This inspection was carried out over three days between 12 and 14 February 2018. Our initial visit on 12 February was unannounced.

We last inspected Cawood House in December 2016. At that inspection we rated the service as good in all domains.

Cawood House is one of 11 care homes in Stockport owned by Borough Care Limited. Cawood House is situated in the Brinnington area of Stockport and provides accommodation for up to 42 older people who require accommodation and personal care. All rooms provide single accommodation and nine rooms have en-suite facilities. Bedrooms are located over two floors and can be accessed by stairs or passenger lift. Communal bathrooms and toilet facilities are available throughout the home. The home is divided into two floors; each floor consists of a lounge and dining area. There is a quiet room on the first floor and a garden room on the ground floor. The laundry and large kitchen are located on the ground floor. There is a large enclosed paved patio and lawned areas to the rear of the building that are accessible to people who live at Cawood House.

At the time of our inspection there were 39 people living at Cawood House.

The service had a registered manager 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.

This inspection was carried out in response to information contained in a regulation 28 report from the Coroner’s office. This is a report that is written after an inquest into someone’s death and the Coroner believes there is a risk of other deaths occurring in similar circumstances. Cawood House was not the subject of the regulation 28 report, but was involved in the care of the person who was the subject of the inquest and concerns relating to Cawood House were raised by the Coroner. .

We identified breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to Safe Care and Treatment, in particular infection control, accident management, individual risk assessments, care plans and Good Governance. You can see what action we told the provider to take at the back of this report.

We made three recommendations. One recommendation relates to the provider taking action to ensure people always receive their specifically prescribed fortified diet when required. The second recommendation relates to ensuring handover and meeting notes are completed. The third recommendation relates to ensuring only current policies and procedures are in place.

People, their relatives, visitors and staff spoke highly of the service; one person told us, “I can’t fault the home…There’s nothing they could do to look after [name] any better.”

During this inspection we found that there were enough staff available to meet people’s needs and they were being cared for by people who knew them well.

People were supported by staff who were kind and caring and ensured people’s dignity was respected when providing care and support.

The staff files we looked at showed us that safe and appropriate recruitment and selection practices had been completed by management to satisfy themselves that suitable staff were employed to care for vulnerable people.

Staff we spoke with were aware of how to safeguard people and were able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Relatives and staff gave us mixed feedback regarding the menu

This was an unannounced inspection carried out on 4 October 2016.

We last inspected Cawood House in May 2014. At that inspection we found the service was meeting all the legal requirements in force at the time.

Cawood House provides accommodation and personal care for up to 42 people. Care is provided to older people, including people who live with dementia or a dementia related condition. At the time of inspection there were 41 people living at the home.

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 said they were safe and staff were kind and caring. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Appropriate training was provided and staff were supervised and supported. Staff had received training and had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were able to make choices where they were able about aspects of their daily lives. People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe and timely way. We have made a recommendation about the use of covert medicines. (Medicine that is placed in food or drink without the person’s knowledge).

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care. Most records were in place that reflected the care that staff provided. We have made a recommendation about care plans.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for. A variety of activities and entertainment were available for people. The environment was being refurbished and it was bright and promoted the orientation and independence of people who lived with dementia.

People told us they felt confident to speak to staff about any concerns if they needed to. Staff and people who used the service said the registered manager was supportive and approachable. People had the opportunity to give their views about the service. Feedback was acted upon in order to ensure improvements were made to the service when required. The provider undertook a range of audits to check on the quality of care provided.

During our inspection we spoke with the Registered Manager, Deputy Manager, two senior carers and one care assistant. We also spoke with two 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 Cawood, 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?

People were treated with dignity and respect by staff. People told us they had no concerns about their safety or the care they were receiving. One person told us “I feel safe here, no one bothers me, I get good sleep”.

There were effective systems to manage people's medication. People were supported with their medication by staff who were appropriately trained in this area. Staff worked within a system that was regularly monitored to ensure it worked safely and effectively.

There were effective recruitment processes in place and we saw that the required employment checks had been carried out before people started to work at Cawood. New staff underwent an induction period, where they received support from experienced staff and training to equip them for their role.

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 up to date as they could have been, however the service was in the process of introducing new care plan documentation, which staff were getting used to. Staff told us they were able to access 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. Two visiting relatives told us that staff understood their relative’s needs and that they had settled well at Cawood House.

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. Staff also showed an understanding of what action to take when people needed medical attention, including in an emergency. Staff were aware of the importance of passing on essential information about a person to the health professionals treating them. We spoke with a health care professional who regularly visited the service. They told us that staff communicated well and were available to assist them during their treatment visits to Cawood. They told us staff were proactive in referring people and seeking advice when people needed treatment.

Is the service caring?

We saw staff treating people with respect and warmth and the care we observed was provided in a sensitive, personal way. The people we spoke with generally made positive comments about the care they or their relative received. Two relatives we spoke with told us staff treated their relative with dignity and respect, and that staff were caring.

Before people started using the service, the Registered Manager told us they were encouraged to spend some time visiting the home, where they could enjoy a meal and get to know some of the staff.

The Registered Manager clearly understood the importance of respecting people’s wishes around their end of life care and supported them and their family to receive the care they wanted during this time.

Is the service responsive?

We saw that reviews of people’s care were 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 to the management team.

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?

Staff felt supported by the management team in place. Staff were provided with support when they started working at Cawood, though shadowing experienced staff and training to equip them in their role. Staff showed a clear understanding of the protocols in place which guided their work.

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.

We spoke with six family members, the manager, two care workers and four people who used the service. We also talked to Stockport Social Services Quality Assurance team as part of our inspection process.

Many of the people who lived at the home had dementia care needs which limited their ability to communicate their views and opinions of the service. However whilst we walked around the home and spoke with people we observed that they were relaxed and that the care workers were polite at all times.

We were able to talk with two family members on the day of our visit and we also spoke with a further four family members by telephone. Everyone said that they were happy with the care their relative received.

We were told by family members; “I am comfortable with the quality of care given;” “The home is very well run;” “It’s as close as possible to being at home;” “I feel the staff really care;” “I am always made to feel welcome and am given a cup of tea.”

One of the staff team told us; “The staffing levels are quite good never really short of staff and the senior team always help out if necessary.” They also said that the company were good at providing training.

Between May 2012 and April 2013 we received three reports regarding areas of concern. All three reports and allegations were looked into and were unsubstantiated.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

At the time of our visit, 38 people lived in the home. We spoke with nine people who lived in the home, the acting deputy manager, two care assistants, the head chef and the registered manager. Limited information was obtained from some of the people using the service due to their dementia care needs or communication difficulties. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

During our observations we saw staff were respectful, kind and patient when addressing people or offering assistance. For example, we saw staff knock before they entered rooms, introduce themselves and ask permission before assisting people with personal care. From the staff interactions we observed we felt that staff had a good understanding of people's individual needs and personal preferences. They spoke with people in an appropriate manner, explained what they were doing and did not rush them, taking time to support them properly.

People we spoke to who live at the home told us they were treated well, with dignity and in a way that reflected and met their individual needs. For example, one person said; “The carers know what I like and meet all my requirements.” Another said; “I am treated with respect.” People also told us they were asked about what they wanted to do during the day and provided with choices. For example, one person said; “I pick my own clothes.”

One area people were less happy about was the availability of things to do to keep them occupied and several raised this as an issue. One person said; “There is very little to do. We just sit and watch TV mostly.” During our visit we did observe that people had little to keep them occupied in the morning. Once they had got up they had the choice of where they would like to go and most either sat upstairs watching TV or downstairs listening to music. In the afternoon there was more to do and we observed that one of the care assistants organised card playing in the downstairs lounge.

We observed that people were given choice about what they would like to eat and drink. For example, at lunchtime we saw people choose what they wanted for lunch from a menu that had alternatives for both the main meal and pudding. Additional alternatives were also made available for people with specific preferences or needs. A variety of drinks was offered regularly during the day and people were always asked what drink they preferred.

People we spoke to said they thought the food met their needs and told us they were always consulted and given choices about their next meal. One person said; “I always chose the things I want to eat and the food is adequate.” They all said they were helped as needed to have sufficient to eat and drink.

We saw the interaction between people who lived at the home and the staff to be relaxed and informal. People looked comfortable and confident when in the company of staff and the atmosphere was friendly and relaxed. We also saw staff respond appropriately to people behaving in a way that presented a risk to themselves. For example, they responded quickly, communicated in a caring way and never shouted. We also saw people were being supported in an appropriate and safe manner. For example, people that needed help to mobilise were assisted in a way that kept them safe.

Every person we spoke with told us they were properly cared for by the staff at the home and they had no reason to complain. For example, one person told us; “I have no concerns about my care and no complaints. If I had I would raise them.” Another said; “I feel safe.”