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Archived: Knowsley Extra Care Good

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Inspection carried out on 30 April 2019

During a routine inspection

About the service

People who use the service live in their own apartments across two complexes. One of the complexes is the registered location. Managers and staff have access to an office in both complexes. There were 26 people using the service at the time of the inspection.

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

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Since the last inspection significant improvements had been made to people’s safety, assessing and planning people’s care, storage and maintenance of records and the systems for checking on the quality and safety of the service.

Medicines were managed safely, and people received their prescribed medication at the right times. Risks to people were assessed and control measures put in place to reduce the risk of harm to people. People were protected from the risk of abuse. Safe recruitment procedures were followed, and people received care and support from the right amount of suitably skilled and experienced staff.

People’s needs were assessed with their full involvement. People received effective care and support to meet their needs and choices. Staff received the training and support they needed for their role. People’s right to make their own decisions was understood and respected.

People were treated with dignity and respect and their independence, privacy and confidentiality was promoted. Staff were knowledgeable about people and formed trusting and positive relationships with them.

People received personalised care and support which was responsive to their needs. People’s needs were regularly reviewed with their involvement. People were given information about how to complain and they told us they would complain if they needed to. Staff understood how to provide people with dignified end of life care.

The interim manager and staff promoted a person-centred service and there was an open and positive culture. There was good partnership working with others to improve and promote the service. There were effective systems in place for monitoring the quality and safety of the service and making improvements. The views and opinions about the service was obtained from people, staff and relevant others.

For more details, please see the full report which is on the CQC website at

Rating at last inspection

At the last inspection the service was rated requires improvement (published 23 October 2018).

Previous breaches

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider is no longer in breach of regulations.

Why we inspected

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

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.

Inspection carried out on 30 August 2018

During a routine inspection

The inspection took place on 30 and 31 August and 03 September 2018, the first day was unannounced.

This was the first inspection of the service under the provider Making Space since their registration with the Care Quality Commission (CQC).

This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

People who used this service lived in their own apartments with access to communal areas, for example an activities room, large bathrooms, a bistro and a hairdressing salon. The registered manager and care staff had access to a large office on site and a staff rest area, which they shared with the housing provider.

Not everyone who used the service received the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; for example, help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection there were 21 people receiving the personal care service.

There was a registered manager at the service. 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 this inspection we identified breaches of the Regulations in relation to safe care and treatment, person-centred care and good governance.

You can see what action we told the provider to take at the back of the full version of the report.

The management of medication was unsafe. People did not receive their prescribed medication because the stock had run out and medication stocks did not always tally with records. Handwritten medication administration records (MARs) had not been signed by two staff to ensure the accuracy of the information recorded. There were no protocols in place to guide staff on the use of medication prescribed to people to be given ‘when required’ (PRN). In addition, there was no information to guide staff on the application of topical creams which people were prescribed and required assistance from staff to apply. There was a lack of checks carried out on people’s medication and a failure to act upon areas for improvement which were identified through audits carried out prior to our inspection. Following the inspection, we were provided with details of the action taken to ensure the safe management of medication.

Risks to people were not always assessed and mitigated. Risk assessments had not been carried out for some people to determine if there were any measures which needed to be put in place to keep them safe. One person had epileptic seizures, however no risk assessment had been completed for this. No risk assessment had been completed for another person who had difficulties mobilising independently and required staff to assist them with transfers using a stand aid. In addition no risk assessment had been completed to determine whether it was safe for a person to self-medicate. Following the inspection, we were provided with records to show that risks to people had been assessed and planned for.

Personal information about people was not safely managed in accordance with the General Data Protection Regulation (GDPR) and relevant data protection law. Files containing people’s personal records were displayed in an open cabinet in an office which was occupied by unauthorised people with no staff present. This put people’s co