The inspection took place on 28 September and 9 October 2018 and the first day was unannounced. The inspection team consisted of one adult social care inspector.

At our last inspection in May 2017 we found three breaches of regulations relating to the way safeguarding concerns were managed and followed up, a lack of regular supervision of staff and ineffective quality monitoring systems. At this inspection we found improvements had been made and the service was now meeting these requirements.

Bamford Grange 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.

Bamford Grange is a nursing care home in the Shaw Heath area of Stockport and can accommodate 79 people. The home is divided into five units each with a communal lounge and dining room. The home has an enclosed garden which is accessible from the on the ground floor.

People told us they felt safe in the home. Regular checks were made on the equipment and premises to ensure they were safe.

Risks to people were assessed and they were supported to do the things they chose in as safe a way as possible.

Sufficient, well trained staff were on duty. The home performed appropriate background checks on people before they were offered employment.

People’s medicines were stored and administered safely. Records relating to the administration of medicines were clearly written and regularly audited.

The home was clean and in a good state of repair. Staff were trained in infection control and during our inspection we observed staff following good infection control practice.

People’s needs were assessed and regularly reviewed to ensure they were receiving support in the way they chose and preferred, including where their culture of beliefs influenced the way they chose to receive support.

Staff were well trained and received regular reminders to keep their training updated. Regular supervisions were held with staff to provide them with support.

People were supported to eat and drink and were not rushed. A choice of meals was available people said they enjoyed the food. Where people required special diets, staff ensured they received appropriate meals.

Where people needed specialist support from other healthcare professions, they were referred promptly and we saw advice given by other professionals was followed by staff.

The home was acting under the principles of the Mental Capacity Act and people were asked for their consent before support was given. Where people lacked the capacity to make decisions for themselves, appropriate processes were in place to identify the person’s best interests.

People told us they felt treated with compassion and respect. We observed friendly, support interactions between staff and people living in the home during our inspection.

People were treated as individuals and were encouraged to be as independent as possible and to do the things they could for themselves. People’s privacy and dignity was respected.

Complaints were investigated thoroughly and where possible were discussed face to face to resolve issues as quickly as possible. People told us they felt able to speak up if they weren’t happy.

Processes were in place to provide care to people as they neared the end of their life if the person wished to continue to be supported in the home.

The home had a registered manager in post. The 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 in the home, their relatives and staff and felt the registered manager had improved the home since they started and had pr

We carried out this inspection on 24, 26, 30 and 31 May 2017 and the first day of the inspection was unannounced.

We last inspected Bamford Grange Care Home in December 2016 and rated the service overall. We found the service was in breach of one of the regulations. This was in relation to formal staff supervision which had not consistently been taking place.

Prior to this inspection, we received some concerns about the way in which safeguarding matters were managed and the lack of consistent, responsive and proactive management and leadership of the service. Details were provided of incidents and concerns that had taken place since our last inspection of the service. These incidents included lack of timely responses to sharing safeguarding information with the local authority, lack of compliance with the safeguarding policy and lack of follow up on actions taken.

This inspection was to check improvements had been made following the last inspection, to check how the home managed safeguarding concerns, how the home was being led and to review the ratings.

During this inspection we identified one continuing breach and a further two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Bamford Grange Care Home is purpose built offering accommodation for up to 79 people. The home is set out in five units with all bedrooms being single with en-suite facilities.

The service had a registered manager in place. A registered manager is a person who has been 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.

During our inspection we found the atmosphere in the home to be unsettled with a number of care workers telling us about a divide between the registered manager and deputy manager.

Safeguarding matters were not always managed appropriately or in a timely manner. The local authority had raised a number of concerns and, at the time of the inspection, the matters had still not been satisfactorily resolved. We also found that staff training in safeguarding vulnerable adults had not taken place for all staff, with some staff requiring refresher training.

People living in the home and their relatives who we spoke with, said that they felt safe and well looked after.

Medicines were safely managed.

Some staff personnel files did not contain all the required details including a recent photograph of the person.

At the time of the inspection sufficient numbers of care staff and qualified nursing staff were available to support people and help meet their assessed needs.

Each person using the service had an up-to-date care plan, risk assessment and other associated documentation in place.

All areas of the home seen were found to be clean and tidy and we observed domestic staff carrying out routine daily cleaning duties.

We observed some good interaction communication between staff and people who used the service.

Systems were in place to monitor the quality of service people received. However due to the shortfalls we found during our inspection they require improvements.

This inspection took place on 8, 9 and 12 December 2016 and was carried out by one adult social care inspector.

The service was last inspected in July 2015 following which the service was rated as ‘requires improvement’. This inspection was carried out to check sufficient improvements had been made to the service.

Bamford Grange Care Home is purpose built offering accommodation for up to 79 people. The home is set out in four units with all bedrooms being single with en-suite facilities.

The service had a registered manager in place. A registered manager is a person who had been 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.

During this inspection we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Formal staff supervision had not consistently been taking place. Supervision provides staff and their manager the opportunity to discuss staff development and performance and any other issues that staff may want to bring to the attention of their manager and vice versa.

We recommend that the provider takes appropriate action to ensure that quality monitoring systems are used effectively and identifies all areas where shortfalls are found and records all actions taken to resolve those shortfalls, including staff supervision.

Sufficient numbers of appropriately trained care staff and qualified nursing staff were available to support people and help meet their assessed needs.

Medicines were managed safely with those staff with the responsibility for administering medicines in the home receiving appropriate training in this topic.

Each person using the service had an up-to-date care plan, risk assessments and other associated documentation in place.

All areas of the home were found to be clean and tidy and we observed domestic staff carrying out routine daily cleaning duties.

We observed some good interaction and communication between staff and people who used the service.

We saw that the service had a written complaints policy and a procedure which was visible throughout the home.

During this inspection we spoke with two members of the management team and looked at two care records of people recently admitted into the home. We also looked at pre-admission assessment records for seven people that had recently received an assessment of need. None of the seven were admitted into the home as their individual assessed needs could not be met by the service.

We considered the evidence collected under this regulation and addressed the following questions, is the service safe and is the service effective?

Is the service safe?

We found that the registered manager and senior staff had taken appropriate steps to assess the needs of people requesting admission to the home. We found that risks to the health, safety and wellbeing of the individuals and others had been adequately assessed and an appropriate care plan had been put in place. This meant that the service provided safe and effective care and took reasonable action to minimise the risks associated with providing a caring service to people.

Is the service effective?

We found that two people who had recently been admitted to the home had an effective care plan in place that supported staff to meet their individual assessed needs.

Prior to this inspection Bamford Grange Care Home had reported two concerning incidents to us, involving people who used the service. We carried out this inspection to look at the way the service assessed and responded to people’s needs and risks to their health, safety and wellbeing. During this inspection we spoke with three members of the management team and looked at a selection of people’s care records. At the time of our inspection the registered manager had left the service, although they have not yet cancelled their registration with the Care Quality Commission (CQC). There was a manager in place who is due to register with CQC as the manager for that service.

We considered the evidence collected under this outcome and addressed the following questions, is the service safe and is the service effective?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We found that the home had not taken appropriate steps to assess the needs of a person admitted to the home. Risks to the health, safety and wellbeing of this person and others had not been adequately assessed and an appropriate care plan had not been put in place. This meant that the service did not provide safe and effective care or take reasonable steps to minimise the risks associated with providing this person with a service.

Is the service effective?

We found that a person who had recently been admitted to the home had to be transferred to another provider a short time later. This was because the service did not have an effective plan in place to meet this person’s needs, which included staff having the appropriate skills to support this person.

During our inspection we spoke with the deputy manager, a regional manager, five members of staff and a visiting training tutor. We also spoke with five people who lived at the home and two visiting relatives. 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. Following our inspection we contacted a health professional by telephone, who regularly visited Bamford Grange Care Home to ask for their feedback on the service.

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?

We saw that people were treated with dignity and respect by staff. The people we spoke with who lived at the home or were visiting relatives, told us they had no concerns about people’s safety or the care provided. One person told us “I feel safe”, “it’s lovely here”, “staff are very good”.

Following our inspection, we spoke with a GP who regularly visited people living at Bamford Grange Care Home. They told us they had no concerns about the care people received.

Although we found that people’s needs were being met by the number of staff on duty, it was acknowledged by the managers who we spoke with, that there was a shortage in the pool of available staff, particularly nursing staff. The provider was in the process of recruiting new staff and also using agency staff where needed to cover shifts. There was some evidence that staffing numbers were having some impact at times on opportunities for staff to engage in activities with people who lived at the home and on staff morale.

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. We did find some examples where people’s care records were not as complete as they could have been; however there was no indication that people were receiving poor care.

Staff told us they had access to appropriate information to guide them in supporting people and they demonstrated a good understanding of the needs of the people they worked with. The people we spoke with made generally positive comments about the staff and the care they or their relatives living at the home received. One relative told us “I like the place, I’m impressed with it”, “she’s cared for, she is attended to”.

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. Staff told us they had a good working relationship with local medical professionals. We also saw that staff were aware of what action to take when people needed medical attention, including in an emergency. Following our inspection, we spoke with a GP who regularly visited people living at Bamford Grange Care Home. They told us that the service made appropriate and timely referrals to them and that staff were aware of peoples’ needs, care and treatment and provided a good ‘handover’ of information. They told us staff were available to assist them on their visits and they felt staff were well organised.

Staff felt that they received the appropriate training they needed to do their job. Staff also told us they felt supported and that the management team were approachable. We saw that staff received regular supervision sessions and annual appraisals.

Is the service caring?

We saw staff treating people with respect and warmth and the care we observed was provided in a sensitive, unhurried, personal way. The people we spoke with made positive comments about the care they or their relative received. A person we spoke with who used the service commented They’re [staff] kind and gentle”, “They’ve helped me a great lot, they’ve helped me make my room nice”. A visiting relative told us “[Staff are] pleasant and tender when required”.

We were told that before people started using the service, they were encouraged to spend some time visiting the home, where they could enjoy a meal or an overnight stay to experience the environment. This was to help them to settle in.

Is the service responsive?

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

Staff were aware of the importance of engaging medical practitioners and other professionals in people’s care when required and were proactive in accessing this support to ensure people’s changing needs were met.

Is the service well led?

There were effective systems in place to monitor the quality and the safety of the service that people received. This meant that the service was able to identify and respond to any shortfalls in the service, as well as recognising the strengths of the service people received.

Staff generally felt supported by the management team in place and there lines of accountability and support for staff. Staff showed a clear understanding of the protocols in place which guided their work. 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 to the management team.

When we inspected Bamford Grange in November 2013 we found that improvements were needed to protect people from receiving inappropriate or unsafe care. Following our visit the provider sent us a detailed action plan which indicated that appropriate arrangements to protect and assure the health, safety and welfare of people living at the home would be in place by 31 January 2014.

We carried out this inspection to follow up on action taken by the provider to ensure people were receiving safe and appropriate care. We focused our inspection on the sections of the home which provided care for people with dementia.

We found that the home had a relaxed, sociable and welcoming atmosphere. Some of the people spoken with were able to discuss the arrangements made for their care and support. They told us that they were happy and content and we saw that they were treated with respect and enjoyed good relationships with staff.

We looked at the personal care files for four of the people who lived at the home and saw that improvements had been made in the way care plans were written. Records showed that each person's health and wellbeing was monitored closely and where appropriate staff had sought medical attention or advice and guidance from the person's health and social care professionals.

We found that improvements had been made in all outcomes areas and we observed staff carrying out their work with care, sensitivity and skill.

When we inspected Bamford Grange in March 2013 we found that improvements were needed to protect people from receiving inappropriate or unsafe care. We took enforcement action and served warning notices on care and welfare, staffing and records. We told the provider that the warning notices must be met by the 28 May 2013 to protect the health, safety and welfare of people using this service.

We carried out this inspection to follow up on action taken by the provider to ensure people were receiving safe and appropriate care. We focused our inspection on the sections of the home which provided care for people with dementia. Some of the people spoken with were able to discuss the arrangements made for their care and support. They told us that they were treated with respect and were content with arrangements made for their care and support.

Visiting family members told us that they had seen some improvements but some family members told us that they remained concerned for the care and welfare of their relatives. They told us that staffing levels were still inadequate so there were times when their relatives lacked stimulation and their health and social care needs were not always met.

We observed examples of individual staff carrying out their work with care, sensitivity and skill but we found that the warning notices were not met in full so people remained at risk of receiving unsafe and inappropriate care.

When we carried out our unannounced site visit on 14 December 2012 we spoke with eleven of the people living at the home. All made positive comments about the home and the standard of care provided. We asked them about their experiences of how the service involved them and kept them informed. They told us that they were treated with respect and were always involved in making decisions about their care and support. One person said “I am very well looked after, the staff are excellent. I go out two or three times a week and I have everything I need.”

We found that the home had a relaxed, sociable and welcoming atmosphere. We could see that the people were treated with respect and enjoyed good relationships with staff. However, there was a short period of time during the early afternoon when there was an inadequate number of staff on duty to offer people activities and the level of support they needed to take part in them.

People told us that they felt safe. We found that people were protected from abuse by robust safeguarding procedures which were effectively implemented.

We looked at the care records for a number of the people who used the service and could see that arrangements made for their care and support were centred on their individual needs and personal preferences. We found that there were areas where improvements were needed. These included assessment, care planning, staffing and records.

This inspection was carried out over three days on 27, 29 and 30 July 2015. Our visit on the 27 July 2015 was unannounced.

Prior to this inspection of the service, we received some concerns and about care practices within the home.  These concerns included, lack of appropriate personal hygiene support for people, a lack of suitable moving and handling equipment being available and people with swallowing difficulties receiving incorrect consistencies of food and drink.

We last inspected Bamford Grange Care Home in February 2015 to follow up a Warning Notice that had been issued to the provider. This notice was served under Section 29 of the Health and Social Care Act 2008. At that time, the provider failed to ensure that service users were protected from the risks of receiving unsafe care by failing to ensure appropriate assessments were carried out prior to admission to the home and failing to appropriately plan and deliver care. At that inspection we found that the service was meeting the standard we assessed.

Bamford Grange Care Home is purpose built offering accommodation for up to 79 people. The home is set out in four units comprising of the Balmoral Unit for people with enduring mental health needs, Highgrove and Kensington Units for people with dementia and the Windsor Unit for people who are physically frail and who have advanced dementia. All rooms were single and had en-suite facilities.

The home is situated close to local amenities and within a short drive of the motorway network and Stockport town centre.

A Registered Manager was 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.

During this inspection we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Medicines were not managed safely because we found some discrepancies in balances of medicines when we undertook a tablet check for boxed medication and there was not always accurate, documented evidence that prescribed creams had been applied which could have resulted in unnecessary discomfort to the person.

Consent had not been obtained for the care and treatment provided to some people living at Bamford Grange.

We saw that some areas of the home were not visibly clean and there were no detailed cleaning schedules in place to indicate exactly what cleaning had been undertaken.

The garden/patio area posed some risk to people. For example, the lack of appropriate ramp facilities being available for people using wheelchairs to enable them to access the garden area safely.

We saw staff treated people with kindness and care and respected people’s privacy and dignity.

There were not enough staff on the Windsor Unit to cover the lunchtime period.

Staff were seen to have good relationships with people and were able verbally describe the individual care needs of people.

Information seen in those care records we looked at indicated that referrals had been made to the appropriate health care services and health and social care professionals when changes became apparent in a person’s health needs.

There were systems in place to record complaints. Relatives spoken with said they had not made a formal complaint but would feel comfortable doing so.

Recruitment practices were safe and relevant checks had been carried out and completed before staff started working at the home.

Systems were in place to monitor the quality of service people received. However due to the shortfalls we found during our inspection they require improvements.