not being recorded appropriately.

We told the provider to take action.

People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained. We asked people how their care was managed to meet their personal preferences and needs. People were satisfied with living in the home and felt the care of offered met their care needs. People we spoke with said they were consulted about their care and we saw some examples in care planning documentation which showed evidence of people’s input.

We saw written care plans were formulated and reviewed ongoing. Some plans did not always contain necessary detail which meant it was difficult to follow the care. We discussed the care of one person who had a pressure ulcer and how the planning and ongoing monitoring could be improved.

We made a recommendation regarding this.

The registered manager was able to evidence a series of quality assurance processes and audits carried out internally and externally by staff and from visiting senior managers for the provider as well as the Trust Board. We found these were developed to ensure effective monitoring and development of the service as well as helping to ensure standards were continually maintained.

The manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

The managers had made referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the applications were completed and were being monitored by the registered manager.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw checks had been made so that staff employed were ‘fit’ to work with vulnerable people.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits wer

Inspection carried out on 16 April 2014

During a routine inspection

Our inspection was carried out unannounced. As part of the outcomes we looked at we followed up on two areas that the home needed to make improvements in following our last inspection in January 2014. The inspection helped answer our five questions:

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe and well cared for.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. We were told about one application that had been made. This showed that the service understood the process involved. The home had also introduced a tool for measuring people�s mental capacity in terms of individual decisions that might need to be made. The provider might like to know that when we spoke with staff they were unaware of how to make best use of this tool and under which circumstances it would be used. We spoke with the manager about the development of staff knowledge in the field of dealing with people who lacked capacity to make decisions. In particular we discussed knowledge and awareness regarding the Mental Capacity Act and Deprivation of Liberty [DoLS].

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that staff were recruited correctly and people were protected.

Is the service effective?

People�s health and care needs were assessed with them, and they were involved in their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that the care plans reflected their current needs.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, �I don�t have to wait long for staff to attend to me. They come straight away when I call.�� Another person told us, ��The staff are excellent. They are careful to explain everything they do.�� People said staff did everything needed to support them with their day to day living.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People�s preferences and diverse needs had been recorded and care and support had been provided in accordance with people�s wishes.

Is the service responsive?

We saw that people were supported to complete a range of daily activities and these included social activities. People were supported as their care needs changed. This was particularly evident with changing medical and nursing care needs.

Following our last inspection in January 2014 we had made some compliance actions [requirements] that the service needed to respond to and address. We found that these had been addressed and the improvements made. For example, the complaints procedure had been reviewed. People knew how to make a complaint if they were unhappy. People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well-led?

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

Inspection carried out on 22 January 2014

During a routine inspection

We spoke with people about the service they received. They told us they were happy with the way staff supported them and the tasks they carried out for them. Those we spoke with said the staff knew what support they required and did everything that was needed for them. One person told us, �The staff are excellent. They really take their time helping me to get up in the morning.�

Those people we spoke with were very relaxed around staff and said they were listened to, so any concerns could be addressed. People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening

We spoke with staff. They told us they had received relevant training and said they felt supported in their job. They told us there was good communication between different levels of staff. We asked people who used the service about the skills of the nurses and support workers. They told us the staff worked very hard and knew how to do their job. They felt staff were competent.

We found there were systems in place to monitor the quality of service that people received but some of these did not identify or analyse in enough detail to highlight areas of need for improvement.

We looked at various records. We were concerned that some records were not being kept in a way that ensured their confidentiality.

Inspection carried out on 4 October 2012

During a routine inspection

People living in the home spoke positively to us about the care and attention they received. One of the comments included: �You have a buzzer in your room and in the lounge. Someone comes as soon as they can.� We also spoke with relatives and were told: �There are always plenty of staff. They make me feel welcome.� Another relative said: �I can visit at any time and they keep me up to date. It is first class care. I am always told if there are any changes in my wife�s health and I would go to the Manager if I had any concerns."

Some people were unable to communicate verbally with us, however, we observed staff being attentive to their needs. Their tone and manner was respectful and caring. We found that people and their families were involved in care planning. The home respected people's preferences around daily living.

We looked at the care records of five people and we saw that up to date and person centred care plans were in place which supported staff to be able to deliver the care required. Training records showed that staff had all received safeguarding training and were up to date with refresher courses.

The home had systems in place to recruit and support skilled and experienced staff to meet people�s needs. The provider had an effective system to regularly assess and monitor the quality of service that people receive.