The inspection was unannounced and took place on 21 March 2017.

Adlington Manor is part of the Barchester Healthcare Homes Limited and is registered to accommodate people who require nursing care and support with personal care. Care is provided in two units: Rowan Unit which provides specialist care for people living with dementia and Cedar Unit which provides general nursing care. Both units, as well as common areas to the home have undergone extensive redesign and refurbishment. The home is located in a rural part of Cheshire between Macclesfield and Poynton.

The service was last inspected in December 2015. The inspection in December was to follow up on a number of concerns that we had found at our inspection in March 2015 when the provider was in breach of seven regulations. In March we served warning notices asking the provider to ensure they were compliant with the regulations by 17 August 2015. In December 2015, we found that improvements had been made within the service, however we still found the provider to be in breach of three regulations and we requested an action plan of how they would address these issues. In December, they were not meeting the required standards in relation to safe storage and management of medications, providing person centred care and keeping accurate, contemporaneous records. At this inspection we found that the provider was meeting all the regulations and had made significant improvements to the service, however we found there was still some areas for continued improvement.

The home has 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. At the time of our inspection there were 61 people living in the home.

We found that people were provided with care that was safe, person centred, sensitive and compassionate. There had been significant improvements in the home since the existing registered manager had been in post; both in the standard of care and the home environment.

We saw that the administration and storage of medication was safe. We saw that the service was now auditing and correctly accounting for medication in order to pick up any discrepancies to ensure that people were receiving medication safely.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

We saw that the service correctly followed safeguarding procedures and accurately recorded and reported where issues had arisen. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns.

We found that there were sufficient staff deployed to meet the needs of the people living in the home. The registered manager told us they booked agency staff well in advance to ensure consistency of staff and were actively recruiting to the vacant posts that remained.

The provider had their own induction training programme which was designed to ensure that any new staff members had the skills they needed to do their jobs effectively and competently. This resulted in staff having the skills and knowledge to carry out their jobs well and provide safe and effective care.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that this was up to date and provided them with knowledge and skills to do their jobs effectively.

There was a flexible menu in place which provided a good variety of food to people using the service. People living there told us that the food was very good and their preferences were accommodated.

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When we visited Adlington Manor we spent time in both of the units which make up the home. We started our visit before lunchtime and completed it in the evening so that we could observe the pattern of care over this period of time which included two meal times.

We talked with five people who used the service and to four carers or family members who were visiting people who lived in the home. We visited people in their bedrooms and spoke with them in private. On person told us “I’m happy here, and the food is good. The staff are lovely”. We talked with six members of care staff as well as the manager of the home and three of the supervisory staff. We spent time observing the way that care was provided throughout the home.

We found that there were sufficient staff available to meet the needs of the people who used the service. Staff told us that they enjoyed working at Adlington Manor. One member of staff said “We give good care here. I really love my work and my job”. We checked the records that were kept by the home and found that these were mainly up to date and accurate and supported the provision of safe and appropriate care.

When we inspected Adlington Manor we visited the Cedar Unit in which 40 people were living. We talked with seven of the people who lived in the home. The people who lived in the home said that they enjoyed living there. They told us that it was “very good” and that the staff were "very friendly” and that the staff “do the best they can”. We also talked with five relatives of people living there. One relative told us “(My relative) can be difficult. But the care here is absolutely wonderful”.

We spent time looking around the building and talked to staff. We looked at the care records relating to the people who lived in the home. At the time of our inspection we found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. However we found that people’s personal care records were not always complete.

During our inspection we looked around the home, and talked to staff. People who used the service told us that they had nothing but praise for the staff and said that “it’s very nice”, “it’s nice being looked after” and (about the staff) “nice people, nice grub”.

We saw that there was a positive relationship between the staff and people who used the service, that the staff were smart and in uniforms, the majority wore name badges, and there were sufficient staff for the number of people using the service. The atmosphere in the home was quiet and calm with no excessive noise.

We spoke to a relative who was visiting the home who said that they were very happy with the service and care provided over the last year to their parent. Another relative told us “the manager and his staff do listen”.

During our inspection we saw that the home received support from a GP nursing home scheme which had been introduced by the former local primary care trust. This meant that people had access to medical advice and treatment from a medical practitioner who visited the home twice a week.

During our visit we spoke with people who used the service and a number of relatives who were visiting the home. We also used the Short Observational Framework for Inspection (SOFI) in the unit that provides accommodation for people living with dementia. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People who lived in the home told us that they although staff may have spoken with them about care plans they usually rely on their family to ‘‘deal with those sorts of things’’. Another person told us how they had been given a three-wheeled walker. They told us ‘‘I am delighted with it. This has given me back some independence’’.

The relatives we spoke with told us that during their visits to the home they had seen staff treat people with respect and maintain their dignity. They also told us that they had been involved in reviews and other meetings about their family member and had seen their care plans.

One relative told us that the care and support given to their family member by staff had helped them regain a ‘‘tremendous amount of independence’’.

The people who lived in the home told us that they felt ‘’safe’’ living in Adlington Manor. They, and the relatives we spoke with, told us they had not experienced or seen people been ‘‘ill treated by staff or anyone else’’. They did not express any concerns about the procedures for administering medication within the home. People told us that the home was usually clean, tidy and free from unpleasant smells.

People were very positive in their comments about the staff. They told us that, although staff were kept very busy and worked very hard, they had noticed how things had improved over the last few months.

They also told us that the manager had made ‘‘significant’’ changes and improvements to the overall running of the home. The manager operates an ‘‘open door’’ policy so that people could approach him at any time. People told us that the manager welcomed feedback from people on the quality of the care offered by Adlington Manor.

We spoke with the people living at the home and they agreed that the staff were very nice, polite and respectful and we observed staff responding to people with patience and kindness.

People living at the home told us that they felt well cared for, that staff come when they are needed and they were satisfied with the support they received. One person commented “I had to wait a long time the other night between ringing for assistance and someone coming, but I have reported it and it has improved. I had a fall recently and the staff came straight away and were very concerned for me.” We received many positive comments about the home and the staff team including “My relative had been in two other homes prior to moving here. This is a tremendously good place. The staff are very good and wonderful.”

We received positive feedback about the staff team and we observed care staff carrying out their duties. A relative commented “. I have no concerns or complaints. The food is very good here and if you don’t like something the kitchen staff will make an alternative, they are very obliging”, “My relative has been here two years and they are well looked after here. I think this home is okay” and “My relative has only been here a short time. The home is very good and they have settled well. The staff are lovely and very caring and I don’t have any concerns about the support we get.”

On discussions with the staff team it was evident that they were aware of the peoples needs and that they had taken time to get to know them. Other staff comments included, “I have worked here six years. The training is good and the staff team is nice and we work well together. I have met the new manager and he is okay”, “I have worked here a while. We have had good training and on line updates which we can do from home. I have met the new manager and he seems to be a nice man with some new ideas” and “I have had some good training and the new manager seems very nice. I enjoy my job and feel that I am doing something worthwhile.” Other comments included “I like working here and helping the residents. Sometimes we are rushing to get the job done. The communication between the staff team is good” and “I like my job and the training is good.”

We spoke to people who use the service and they said:

The staff are lovely

Its very nice here

The staff are good and kind

The food is good

We spoke with relatives of the people who use the service and they said:

the staff were very good and that they were happy with the support their relative received.

They also mentioned the disruption there had been due to a consistent manager not being at the home. Also there has been quite a lot of new staff and it is taking time for them to get to know the people who live in the home and their individual needs and requirements.

We spoke with staff and they commented:

I have not worked here long. I work nights and these are usually consecutive. The acting unit manager is good. The training is good and I have done NVQ 2 and 3, moving and handling, fire safety and first aid.

Have worked here for ten years. We are slightly understaffed at present and so there is extra work, but recruiting is taking place. Have had training on fire safety, moving and handling and dangerous chemicals. The staff team are good to work with.

I have worked here for 15 years. The regional director is very good. The staff team have been here a long time, and there are a few new ones at present. The staff are good and well experienced. Training is very good.

I have worked here for a very long time. Generally speaking the staff are ok. The staff team are good and the training is good.

We also spoke with other professionals. They had raised issues about the home with the local authority. The local authority was working with the home to put plans in place to ensure that people living at Adlington Manor remained safe and were well cared for.

Concerns were raised under whistle blowing about people being made to get up unreasonably early in the morning and that staff were being encouraged to get as many of the people up and dressed by 8.00am. This visit to the home was unannounced and started at 7.00am to see how many people were up. There were four people in the lounge area; one person had got up without staff assistance and confirmed that they liked to get up early; another person said they always ask to get up early and staff assist them with personal care tasks in the morning. Of the other two people who were up, neither were able to confirm whether or not they like to get up at this time. However, one person had been assisted with a shower on rising. At 8.00am eight people were up and during this time all the people had been offered a hot drink. It had been explained to several people that breakfast would be served shortly. At this time no evidence could be found to substantiate the concerns raised.

We undertook this comprehensive inspection on the 24 and 30 September 2015.

We previously carried out an unannounced comprehensive inspection of this service on 12 and 20 March 2015 at which a number of breaches of legal requirements were found. This was because we found that there was insufficient staff and that medicines were not administered correctly. Arrangements around mealtimes and for people to receive food and drinks were not adequate and some people were not provided with the care and treatment they required. We found that the environment needed improvement for people living with dementia and quality assurance and monitoring systems were not developed sufficiently to be effective.

After the comprehensive inspection, we served warning notices on the registered provider in respect of the requirements in the Health and Social Care Act 2008 and the following associated regulations: Regulation 9 (Person-centred care), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment), Regulation 14 (Meeting nutritional and hydration needs), Regulation 17 (Good governance) and Regulation 18 (Staffing). We required the registered provider to become compliant with these regulations by 17 August 2015. We also found that there was breach of Regulation 15 (Premises and equipment). We did not take enforcement action in respect of this regulation but asked the provider to send us a report with their plans for improving this aspect of the service.

We undertook this comprehensive inspection on the 24 and 30 September 2015 to check if Adlington Manor now met legal requirements and had made the necessary improvements.

It is a condition of the provider’s registration that Adlington Manor has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 had been no registered manager when we last inspected Adlington Manor because the current manager was very new in post. The current manager has now registered with the CQC.

Adlington Manor is part of Barchester Healthcare Homes Limited and is registered to accommodate people who require nursing care and support with personal care. Care is provided in two units one of which (the Rowan unit or Memory Lane) provides specialised care for people living with dementia. The other unit is called Cedar unit and provides care for people who have more general nursing requirements. The home is located in a rural part of Cheshire between Macclesfield and Poynton.

At this inspection we found that there had been improvements relating to Regulation 11 (Need for consent), Regulation 14 (Meeting nutritional and hydration needs), Regulation 15 (Premises and equipment) and Regulation 18 (Staffing). There had also been an improvement in the availability of activities for people who lived in the home which we had felt breached part of Regulation 9 (Person-centred care).

However we found that there were continuing breaches of other parts of Regulation 9 (Person-centred care) as well as 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 this report.