We inspected Archmoor Care Home on 14 and 15 February 2018. The first day of the inspection was unannounced. Archmoor Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Archmoor Care Home is registered to provide accommodation for up to 20 older people who require personal care. There were 17 people using the service at the time of the inspection. We last inspected Archmoor Care Home on 31 January and 01 February 2017 where we found there were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medicines not being managed safely, unguarded radiators and pipework in parts of the home that posed a risk of harm to people and records that are necessary for the management of the home were either not in place or were incomplete.

Following the last inspection of 31January and 01February 2017 we required the provider to take action to make improvements. The provider sent us an action plan informing us they had taken action to ensure the regulations had been met.

During this inspection we found that records necessary for the management of the home were in place. We found however that the provider had not addressed the issue of the unguarded radiators and pipework and although there had been some improvement in the management of medicines, the recording of medicines was not safe.

During this inspection we found there were further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The care records contained guidance for staff on how people were to be supported and cared for. They did not however reflect the person’s current care needs as they had not been updated when a person’s needs had changed. We also found that risk assessments in relation to care and health issues had not been reviewed as often as they should have been. In addition we found the provider had failed to provide the CQC with information that is required by legislation. This was in respect of the Provider Information Return (PIR). This is a form that asks the provider to give us some key information about the service.

You can see what action we have told the provider to take at the back of the full version of the report. Where we have identified a breach of regulation which is more serious we will make sure action is taken. Full information about the CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Although systems were in place to monitor the quality of the service provided we have recommended they need to be improved, as they had failed to identify the issues of concern we found during the inspection.

We have recommended there is a more effective system in place so that information necessary for the running of the home is more easily located.

We have recommended that the induction programme in place for new staff be improved to ensure staff are prepared for their role by helping to develop their skills, knowledge and understanding.

People's rights were protected as the manager knew the procedures to follow if people were to be deprived of their liberty. There was no evidence however to show how the manager had determined that an application to deprive a person of their liberty was required.

We found that suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and c

We inspected Archmoor Care Home on the 31 January and 1 February 2017. The first day of the inspection was unannounced. Archmoor Care Home is registered to provide accommodation for up to 20 people who require personal care. There were 20 people using the service at the time of the inspection.

We last inspected Archmoor Care Home on 16 July 2014 where we found there was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations. This was in relation to the lack of systems in place to monitor the quality of the service provided. During this inspection we checked to see if the breach in regulation had been met. We found the registered provider had taken the necessary action to meet the regulation.

The home had a manager registered with the CQC who was present on the day of the inspection. A registered manager is a person who has registered with the 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.

During this inspection we found there were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medicines not being managed safely, unguarded radiators and pipework in parts of the home that posed a risk of harm to people and records that are necessary for the management of the home were either not in place or were incomplete. You can see what action we have told the provider to take at the back of the full report.

We found that suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely. Several of the care staff had received end of life training to help ensure that people were supported at the end of their life to have a comfortable, dignified and pain-free death.

People's care records contained enough information to guide staff on the care and support required. The records showed that risks to people's health and well-being had been identified and plans were in place to help reduce or eliminate the risk. We saw that people were involved and consulted about the development of their care plans. We also saw how the staff worked in cooperation with other healthcare professionals to ensure people received appropriate care and treatment.

All areas of the home were clean and procedures were in place to prevent and control the spread of infection. Procedures were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and water supply.

We saw people looked well cared for and there was enough equipment available to ensure people's safety, comfort and independence were protected. People told us they received the care they needed when they needed it. They told us they considered staff were kind, had a caring attitude and felt they had the right skills and knowledge to care for them safely and properly. We saw that staff treated people with dignity, respect and patience.

Staff were also able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. We saw that food stocks were good and people were able to choose what they wanted for their meals.

We saw people were provided with clear information about the procedure in place for

Archmoor Care Home is situated in Middleton and provides care and accommodation for up to 20 older people who require assistance with personal care and/or have a dementia related condition. People are accommodated on a permanent and respite basis. At the time of our inspection there were 15 people living at the home.

We carried out this unannounced inspection of Archmoor Care Home on 16 July 2014. The home was last inspected on the 11 July 2013. The Provider was assessed as meeting most of the regulations we assessed at that time. However improvements were needed to people’s care records and the safe storage of information. We inspected the home again in October 2014 to check this had been address. The Provider had made the improvements needed and was meeting the regulation we assessed at that time.

The Manager has been registered with the Care Quality Commission (CQC) since 2011. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Effective systems to monitor and review the service people and staff received were not in place to show how improvements were identified and acted upon to enhance the service further. This was a breach of Regulation 10 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2010.

Suitable arrangements were in place with regards to the Deprivation of Liberty safeguards so that people who lacked the mental capacity to make important decisions for themselves were protected. Opportunities for on-going training and support for staff will help staff develop their knowledge and understanding further and promote good practice.

We saw that staff understood the individual needs and wishes of people and cared for them in a sensitive manner. Records about people’s care and support needed updating to clearly guide staff. People had regular access to health care professionals so that their health care needs were addressed.

We saw people were offered a varied and nutritious diet. Mealtime were relaxed and unhurried providing people with an opportunity to socialise with each other. People told us opportunities were provided for people to take part in occasional activities at the home. The registered manager acknowledged that improvements could be made in the activities and social opportunities made available to people, promoting people’s autonomy and choice.

All the people we spoke with were confident if they raised any issues or concerns with the registered manager or provider, these would be dealt with to their satisfaction. Relevant checks were made to the premises and servicing of equipment ensuring people were kept safe.

Improvements were identified as being required during our inspection in July 2013 in relation to people’s care records and the reporting of incidents at the home. As part of this inspection we looked to see what progress had been made.

We reviewed the records for three people living at the home. Information provided guidance for staff about how people’s needs were to be met. Records had also been reviewed and updated, where necessary.

Following our July 2013 visit, incident reports about events within the home were being forwarded to the Care Quality Commission as required.

During our inspection we spoke with four visitors, two of whom were visiting the same person. All the visitors felt that their relatives were treated well and were safe at the home.

One visitor told us their relative enjoys the singer who comes to the home on some weekends. However, two visitors told us there was a lack of daily activities taking place at the home for their relatives.

One visitor said “There is a severe lack of activities and stimulation.”

All the visitors told us they felt the meals provided by the home were not good quality.

One visitor said “The food is not good; it is appalling and poor quality.”

Everyone was complimentary about the staff and commented on how helpful they were. However, all the visitors told us they felt there was a shortage of staff during some busy periods.

We were told by people that we spoke to that they were looked after well and “nothing is too much trouble for staff.”

A person that lived at the home told us, “All the staff are so nice with you”.

During this visit we found that suitable arrangements were in place to address the previous concerns identified during our last inspection in August 2012. This included people’s care and welfare, nutrition and staffing arrangements.

We saw that people were offered choice in their daily routine and were able to spend their time as they wished. Information was recorded about people’s individual preferences, likes and dislikes. Improvements were needed so that care plans clearly directed staff in the safe delivery of care.

We found the nutritional needs of people were being met. People told us that sufficient food and drink was provided throughout the day. One person told is “I’ll eat everything they put in front of me”.

People were provided with a good standard of accommodation, which was clean and well maintained. Plans were being considered by the provider to expand and refurbish the property.

Sufficient staff were on duty to meet the assessed needs of people. The team had been very stable with many staff having worked at the home for some considerable time.

Systems were in place to monitor and review the service provided so that people received a good standard of care and support.

During our visit we spoke with three people living at the home and the relative of one person. People spoke positively about the care and support provided. We were told; “They are lovely carers, they always help us” and “I’m happy with the care, they are all very helpful”.