About the service: Chadderton Total Care is a residential care home providing personal and nursing care for up to 146 people. At the time of the inspection 124 people were usig the service. The service provides care for people with a variety of social and nursing needs including physical and learning disability, dementia related disease, and acquired brain injury. The home consists of five units on ground floor level.

People’s experience of using this service: We found improvements were required in key areas including medicines management, staff deployment and treating people with dignity. Internal and provider level audits had picked up on the majority of issues we noted during the inspection, however senior/nursing staff had not always reported issues of concern to the registered manager.

Medicines were not always managed safely. People did not always receive the medicine they were prescribed and the storage conditions had not been recognised as being unsuitable to keep medicines at the correct temperature.

Staff had appropriate skills and knowledge to deliver care. Staff understood where people required support to reduce the risk of avoidable harm.

People told us Chadderton Total Care was safe and staff were kind and treated people well. Staff had built positive caring relationships with people they supported and their families.

All the people we spoke with told us that the registered manager and staff listened to their views, acted to resolve concerns, when needed, and met people's needs.

People's capacity to consent had been assessed in line with legal requirements.

Where people required support at the end of their life, this was carried out respectfully, compassionately and with professionalism.

We have made a recommendation that the provider reviews the deployment of staff on all units to ensure that staff have appropriate oversight to keep people safe.

We have made a recommendation that the provider increases staffing levels on the young disabled person’s unit to ensure that people receive individualised care and that staff are refreshed with the necessary training and supervision to ensure that people are always treated with dignity and respect.

At the last inspection we identified one breach of Health and Social Care Act (Regulated Activities) Regulations 2014 relating to person-centred care. At this inspection we found that the majority of people at Chadderton Total Care received person-centred care and the provider was no longer in breach of this regulation.

At this inspection we identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to medicines management and good governance. You can see what action we told the provider to take at the back of the full version of this report.

More information is in the full report.

Rating at last inspection: Requires improvement (report published February 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we identified some areas which required improvement.

Enforcement: Full information about CQC's regulatory response to the more serious concerns found in inspections and appeals is added to the reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in accordance with our re-inspection programme. If any concerning information is received we may inspect sooner. Chadderton Total Care will complete an action plan detailing how then plan to meet the breaches of Regulations laid out in this report.

We inspected Chadderton Total Care on 10, 11, 12 and 16 October 2017. Our visit on 10 October was unannounced.

The service was last inspected in September 2015 and rated Requires Improvement. We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to poor care planning and recordkeeping; inappropriately stored food; poor use of equipment and concerns around governance and supervision. Following the inspection the provider sent us an action plan which stated the breaches would be addressed. At this inspection we found significant improvements in these areas but we found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) 2014, relating to person centred care. You can see what action we told the provider to take at the back of the full version of the report.

Chadderton Total Care Limited is situated in a residential area approximately two miles from Oldham town centre. The home is registered to provide accommodation for 151 adults who require nursing or personal care. At the time of our inspection there were 136 people living in the home. It is a purpose built home, providing accommodation and facilities all at ground floor level. The service provides care for people with a variety of social and nursing needs including physical and learning disability, dementia related disease, and acquired brain injury. Many of the people supported at Chadderton Total Care had multiple and complex needs. The service is separated into five units. The Dales Suite is designed to care for people who have been assessed as needing residential dementia care. The Middlewood Suite is a small unit that cares for people with a variety of nursing needs. The Saddleworth Suite is a purpose built Dementia unit, which has recently undergone some redesign and modernisation to provide a more dementia friendly environment. The Young Disabled Suite provides care for adults aged 18 to 65 years old, and the Lakeland Suite is separated into three much smaller units named, Borrowdale, Ullswater, and Windermere, which provide care for people who have nursing needs.

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.

People told us that they felt safe at Chadderton Total Care, and when we spoke with staff they demonstrated a good understanding of how to prevent abuse. We saw that the service had safeguarding procedures in line with legislation and local authority policies so when allegations of potential abuse were raised these were reported and appropriate action taken to protect people from harm.

Staff were well trained and the service made appropriate checks during the recruitment process to ensure that new staff had the right attributes and character to work with vulnerable people. All new staff received a full induction, and systems were in place to provide supervision for staff. The service recognised staff achievements and provided them with opportunities to develop their skills. We saw that there were generally enough staff on duty, but care workers informed us that staff would occasionally call in sick at the last minute and their shift would not be covered, leaving units short of staff.

When we looked at care plans we saw that potential risks to people’s safety were assessed and measures put into place to minimise the risk, although in some the level of risk was not always clear. Environmental risks were also monitored; wide corridors and walkways allowed easy access, free from obstacles, and regular checks were made to ensure the building and equipment was well maintained. When accidents occurred the cause was analysed with steps to pre

This inspection was carried out over three days on 14, 15 and 16 September 2015. Our visit on the 14 September 2015 was unannounced. We last inspected Chadderton Total Care in May 2013. At that inspection we found that the service was meeting all the regulations we assessed.

Chadderton Total Care Limited is situated in a residential area approximately two miles from Oldham town center. The home is registered to provide accommodation for 151 adults who require nursing or personal care.

Chadderton Total Care is a purpose built home, providing accommodation and facilities at ground floor level. The service is separated into five units. The Dales Suite is designed to care for people who have been assessed as needing residential dementia care. The Middlewood Suite is a small, unit that cares for people with a variety of nursing needs. The Saddleworth Suite is a purpose built Dementia unit. The Young Disabled Suite provides care for adults aged 18 to 65 years old and the Lakeland Suite is separated into three much smaller units named, Borrowdale, Ulswater, and Windermere, which provide care for people who have nursing needs.

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.

We identified seven 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 the report.

We looked at the systems in place to manage medication. The records of the administration of medication did not give us confidence that medicines were always managed safely.

There was a lack of evidence to show nursing staff were receiving clinical supervisions and kitchen staff were receiving regular supervisions or appraisals. Supervision and appraisal meetings support and help staff to discuss their progress at work and also discuss any learning and development needs they may have.

Systems were in place to help ensure people’s nutritional needs were met. However cooked food was inappropriately stored in the cooling fridge, without the correct labelling and looked least appetising for people on a pureed diet. There was no evidence to show choice or involvement of people was considered when creating menus for people who required pureed meals.

We reviewed records for one person who was at risk of aspiration. There was no evidence of a care plan being developed for the risks associated to aspiration or support needed to mitigate risk.

We saw five people who were using wheelchairs without footplates which is not safe and not good practice.

Staffing levels were sufficient to meet the needs of the people who used the service.

We looked at fourteen staff recruitment files and found that all of the staff had been recruited in line with the regulations and had appropriate pre-employment checks.

Staff we spoke with told us they had received training in safeguarding and ‘whistle blowing’ (exposing bad practice) and were fully aware of their responsibilities for recognising and reporting any suspicion of abuse.

Accidents and incidents were monitored, but there was insufficient evidence of lessons learned from the analysis.

Infection control policies and procedures were in place to support staff to deal with the risk of cross infection and regular checks were undertaken to ensure cleanliness was maintained throughout the service.

Care staff told us they had received training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. They told us they would always support people to make their own decisions and choices.

We found that 5 DoLs applications had been completed by the service but not submitted to the Local Aut

During our inspection at Chadderton Total Care Unit Limited we visited a suite which provided nursing care for people with dementia and the young disabled unit. We spoke the Manager, the Deputy Manager, two nurses and three care workers. We looked at the care records for eight people living at the home and the personnel records for six staff members. We also spoke with four people living at the home.

We saw that in depth risk assessments and care plans were in place for people. These were easy to understand and we saw they were usually updated at least every month. Other healthcare professionals were consulted appropriately if a need arose.

The Manager had in place a programme of quality control audits covering all aspects of the home. We saw evidence that when the need for improvements was identified action was immediately taken.

Staff had been trained in the Mental Capacity Act 2005 and had a good understanding of the action to take if a person did not have the capacity to make their own decisions. People were treated respectfully and we saw they had choices in how they spent their days.

Robust recruitment procedures were in place to confirm staff members were of good character and had the required skills to perform their work.

We saw the results of the latest residents’ satisfaction survey carried out in early 2013. Comments included “You are treated as an individual”, “I have privacy and feel welcome” and “All my needs are met”.

During our inspection we spoke with three people who lived at Chadderton Total Care Unit Ltd. They told us that care workers always asked permission before they carried out any care. One person said they were well looked after and had choices about what they did during each day. Another said that care workers always did what they were asked to do, and there were plenty of activities and trips to choose from.

We were told "I'm looked after here and that's the main thing" and "[Chadderton Total Care Unit Ltd] is as good as a hotel; probably better than some". When asked about the care workers one person said "I couldn't ask them to do anything more. They're brilliant".

We saw the results of the resident satisfaction survey completed in March 2012. Everyone who completed the survey said they would recommend the home to others. One person commented "Each department ensured the welfare, health, safety and comfort of all residents". Other comments included "[Care workers] are very approachable without doubt" and " We can relax knowing all residents are cared for individually".