This inspection was unannounced and took place on 28 March and 5 April 2018. The last inspection of Carr Bank House took place in January 2017 when we found all the regulations we reviewed were met.

Carr Bank House is a privately owned care home providing accommodation for up to 14 adults with mental health needs. The home consists of two adjoining properties that have been adapted to form a large house. There is a small garden to the front of the home. It is located in a residential area, close to Bury town centre, and is within easy reach of public transport. There were 13 people accommodated at the home on the days of the inspection.

Prior to this inspection we received information that raised some concerns around record keeping at the service.

At our last inspection on 10 January 2017 we rated the service Good overall. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in the shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

The service has 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 requirement in the Health and Social Care Act 2008 and associated Regulations about how the service is run. People were positive about the registered manager and the way the home was run.

The people who used the service felt safe and staff we spoke with understood their role in protecting vulnerable adults. Recruitment procedures were robust and minimised the risk of unsuitable people being employed.

People enjoyed support from a stable team of staff who knew the people living at Carr Bank House well.

People received support that maximised their independence and risk assessments were in place to support them in the least restrictive way possible.

Appropriate action was taken to keep the property clean and to remain free of any offensive odours.

Medicines were safely managed and people told us they received their medicines as prescribed by their doctor.

Care plans and risk assessments were in place and were based on the individual needs of each person and were regularly reviewed.

Staff we spoke with and records seen showed that staff received the training and support they needed to carry out their job roles effectively.

Care records were stored securely in order to maintain confidentiality.

There was a suitable complaints procedure located in the hallway and each person was provided with their own copy as part of the service user guide information provided on admission.

Systems were in place to monitor and help maintain the quality of service being provided.

Carr Bank House is a privately owned care home for 14 adults with mental health needs. The home consists of two adjoining properties that have been adapted to form a large house. There is a small garden to the front of the home. It is located in a residential area, close to Bury town centre, and is within easy reach of public transport. There were nine people accommodated at the home on the day of the inspection.

At the last inspection of January 2016 the service did not meet all the regulations we inspected and were given requirement actions for safe recruitment and suitable activities. The service sent us an action plan to show us how they intended to meet the regulations. At this inspection we saw that improvements had been made and the regulations were met. This unannounced inspection took place on the 10 January 2017.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. However, the registered manager was on long term sick leave. The deputy manager and a consultant assisted during the inspection.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to. Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

At the last inspection we found there were very few activities being provided for people who used the service. At this inspection we found there were more meaningful activities for people to enjoy if they wished. People were also able to go out in the community or help with tasks within the home.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

The home was clean and tidy. The environment had been improved and was homely in character. We saw there was a maintenance person to repair any faulty items of equipment.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005). People at this home had the mental capacity to make their own decisions and had agreed to their care and treatment.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

Carr Bank House is registered to provide personal care for up to 14 people who have a mental health condition. On the day of our inspection 10 people were using the service.

This was an unannounced comprehensive inspection which took place on 12 January 2016.

The service had a registered manager, who was present during the inspection. 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 found breaches of 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.

This was because systems for the recruitment of staff were not always safe. In three staff files we found gaps in staff previous employment history had been identified but there was no written explanation of the reason. We also found there was a lack of meaningful activity organised by the service.

People told us they felt safe at Carr Bank House. Policies and procedures were in place to safeguard people from abuse and staff had received training in safeguarding adults. Staff were able to tell us how to identify and respond to allegations of abuse. They were also aware of the responsibility to ‘whistle blow’ on colleagues who they thought might be delivering poor practice to people.

Staff had received the training, support and supervision they needed to deliver safe and effective care. There were enough staff to meet people’s needs. Improvements had been made to staffing arrangements at night; this allowed staff to respond more effectively to people needs.

There were safe systems in place for managing medicines. We saw that people were supported to access a range of health care services when needed.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards; these provide legal safeguards for people who may be unable to make their own decisions.

People enjoyed the food provided by the service. The kitchen was stocked with sufficient supplies and was clean and tidy. We found that food temperatures were not checked; ensuring food is served at the correct temperature reduces the risk of food poisoning.

Improvements had been made to the furnishings and décor of the home. There was an ongoing programme of redecoration. Procedures were in place to deal with any emergency that could affect the provision of care such as failure of gas and electricity. We saw that health and safety checks including fire safety were undertaken. During our last inspection we were told some residents were smoking in their bedrooms. At this inspection we found this was still happening. We have recommended provider seeks fire prevention advise to help keep people safe

People spoke positively about the kindness of the staff. We saw staff were respectful to people and encourage people’s independence. The registered manager and staff knew people well and knew the support they needed, their likes dislikes and routines.

Care records were detailed and contained good information to guide staff on the care and support people needed. Risks to people’s health and well-being had been identified and plans were in place to reduce or eliminate the risk.

The system of quality assurance had been improved but checks of care plans and food preparation had not been completed effectively. This meant the registered manager could not identify when action needed to be taken.

We found that people had opportunities to comment on the service and how it could be improved, but their feedback was

The service is registered to provide personal care for 14 people who have a mental health condition. On the day of the inspection eight people resided within the home. The commission has imposed a condition on the provider’s registration that until further notice no admissions can be made to the home. This condition was imposed because there was no registered manager and the service was not providing consistent care in line with the standards and regulations we inspected.

We last inspected this service in February 2014 when they met all the standards we inspected.

This was an unannounced inspection. However, the Care Quality Commission chose to leave the restrictions upon admissions in place.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who used the service told us that Carr Bank House was a safe place to live. We saw from staff training records and talking to staff that staff were aware of the procedures for safeguarding vulnerable adults.

We saw that people were supported to take their medicines as prescribed although medicines errors were not fully investigated to minimise further risks to the people who used the service.

The front door and the conservatory were locked at 5pm for the security of the premises. These two doors are designated fire doors and this meant people could be trapped in the event of a fire. However, we were told the doors would no longer be locked and a more suitable locking device fitted to ensure people could escape in an emergency.

We found that recruitment procedures were thorough and protected people from the employment of unsuitable staff.

Staff were well trained to help them meet the needs of people who used the service and were supported and supervised by the registered manager.

Some staff had completed training had completed training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) so they should know when an application needs to be made and how to submit one.

There was a choice of food for people accommodated at the home. However, the food was not always good quality and may mean people’s diets were not nutritionally beneficial.

People were registered with a GP and had access to a full range of other health and social care professionals.

Throughout the inspection we saw that members of staff were respectful and spoke to people who used the service in a courteous and friendly manner.

We saw that care plans included information about people’s personal preferences which enabled staff to provide care which was person centred and promoted people’s dignity and independence. People had helped develop the plans of care and signed their agreement for the care they received.

There were very few activities on offer to keep people stimulated. Staffing levels were sufficient to meet the care needs of people who used the service but in the evenings there were not enough staff on duty to ensure people had access to activities or be assisted to go out.

The systems for auditing the environment, infection control, medicines management and care plans were available for the registered manager to use to improve the service. However, some of the audits were not well detailed enough to provide the registered manager with sufficient information or she had not acted upon the information. This meant the chance to improve the service or minimise errors had been lost.

During the inspection we spoke with two people using the service. Comments made included; “Yes I’m Ok” and “I’m doing alright”.

We saw that systems were in place to protect the rights of people who may lack the capacity to make decisions about their own treatment, care and support.

Regular monitoring of the services and facilities provided was in place to help protect people against the risks of inappropriate or unsafe care.

We found there had been an improvement in people’s care records. We were told that new documentation was being introduced to ensure that information in care records remained up to date and was relevant.

We spoke with two people using the service. Comments they made included; “I’m doing OK just getting on with things” and “Yes fine, I’m alright”.

The home has been without a registered manager since June 2012.To ensure people benefit from safe quality care and treatment, a manager with the necessary skills and experience needs to be employed by the home and be registered with the Care Quality Commission (CQC). We were told that the present manager was in the process of applying.

People were not protected against the risk of unsafe or inappropriate care and treatment because personal care records and records in relation to the management of the home were not accurate.

The systems in place to protect people who lacked the capacity to make decisions about their own care and support were not adequate.

Appropriate arrangements were in place to help safeguard people from abuse.

Suitable arrangements were in place to ensure staff were supported to deliver care to service users to an appropriate standard.

The systems in place for monitoring the quality of the service within the home were not good enough. Very little auditing of the facilities and services had been undertaken.

We spoke with three people using the service. We asked them to tell us how they felt they were being cared for. Two of the people told us, “Yes, it’s OK, I can’t grumble” and “I’m alright”. Another person told us how well staff supported them to cope with a change in their treatment.

People were consulted about their care and support. The systems in place to protect people who were lacked the capacity to make their own decisions were, however, not good enough.

The care plans we looked at did not always contain enough information to show how people were to be looked after. This puts people at risk of receiving unsafe care and treatment.

People were provided with sufficient food and drink to ensure their nutritional needs were met.

The systems in place to help protect and safeguard vulnerable people from the risk of abuse were not adequate.

Staff did not receive appropriate training and supervision to enable them to safely deliver care and support to people using the service.

The systems in place for gathering and acting upon information about the quality and safety of the service provided were not adequate.

People’s personal records were not always accurate and up to date. Records in relation to some aspects of the management of the home were either not in place or not up to date.

We spoke with four people using the service. We asked some of them if they had seen any improvement in the meals they were provided with. We were told, ”It’s improved a bit from last time, but not a lot”. People told us they were still not asked what they would like to see on the menu. We saw there had been an improvement in the amount of fresh, frozen and dried foods that were in stock. The choice of food was limited however, and as people were not involved in menu planning, they regularly bought their own favourite foods.

Staff were now more aware of their responsibilities in reporting any safeguarding incidents.

We saw there had been some improvement in the way that staff were trained and supervised.

People’s personal records were not always accurate, securely stored or readily accessible.

We spoke to five people using the service and asked for their views on the care and facilities provided at Carr Bank House. Some of the comments were:

“Yes it’s ok but not like being in your own place”.

“Compared to where I came from, it is heaven”.

“It’s ok”.

“I am alright here”.

People told us they felt there was enough to eat for the evening meal but not enough food to eat during the rest of the day. People also told us that despite what it stated on the menu, there was very rarely a choice of main meal. We were also told that people were not involved in deciding what food they would like to see on the menus.

People using the service told us that they felt safe with the staff and “trusted them”. They also told us that they had no problems getting their medicines.

The residents that we spoke to were complimentary about the staff. They told us that the staff were “fabulous” and were always there when they needed them.

Residents liked the fact that they could make choices about how they spent their time.