We inspected Bickham House on 7 and 9 December 2016 and the inspection was unannounced. Our last inspection took place on 18 September 2015. At that time we found two breaches of the legal requirements in relation to recruitment checks for new staff and the safe management of medicines. At this inspection we found improvements had been made.

Bickham House is a large detached Victorian building which provides accommodation for up to 26 people. There were 25 people using the service at the time of the inspection. The home operates as a registered charity. All bedrooms are single rooms and there is a large and well-maintained garden. The house also has a large communal lounge area with separate dining room. Bickham House is situated in Bowdon, which is near Altrincham.

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.

The registered manager and deputy manager both positively engaged in the inspection process. Both managers were friendly and approachable and operated an open door policy to people using the service, staff and visitors. Throughout the inspection we found Bickham House to have a warm and relaxed atmosphere and overall people living in the home were happy and content.

Feedback received from people using the service and relatives spoken with was generally complimentary about the standard of care provided.

We found that the home was properly maintained and ensured people's safety was not compromised.

The registered provider had policies and systems in place to manage risks and safeguard people from abuse. Staff were aware of the whistle blowing policy and they told us they would use it if required. Staff told us they were able to speak with the management team if they had a concern.

Person centred care was fundamental to the service and staff made sure people were at the centre of their practice. Care plans focused on the whole person, and assessments and plans were regularly updated.

Staffing levels were structured to meet the needs of the people who used the service. There were sufficient numbers of staff on duty to meet people's needs.

Staff recruitment systems were in place and information about staff had been obtained to make sure staff did not pose a risk to people using the service.

Medicines were ordered, stored, administered and disposed of safely.

People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals. Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need).

Staff were supported through induction, regular on-going training, supervision and appraisal. A training plan was in place to support staff learning. Staff told us they were well supported in their roles and responsibilities.

Policies were in place relating to the MCA (Mental Capacity Act (2005) and DoLS (Deprivation of Liberty Safeguards). We found staff were aware of the people using the service who were subject to a DoLS.

A process was in place for managing complaints and the home's complaints procedure was displayed so that people had access to this information. People and relatives told us they would raise any concerns with the manager.

Quality assurance systems were in place in assessing, monitoring and improving the quality and safety of services provided.

We inspected Bickham House on 7 and 9 December 2016 and the inspection was unannounced. Our last inspection took place on 18 September 2015. At that time we found two breaches of the legal requirements in relation to recruitment checks for new staff and the safe management of medicines. At this inspection we found improvements had been made.

Bickham House is a large detached Victorian building which provides accommodation for up to 26 people. There were 25 people using the service at the time of the inspection. The home operates as a registered charity. All bedrooms are single rooms and there is a large and well-maintained garden. The house also has a large communal lounge area with separate dining room. Bickham House is situated in Bowdon, which is near Altrincham.

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.

The registered manager and deputy manager both positively engaged in the inspection process. Both managers were friendly and approachable and operated an open door policy to people using the service, staff and visitors. Throughout the inspection we found Bickham House to have a warm and relaxed atmosphere and overall people living in the home were happy and content.

Feedback received from people using the service and relatives spoken with was generally complimentary about the standard of care provided.

We found that the home was properly maintained and ensured people's safety was not compromised.

The registered provider had policies and systems in place to manage risks and safeguard people from abuse. Staff were aware of the whistle blowing policy and they told us they would use it if required. Staff told us they were able to speak with the management team if they had a concern.

Person centred care was fundamental to the service and staff made sure people were at the centre of their practice. Care plans focused on the whole person, and assessments and plans were regularly updated.

Staffing levels were structured to meet the needs of the people who used the service. There were sufficient numbers of staff on duty to meet people's needs.

Staff recruitment systems were in place and information about staff had been obtained to make sure staff did not pose a risk to people using the service.

Medicines were ordered, stored, administered and disposed of safely.

People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals. Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need).

Staff were supported through induction, regular on-going training, supervision and appraisal. A training plan was in place to support staff learning. Staff told us they were well supported in their roles and responsibilities.

Policies were in place relating to the MCA (Mental Capacity Act (2005) and DoLS (Deprivation of Liberty Safeguards). We found staff were aware of the people using the service who were subject to a DoLS.

A process was in place for managing complaints and the home's complaints procedure was displayed so that people had access to this information. People and relatives told us they would raise any concerns with the manager.

Quality assurance systems were in place in assessing, monitoring and improving the quality and safety of services provided.

Is the service safe?

There was a robust recruitment process in place which included a check with the Disclosure and Barring Service (DBS). This ensured care workers employed at the home were not barred from working with vulnerable people.

Staffing levels were determined by the manager and based on peoples care needs and dependency. This meant there were enough staff on duty to make sure peoples care needs were being met.

CQC has a statutory duty to monitor the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We saw there were policies and procedures in place and training had been provided for staff in relation to the Mental Capacity Act and DoLS Codes of Practice.

We spoke with staff who demonstrated an understanding of the process and were able to identify when an application might be required. There had been no applications made to deprive people living in the home of their liberty.

Staff approached people with respect and worked in a way that maintained privacy and dignity. We spoke with people who lived at the home who told us: “The staff always explain what they are doing and why and they ask if it is alright.” “I am offered choices and encouraged to make my own decisions.”

There were policies and procedures in place to minimise risks. The care staff we spoke with demonstrated a good understanding of the safeguarding and whistleblowing policies and procedures and their role and responsibility to report poor practice.

Is the service effective?

There was evidence to show people who lived at the home or their representatives had been involved in the care planning process. We saw in some of the care plans we looked at; relatives had completed a social history.

The people we spoke with told us there were forums in place for them to express their views and opinions about the service they received. This included regular ‘residents meetings’ and an annual questionnaire. In addition the people we spoke with told us the manager spoke to them on a daily basis.

We looked at the most recent questionnaire and saw comments were positive. Minutes were taken during residents meetings and we saw topics such as; entertainment, new staff and menus.

Staff demonstrated a good awareness of people’s care and support needs. We spoke with people who lived at the home and their comments included: “All of the girls are very kind.” “They work really hard and are always very pleasant.” “They are polite and caring.” “I am very satisfied with the care I receive.”

We looked at staff training records and saw staff received appropriate training to further improve their skills and knowledge.

Is the service caring?

We spent time observing the interactions between people who lived at the home and staff. We saw where people needed assistance staff were patient and support was provided in a sensitive manner.

We looked at a sample of people’s care plans and found they contained information about preferences and interests. This meant care and support was provided in the way the person wanted. The people we spoke with told us: “They are aware of my likes and dislikes.” “The staff respect me and ask me how I prefer things to be done.”

We saw staff were attentive to people’s needs and took time to sit and chat with people. The people we spoke with told us: “They are very helpful they will do whatever they can to help.” “They are understanding and compassionate.” “They really do care.” “The staff are wonderful; they are kind and considerate.” “I am very happy here and the staff are lovely.” “On the whole it is very good.” “When my visitors arrive they are offered a cup of tea.”

Is the service responsive?

On the day of our inspection staff were busy decorating the lounge in preparation for the Easter celebrations. The people we spoke with told us there were a variety of activities arranged. One person told us: “There is plenty going on; an entertainer comes in every month and there is a notice board to tell us what is going on.”

People told us they were involved in decision making. One person told us: “We have a meeting with the manager and discuss any changes.”

We spoke with the relatives of two people who lived at the home who told us if they had any concerns they were dealt with promptly. One person told us: “I have no concerns whatsoever but if I did have cause for concern I think it would be dealt with appropriately.” “There is always a manager around to speak to and any issues are dealt with.”

Is the service well led?

There were systems in place to monitor the quality of the service they provided. These included quality monitoring questionnaires, audits and resident and staff meetings.

Comments made by people who lived at the home and their representatives were used to improve the service. This meant the provider took people’s views into account.

We spoke with care staff who told us they were well supported by the management team. Comments included: “We have regular supervision and there is always a senior or a manager to talk to.” “We have staff meetings and the managers are all very supportive.”

We spoke with four people at length during our visit, they told us: “They look after me well; the staff are kind, I prefer to stay in my own room as I have lots of visitors, and staff sit and chat with me.” “I like the activities, I have been to painting a couple of times and I enjoy the singer.” “The girls help me to get dressed, most people take there time with me.” “They are all kind.”

One relative told us: "“When we visited the home to see about my X moving in, when we saw how compassionate staff were with other residents, and kind when moving people, it felt right.”

We looked at three care plans, a summary of people’s daily needs were recorded in each care plan, followed by comprehensive care plan profile which gave details of people’s personal preferences.

All areas of the home were well presented clean and tidy. Bathrooms and toilets were clean and included personal protective clothing for staff to wear.

Medicines were safely administered; we observed one of the officers distributing medication to people living in the home. They were confident in explaining to us how they handled, distributed, supported people to take their medication and prompt where required.

We were shown the results of a satisfaction survey carried out in March 2013 of people living in the home. The results were positive in all areas including environment, personal care, choice and personal preferences, dignity and helpfulness of staff.

We observed staff gaining consent from people who required support with hoists and wheels chairs. Staff asked permission, explained what they were doing, and chatted throughout the whole process.

One person living in the home told us: “They involve me in everything, but I do most things for myself, I need support sometimes, but they respect my dignity, they are lovely.”

Another person told us: “They involve me in everything, but I do most things for myself, I need support sometimes, but they respect my dignity, they are lovely.”

We looked at three people’s care records all of which included comprehensive assessments of need, details of people’s individual preferences and detailed care plans.

One relative told us: “Respect is very high here, I’m encouraged by the dignity and individual care people get.”

There was enough equipment to promote the independence and comfort of people who used the service.

Appropriate checks on staff had taken place, including visas, criminal record checks; references had been taken and verified.

We saw a copy of the complaints procedure. One person living in the home told us “I can talk to anyone here, if I have a problem.”

Relatives told us:

“Bickham House gives me peace of mind.”

People using this service told us that they got on well with staff and that their care and support was provided in a respectful and dignified manner. People confirmed that they received the right amount of support to make decisions and choices about things that were important to them. Advocacy services were available if people needed independent support.

Some comments we received from people living at Bickham House were:

“I feel very safe here. The carers are very good, they can’t do enough for you”.

“Nothing is too much trouble for the staff, they are all like family to me”.

“The staff are really good and very, very kind”.

“I come here when my daughter goes on holiday and although its not home the staff are very sweet and caring”.

We spoke to several professionals who were visiting the home during our inspection visit. They told us that people get a lot of choice around their day to day activities. They also told us that staff were, “Very respectful and discreet, they always put the residents needs first”. One professional told us, “This is one of the best homes I visit”.

We spoke to some visitors to the home. One visitor told us, “I am very impressed with this home, the staff are kind, supportive and I am confident that ‘X’ is well cared for and completely safe. I have never seen or heard anything that concerns me”.

Other visitors said::

“We have never had any worries or complaints about anything”.

“I feel totally confident that even when I am on holiday I don’t worry about ’X’.

“Staff keep us informed of everything and will phone the GP if they are worried at all”.

And,

“I can’t fault this home in anyway”.

We asked people if they thought the service could be improved in any way. Everybody we spoke to said they were totally satisfied with the service and told us that they wouldn't change anything.

People said that they enjoyed the meals and that they had access to drinks and snacks at all times. One person said, “The food is nice, the meals are lovely”.