This inspection was carried out over two days on the 8 March and 4 April 2018. Our visit on the 8 March being unannounced. At the last inspection on 2 August 2016 we rated the service as requires improvement overall. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to, medications, the need for consent and effective governance systems.

This inspection was to check satisfactory improvements had been made and to review the ratings. Following the last inspection, the provider sent us an action plan that detailed how they would make improvements to become compliant with the regulations. At this inspection we found improvements to the service however there was a continuing breach of Regulation 17 HSCA RA Regulations 2014, Good governance.

Bamford Close provides accommodation for up to 40 people who require personal care, some of whom are living with dementia. There were 40 people living there at the time of our inspection, some of whom could not always communicate their views so we also asked relatives for their views.

The accommodation is single storey and consists of four units which accommodate 10 people each. Each unit has a communal lounge, dining room and kitchen although people living at the service can walk around all four units. A large lounge, dining room and activities room is located in the middle of the service. The service is located near local facilities, a main road and a bus route. The home is one of a group of eleven homes managed by a 'not for profit' organisation; Borough Care Limited.

A registered manager was in place. 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 living at the service, told us they had no complaints. The atmosphere was relaxed and welcoming with lots of information available to people about the service. The service had developed a ‘Compliments tree’ at reception. This was an innovative idea to encourage anyone to leave a comment to hang on the tree to offer their feedback if they chose to.

The registered manager and registered provider had systems in place to monitor the quality of the service. Governance systems needed further review to help identify and monitor all aspects of the

quality and safety of the service being provided. This was a breach of Regulation 17 HSCA RA Regulations 2014, Good governance.

Procedures were in place to minimise the risk of harm to people using the service. People received their medicines safely and as prescribed by their doctor. Medications were well managed.

Staffing levels had been recently revised by the registered provider to have senior staff and deputies on duty each day. This initiative provided access for everyone to senior leadership and consistent management of the service over a seven-day period. During day one of the inspection three staff were off sick. Some staff and visitors felt the staffing levels were affected when staff were off sick.

We recommended the registered provider reviews published guidance to help them to demonstrate how staffing levels are calculated to meet people’s needs.

Staff were recruited following a detailed recruitment procedure. Recruitment checks are managed at head office and were not always available for the registered manager. The registered manager had to follow up outstanding records to show required recruitment checks were in place on staff files .to make sure they were suitable to work with vulnerable people.

The building was well maintained and developed to meet the different needs of people living there. The service had lots of areas designed for people who had dementia including a bar situated in the gardens and a sweet shop in the activity l

The inspection took place on 2 August 2016 and was unannounced. This meant the provider did not know we were coming. We last inspected the service in April 2014 and found the service met the regulations we inspected against at the time.

Bamford Close provides accommodation for up to 40 people who require personal care, some of whom are living with dementia. There were 40 people living there at the time of our inspection, some of whom could not always communicate their views so we also asked relatives for their views.

The accommodation is single storey and consists of four units which accommodate 10 people each. Each unit has a communal lounge, dining room and kitchen. A large lounge, dining room and activities room is located in the middle of the service.

The service had 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.

We found the provider had breached Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider had not assessed people in line with the Mental Capacity Act to determine whether Deprivation of Liberty Safeguards applications should be made. The dates of opening on prescribed creams for topical application had not been noted. The temperature of the clinical fridge was slightly above recommended limits and no action had been taken. The provider did not have effective quality assurance checks in place to monitor the quality of the service and drive improvement. The provider had not identified the areas for improvement we noted during our inspection.

We have made a recommendation about people’s personal emergency evacuation plans (PEEPs) as they did not contain enough detail for staff should they need to support people to be evacuated from the building in an emergency. We have also made a recommendation about accidents and incidents.

People received their routinely prescribed medicines when they needed them. Staff administered medicines in a gentle and supportive manner.

People and relatives told us Bamford Close was a safe place. One person told us, “I’m looked after well so I’m safe.” A relative said, “As far as I am concerned the care here is excellent.”

People were encouraged and supported to maintain their independence and to pursue their interests and hobbies. Staff interacted with people in a friendly and respectful way.

Staff training was up to date. Staff received regular supervisions and appraisals.

There was a protected meal time for those who required additional support to eat and drink, which meant staff were able to spend undisturbed time supporting people to eat. People were given choices what to eat and meals looked nourishing and hot.

One person told us, “The food is lovely in here. I really enjoy my cooked breakfast.” Another commented, “We get a choice of food, we don’t go away from the table hungry.”

People spoke positively about the staff at Bamford Close. One person told us, “The girls are really lovely and so caring, I am happy to be here.” Another commented, “We are treated like their friends.”

Staff had access to detailed personalised information about people’s needs and preferences. Care records contained guidance about how to support people based on their individual health needs and how they wished to receive their care.

People we spoke with told us if they had a problem or concern they would speak to staff. Relatives we spoke with knew how to make a complaint.

Staff told us they felt the service was well-run by the registered manager and provider. One staff member told us, “[Manager] is really good, they are not just there for the residents but for the staff as well, you can appr

On the day of our inspection the Registered Manager was on annual leave and the Deputy Manager was attending a Borough Care meeting. We were assisted by a senior carer for the duration of our inspection.

During our inspection we spoke with two people who lived at the home and a visiting relative. We also spoke with three members of staff and a visiting health care professional. We spent some time observing how people were cared for and looked at a selection of the provider’s policies and records, including a sample of people’s care records.

We considered the evidence collected under the outcomes and addressed the following 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. Please read the full report for the evidence supporting our summary.

Is the service safe?

People were treated with dignity and respect by staff and people told us they had no concerns about the care they received.

There were effective infection control systems in place and people were cared for in a clean environment by staff who observed appropriate hygiene practices.

Is the service effective?

People’s care needs were assessed with them, and where appropriate their families were involved. People’s care plans were person centred and generally provided clear guidance for staff in how to deliver people’s care.

Staff demonstrated a good understanding of people’s needs and the people we spoke with made positive comments about the staff and the care they or their relatives living at the home received. One person told us their relative had “Come out of themselves and made friends”.

Appropriate support was provided to meet people’s varied nutritional needs and preferences. People were provided with a nutritious and balanced diet and we generally received positive comments about the meals and drinks available.

Staff understood the importance of working with the other professionals involved in people’s care and their responsibilities in accessing this support, including medical advice and treatment. This ensured people received timely professional involvement with their care and treatment and promoted continuity of care between the practitioners involved with them.

Is the service caring?

The atmosphere in the home was calm and relaxed. People who we spoke with commented positively about the care they or their relative's received. We saw staff treating people with respect and warmth and the care we observed was provided in a sensitive, personal way.

Is the service responsive?

We saw that reviews of people’s care was carried out and people’s preferences and preferred routines considered.

There was a complaints procedure in place and the people who used the service we spoke with and staff felt able to express their concerns, although they had not felt the need to.

The views of people who used the service were sought and the provider’s recent survey showed 100% of respondents were happy to live at Bamford Close and were “overall happy” with the service.

Is the service well led?

There were policies and protocols in place, which provided clear detailed guidance to staff. There were effective systems in place to monitor the quality and the safety of the service that people received.

There was a proactive approach to working with other professionals involved in people’s care and staff were clear about their responsibilities when accessing medical input when it was needed. The home felt they had a good relationship with the local GPs, District Nursing Service and mental health team. Staff felt confident in obtaining specialist advice and support to ensure people’s needs were appropriately met and the care they received was effective.

We spoke with four family members by telephone, the deputy manager, senior care worker, five care workers and the district nurse. We also spoke with 16 people who were living at Bamford Close.

We also talked to Stockport Social Services Quality Assurance team as part of our inspection process.

We looked around the home which was found to be clean, tidy and brightly lit.

We observed that people were relaxed and that the care workers were polite at all times.

The family members we spoke with were all happy with the care their relative received. No one had any complaints. We were told by the family members we spoke with; “I am always made to feel welcome;” “I am always kept informed about my relatives care and I am involved in the annual review”.

We were told either directly or indirectly by both the staff and people who lived at Bamford Close that they did not think there was enough staff. Comments we received were; “Another member of staff would improve staff morale;” “I look around and look at the TV in between, not very exciting but it gets the day over;” “I watch TV until I fall asleep;” “Staff are always busy and the pressure filters through”.

We spoke with eight people who used the service and six relatives, who were very happy with the care provided at the home. People commented that "It's very good here, I'm very comfortable." and "I would recommend it to anyone". Everyone enjoyed the food and one person commented, "they do a good roast" while another told us "I really enjoy the food, it is very tasty". Most people told us how clean they found the home, with several people saying "it is spotless".

The people who lived at the home and their relatives told us they found the staff very caring and attentive and they were "well looked after". One visiting healthcare professional told us "This home is exceptional, it's one of the best I go to" and another told us, "They have a good reputation, everyone likes coming here".