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

We last inspected Ann Challis on 22 and 23 August 2017 when we rated the service requires improvement overall, and for all key questions other than caring, which was rated good. This will be the third consecutive time that the service has been rated requires improvement overall.

At our last inspection we identified breaches of the regulations in relation to assessing risks to people using the service, accurate completion of care records and systems in place to monitor the quality and safety of the service. Following the inspection, we requested and received an action plan from the provider detailing how they would make the required improvements. This indicated that measures had already been put in place to address the breaches of regulations identified. However, at this inspection, we identified ongoing issues and continued breaches of these regulations. Breaches of the regulations found at this inspection related to; the safe management of medicines, premises and equipment, staff recruitment procedures, acing in accordance with the Mental Capacity Act, and good governance. You can see what action we have told the provider to take at the back of this report. This section will be updated once any actions have been concluded.

Ann Challis is a residential care home for women. The service provides care and support to older people, some of whom are living with dementia. The home has a secure garden area and communal facilities include two lounges and a dining area that are open plan to one another.

Ann Challis 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. Ann Challis accommodates up to 23 people in one adapted building. At the time of our inspection, there were 23 people living at the home.

The service is also registered to provide personal care as a domiciliary care agency (home care) although they had not provided this service since 2012. We have asked the registered manager to submit applications to cancel the registration for this regulated activity.

The former registered manager had left the service in March 2018, and an existing staff member had been promoted to the registered manager position. Their registration with CQC was completed shortly prior to our inspection. However, at the time of the inspection they were on planned leave, with an expected return date in January 2019. Another staff member had been appointed as the acting manager in the interim.

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.

Staff were enthusiastic about making a positive difference to the lives of the people they supported. People told us staff were kind and caring. The interactions we observed between staff and people living at the service showed that staff acted in considerate and caring ways that encouraged people to retain independence.

There were sufficient staff on duty to meet people’s needs, although both staff and people living at the home told us there were times when ‘another pair of hands’ would be useful. We looked at staff rotas and saw levels of care staff on occasions dropped from the expected three, to two staff on duty for an hour or two. The manager told us that domestic staff were fully trained and would provide any additional cover and support needed.

We found ongoing issues in relation to the safe management of medicines. As at our last inspection, the amount of medicines in stock did not always ‘tally’ with the amount staff had recorded that they had adminis

This inspection took place on 22 and 23 August 2017 and was unannounced. We last inspected Ann Challis on 5 April 2016. At that time we rated the service requires improvement overall and found the service was meeting the requirements of the regulations.

At our last inspection we made recommendations in relation to providing a dementia friendly environment, care planning in relation to dementia and strengthening governance processes. We found the provider had acted on these recommendations, but found ongoing shortfalls in the processes to monitor and improve the quality and safety of the service. Improvements had been made to make the home more accessible to people living with dementia and to improve care planning for people living with dementia.

At this inspection we identified three breaches of two of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to keeping accurate records of care, provision of safe care and treatment and good governance. You can see what action we have told the provider to take at the end section of this report. We have also made a recommendation that the provider reviews guidance in relation to implementation of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

Ann Challis is a residential care home for women. The service provides care and support to up to 23 older people some of whom are living with dementia. There were 21 people living at the home at the time of our inspection. The home has a secure garden area and communal facilities include two lounges and a dining area that are open plan to one another.

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.

People told us staff treated them with dignity and respected their privacy. We found staff knew the people living at the home well and they were able to talk in depth to us about people’s needs, preferences and social histories. Staff interacted well with people and were quick to act to make sure people were comfy and received the support they needed.

We found records were not always kept up to date and did not always accurately reflect people’s planned care or the care they had received. For example, records relating to the application of cream medicines had not been completed for several days and one person’s records showed they had been administered an antibiotic on one occasion when this was not correct.

Care plans were personalised to people’s needs and had been regularly reviewed. However, they were not always up to date and did not always reflect the care people currently received or needed. We found staff were aware of people’s care needs despite this shortfall. However, this would increase the risk of inconsistent care being provided.

Staff assessed risks to people’s health and wellbeing, and measures were identified to help reduce the risk of harm occurring. However, risk assessments were not always up to date. In one case we found the use of bed-rails had not been risk assessed to help determine they were safe and appropriate to be used for that person.

Staff received a range of training relevant to their job roles. They told us they received adequate training and support to allow them to meet people’s needs effectively. People told us staff supported them to see a health professional such as a GP if they had any health concerns.

Staff had assessed people’s capacity to provide consent to their care plans or in relation to other decisions about their care. We saw examples of documented best interests decisions where these were required. However, we found one person who was subject to potentially restrictive practice

Ann Challis is a residential care home which provides care and support for up to 23 older people some of whom are living with dementia. There were 20 people living at the home at the time of our inspection.

The provider had a registered manager in place as required by the conditions of their registration with the Care Quality Commission (CQC). 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 registered manager was responsible for all the services delivered by the provider.

The home was previously inspected in September 2014 and was compliant in all the areas we looked at then.

People were cared for by staff who knew how to recognise the signs of possible abuse. Staff were able to identify a range of types of abuse including physical, financial and verbal. Staff were aware of their responsibilities in relation to keeping people safe. They were able to explain the process which would be followed if a concern was raised and said they felt confident using the process should they need to.

Risk assessments were in place and reviewed monthly. Where a person was identified as being at risk actions were identified on how to reduce the risk and referrals were made to health professionals as required.

Safe recruitment practices were in place and records showed appropriate checks had been undertaken before staff began work. There were sufficient numbers of staff on duty to keep people safe and meet their needs.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. We observed medicines being administered and staff doing this safely. The manager completed an observation of staff to ensure they were competent in the administration of medicines.

Consent to care and treatment was sought in line with legislation and guidance. Capacity assessments had been completed appropriately for people and were in their care records. Staff we spoke with understood the principles of the Mental Capacity Act 2005 which meant staff understood the importance of ensuring people’s rights were protected.

Staff had undertaken appropriate training to ensure that they had the skills and competencies to meet people’s needs. New staff undertook a comprehensive induction programme which included essential training and shadowing of experienced care staff.

People were supported to maintain good health and had access to health professionals. Staff worked in collaboration with professionals such as GPs and district nurses to ensure advice was taken when needed and people’s needs were met.

People received enough to eat and drink. People who were at risk were weighed on a monthly basis and referrals or advice were sought where people were identified as being at risk.

Family and friends were able to visit without restriction and relatives told us that staff were always welcoming and happy to spend time speaking with them about their family members. Relatives told us that they felt involved in the care their family member received.

We have made recommendations to ensure people who are living with dementia are supported in an environment which is appropriate to their needs and is clean and tidy, and have person-centred care plans which outline how much support they need in relation to their dementia care.

We also recommend that the provider ensures there are more formal systems in place to ensure the quality of the care people receive is regularly reviewed and monitored.

The inspection was carried out by one inspector. We considered all the evidence we had gathered under the outcomes we 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 to people's needs?

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, the staff supporting them and the Registered Manager. We also spoke by telephone with the district nurse and a representative of Trafford Local Authority Quality Monitoring team. We looked at records relating to people’s care and the management of the service. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Ann Challis provides support to people with varying personal care needs which include people who are living with dementia. The premises are located in a quiet residential area of Urmston, Manchester. The building is a detached Victorian house that has been extended to provide accommodation for up to 23 people. The premises had recently had new carpet fitted to all communal areas including the stairs and landings on the upper floors. The home was mainly odour free and was clean, tidy and well presented.

Training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) took place which ensured that people who were not able to make decisions or choices were protected and kept safe. Best interest meetings and any other legal requirements such as applications to DoLS were completed in conjunction with other health care professionals such as social workers. We saw that an application to DoLS had been completed for one person and that a best interest meeting was to take place. We discussed with the manager the possibility of obtaining advocacy or be-friending services for those people who may not have meaningful or consistent support from family or friends.

There were a sufficient number of people in the staff team to ensure that people were supported with their care needs.

Is the service effective?

Recruitment and selection procedures were in place. There was an induction period of 12 weeks to ensure that the people who lived at Ann Challis were cared for by staff that had the skills to meet people’s needs.

We saw from looking at the care plans that people had received an assessment and that there was a good understanding of the person's needs and the support they required.

The people we spoke with said that they were happy with the care they received. The majority of people spoke well of the staff team and had no complaints.

Is the service caring?

We spoke with seven people who used the service and two family members. Comments we received were; "I am really happy with the place; there have been times when my relative has been really poorly and they have cared for them over and above; genuine care.” Another person said; ‘I think it is generally ok.”

The majority of people we spoke with including both staff and people who used the service said that they would go to the manager if they had any concerns.

People's preferences were recorded in the care plan and they were able to express their views and opinions during resident meetings, assessments and reviews.

Is the service responsive to people's needs?

We saw that people's needs were assessed before they were offered a place at Ann Challis to make sure that the home could provide the care the person required. We also saw that either the person or a family member had signed consent to care and treatment forms.

There was an activities organiser who worked four days a week. The home also had entertainers and representatives of the local church visiting regularly.

We saw that people were referred to other healthcare professionals as and when necessary; these included GP, district nurse and podiatrist.

Is the service well led?

The manager monitored the care plans and daily records to make sure that they were up to date and reflected the care that had been provided that day.

The manager had monitored the number of staff available for night duty. They had observed that an additional member to the staff would be beneficial to the home in order to maintain continuity.

We visited Ann Challis on 27th February 2013 as a follow up inspection. At a previous inspection we had found the home needed to make improvements regarding the care and welfare of people and their consent to care and treatment.

When we arrived we found the home to be warm and well presented. There was a new manager who had recently submitted an application to the Care Quality Commission (CQC) to become the Registered Manager. Our records confirmed this.

We could see the manager had introduced new systems to ensure the care and welfare of people were maintained and to obtain their consent. We spoke with people who used the service and all gave complimentary feedback. They told us they were well looked after and were happy living there.

We visited Ann Challis on 9 May 2013 and found the home was clean warm and inviting. There was a relaxed atmosphere and it was apparent staff and people who used the service had a good relationship.

We spoke with four people who used the service and all gave complimentary feedback. Some comments received were “I am very happy and satisfied all staff help they are very good, I am looked after properly I feel safe and supported”.

We looked at the home’s policies and procedures which included Protection of Vulnerable Adults, Restraint, Abuse Towards Staff, Whistle Blowing, Missing Residents and Dealing with Residents’ Finances. All of the policies had been reviewed and updated in October 2011.

We saw evidence that people had received the correct administration and monitoring of their medications.

We looked at two staff records and saw they had evidence of training relevant to their role. We saw in one file the staff member had undertaken an induction programme, had received an induction book and an employee handbook when they commenced at the home.

A visiting family member told us “X is lovely and very knowledgeable I am able to approach her with any problems. There is no difference in care since the manager left, the girls are very busy”.

We found there was evidence that people who used the service and their relatives were involved in providing a range of information to enable an individualised care plan to be implemented.

We saw that plans contained assessments of risks which included personal care, nutrition, mobility, pressure areas, falls and medication administration.

We did not find any evidence of mental capacity assessments for people who used the service. We saw that as part of care planning there was a statement of mental state and cognition noted but no further assessment.

We spoke with people who used the service. They said: “I am very happy here”, “I am always looked after well”, “Whenever I use my buzzer the staff come as soon as they can, I don’t normally have to wait long” and “The girls look after me here, I am very happy”.

We also spoke with relatives who were visiting at the time of the inspection. They told us: “My X has only been here a few weeks but we are very happy with the way she has been treated”, “We have no concerns up to now, I feel X is well looked after”.

During the inspection we carried out a Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. This was carried out over lunch.

There were 22 people accommodated in Ann Challis Care Home when we visited. We asked eight people about the care and support that they received.

People living in the home told us that their care and support was being provided according to their preferences. They said that staff respected their rights to dignity and privacy and that they were always encouraged to express their views and make decisions for themselves. They described staff as friendly and caring and they told us that they liked the staff and got on well with them.

Six of the eight people we had conversations with told us that they felt safe and that staff provided their care and support in a safe manner.

The eight people that we spoke to told us that they liked living in the home. They said that their views were listened to and taken seriously.

We spoke to a relative who was visiting the home while we were there. They told us that the home was meeting their expectations and that the manager and staff team were friendly and caring and good at communicating with them.