This inspection was unannounced and took place on 11 and 16 January 2017.

Our last comprehensive inspection took place on 1 August 2014. At this inspection, we found the service had complied with all the regulations we reviewed. However, it was acknowledged by the provider that opportunities for staff training and development needed to improve to help keep people safe. At the time of our last inspection a programme of training and support was being developed to help staff to carry out their role effectively.

Church Walk offers person centred nursing care for people with complex physical and neurological conditions, including mental health needs, Huntington’s Disease, acquired brain injury, early onset dementia including Korsakoffs and Frontal- temporal dementia.

The home is a purpose built two-storey building with 18 single en-suite bedrooms. The home is situated in a residential area of Rochdale and is close to local amenities. At the time of our inspection there were 12 people using the service.

The registered manager had recently left the home. An acting manager was in place and we were told that it was their intention to register with the Care Quality Commission in the near future. 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 service has a condition of registration that it must have a registered manager. Because the service did not have a registered manager the well-led question cannot be rated better than ‘requires improvement’.

Relatives we spoke with told us that they thought their family members were safe at the service. Staff had received training in safeguarding adults. They were able to tell us of the action they would take to protect people who used the service from the risk of abuse.

Procedures were in place to help ensure staff were safely recruited. We saw sufficient numbers of staff were available to help support people’s assessed emotional, social and physical needs were met, so their health and well-being was maintained.

Systems were in place to ensure the safe handling of medicines and to reduce the risk of cross infection in the service.

Staff had access to the training and support they needed to help treat, care for and support people, safely and effectively.

The service had taken appropriate action to apply for restrictions in place in a person’s best interests to be legally authorised.

The service worked in partnership with other health and social care professionals. A consultant psychiatrist visited the service every week. This meant that people had access to the support they needed.

The premises was seen to be well maintained, comfortable, homely, clean, and tidy.

The atmosphere at the home was calm and relaxed and interactions between people and the staff team were seen to be frequent and friendly.

Care plans were in place to help ensure staff provided the level of support necessary to manage the identified risks. Care plans were regularly reviewed to address any changes in a person’s needs.

Activities were available for people to participate in and improvements were being put in place following a review by the new management team.

A recent review of the day-to-day operation of the service had identified shortfalls. These shortfalls were in the process of being addressed, including improvements to the culture at the home.

We found that the managers and staff demonstrated a commitment to continuing to drive forward improvements in the service. People and staff were being asked their views and opinions about the service and evidence showed that these were being listened to and acted upon.

Systems were in place to show the service was under constant monitoring and review, which included extern

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the registered provider.

Church Walk offers nursing care and support to people with a mental disorder and complex health care needs. The home is a purpose built two-storey building with 18 single en-suite bedrooms. The home is situated in a residential area of Rochdale and is close to local amenities. At the time of our inspection there were six people living at the home.

It was acknowledged that opportunities for staff training and development needed improving to keep people safe. A programme of training and support was being developed to support staff in carrying out their role.

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. Relevant policies and procedures were in place to guide staff. Where people were being deprived of their liberty, relevant documentation was in place to show this had been authorised and was lawful. Senior staff had been trained to understand when an application should be made, and in how to submit one. People’s human rights were therefore properly recognised, respected and promoted.

People’s care records provided good information to direct staff in the safe delivery of their care, treatment and support. Records were kept under review so information reflected the current and changing needs of people. Information was stored securely ensuring confidentiality was maintained.

People were offered a wide range of activities both in and away from the home. These ranged from social and leisure activities to housekeeping and laundry. This offered people some structure to their day and where possible helped them to maintain their independent living skills.

Staff worked closely with healthcare agencies so that people received the care and treatment they needed. Information was shared with other services so that people continued to receive safe and effective care. The home did at times experience difficulties in accessing support for those people who were not originally from the local area.

Records showed people who had applied to work at the service had been robustly recruited so only those applicants suitable for employment were offered work at the home.

We saw sufficient numbers of staff were available to support people in meeting their emotional, social and physical needs so their health and well-being was maintained.

Systems to monitor and review the quality of service provided were in place to check that people received a quality service. People were offered a good standard of accommodation. Checks were made to the premises and servicing of equipment ensuring people were kept safe.

During our inspection we observed how staff interacted with people who used the service. We also chatted with people as a group whilst sat in the lounge. People were relaxed and had a friendly rapport with staff. One person told us they liked the staff. Another person told us their routine was relaxed and they could do what they wanted to do. We saw that staff had a good understanding of people’s individual needs.

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. Where people’s liberty was to be restricted, the provider had taken appropriate action to ensure people’s rights were protected.

Staff worked closely with other agencies so that people’s social, emotional and physical health care needs were effectively met.

Sufficient nursing and support staff were available to meet the specific needs of people. One staff member we spoke with said; “We’re a good team”.

Opportunities for on-going training and development were in place. Due to changes in the management team, team meetings and individual supervisions had not been held. These meetings would enable staff to discuss their individual needs.

Systems were in place to monitor and review the service provided. Suitable arrangements in the management and structure of the service were still to be made so that people continued to receive a safe and effective service. This was being addressed by the provider.

At the time of our inspection visit there were only three people living at the home. We spent time speaking with one of the people about their experiences. They told us, “I’ve no complaints at all”, “It’s very peaceful and relaxing” and “The staff help me if I need it”.

From our observations and discussions with staff it was clear they had a good understanding of the individual needs of people. Care records were also very detailed and directed staff in the delivery of care and support people required.

Records detailed people’s individual preferences, wishes and choices and showed how they had been involved in planning their care and support.

People were provided with a good standard of accommodation that had been well maintained and was tastefully decorated.

Systems were in place to ensure that people living at the home were safeguarded from abuse. The manager and staff had completed training in these areas and were aware of their responsibilities in keeping people safe.

Robust recruitment procedures were in place to ensure that only those people suitable to work at the home were offered employment.

Staff were provided with on-going training and support to meet the needs of people at Church Walk. Staff spoken with during our visit confirmed they had regular training updates and said they could ask for other training if they felt it would benefit their work. They told us that the manager was “very supportive” and they “could approach them about anything”.

The purpose of this visit was to follow up on areas of improvement identified during our previous review in October 2011. This included care records, staffing qualifications, skills and experience.

During this visit we did not ask people specific questions about these outcome areas. However we observed staff interactions with people. People at the home appeared to continue to have a good relationship with staff. The atmosphere was relaxed and friendly.

People were able to follow a lifestyle of their choosing. However where necessary additional monitoring and support was provided for some people as part of their placement agreement.

Staff were aware of the specific needs of people and of the need for specific interventions where there were concerns about their behaviour.

At present there are only six people living at Church Walk. Those people who were able to were happy to chat. However, they did not wish to answer specific questions about their care, treatment and support.

During our first visit we observed two people relaxing in the lounge. Both people required full assistance from staff in meeting all areas of their care. They appeared well cared for, were appropriately dressed and clean. Other people were doing activities of their own choosing. Some people were relaxing in their own room, whilst others had been out. One person told us that they had been out shopping.

We observed how staff interacted with people living at the home. Where necessary additional monitoring was put in place to observe people where there were concerns about their behaviour. Members of the team spoken with were all aware of the issues and what to do, if necessary.

People at the home appeared to have a good relationship with staff. The atmosphere was relaxed and friendly. Some of the people were able to come and go freely and this was seen during our visit.

Over the last year Church Walk has gone through a number of changes including the management of the home. Staff told us that ‘things have improved since the change in management’, ‘systems are working well’ and ‘I like working at the home’. Another person said that the management team were ‘very approachable’ and ‘will help out when it’s needed’.

No further issues have been raised with us by the local authority commissioners or safeguarding team.

Little feedback was received from people living at Church Walk, however from our observations we found that interactions with staff were relaxed and respectful. People were able to access all areas of the home and seen to spend time either relaxing in their own rooms or with others in communal areas.

Comments were however received from a number of health and social care professionals involved with the service. Feedback was mixed. Whilst people felt the basic care provided with good, it was generally felt that structured ‘therapeutic’ support to meet the specific mental health needs of people was not being provided. Other issues were also identified in relation to poor care records, management of medication and lack of relevant qualified staff.