We inspected Farnworth Care Home on the 13 June 2018. Due to concerns raised following the inspection we undertook a further inspection day which was focused on certain areas on 28 June 2018. Both inspection days were unannounced

Farnworth Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. In some services this may also include people who receive funding from both the local authority and the local care commissioning group (CCG).

The home is a purpose-built home and is situated off the main road leading in to Farnworth town centre. There is adequate car parking at the front of the home. Farnworth Care Home is registered to provide accommodation for up to 120 older people who require nursing and personal care. There were 103 people using the service at the time of the inspection. On Belmont unit 34 people were receiving nursing care. On Firwood unit 30 people were also receiving nursing care. Burden unit provided residential care for 39 people.

We last inspected Farnworth care on 21 October 2015 and the service was rated as good.

A new manager was in post and was in the process of registering with the Care Quality Commission (CQC) to become the registered manager. The manager was on annual leave and was unable to facilitate the inspection on the first inspection day. We were assisted by the deputy manager and the Regional Operations Support Manager. The manager was available on the second inspection day.

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 and associated Regulations about how the service is run.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safe care and treatment and governance. You can see what action we told the provider to take at the back of the full version of this report.

The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults. Staffing levels were sufficient on both days of the inspection. Staff rotas looked at confirmed the number of staff on both days of the inspection to be correct.

The administration of medicines was not consistently safe despite training records showing that staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

The home was clean, tidy and fresh. The environment was well maintained. However, we found some safety concerns in some bedrooms. For example, wardrobes were not secured to the wall.

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

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP). A PEEP informs the fire service what room people live in and what assistance they require to evacuate them safely.

People were offered a well-balanced and nutritional diet and encouraged to eat and drink to ensure they were hydrated and well fed.

There were some activities and social interactions however these were limited especially for those people who were confined to their room.

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) and followed the correct procedures using indep

Farnworth Care Home is a three storey purpose built home off the main street in Farnworth town centre. The home is registered to provide nursing, residential care and care for people living with dementia. The home is registered to provide care for 120 adults, all rooms are single occupancy with en-suite facilities.

This was an unannounced inspection that took place on 21 October 2015. There were 113 people using the service on the day of the inspection.

We last inspected this service on 19 August 2013. At that inspection we found the service was meeting all the regulations we reviewed.

The home had a manager registered with the Care Quality Commission (CQC) who was present of the day of 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 and associated Regulations about how the service is run.

Staff were very confident regarding safeguarding issues. Staff spoken with were able to demonstrate their understanding of the whistle-blowing procedures and they knew what to do if an allegation of abuse had occurred or poor practice observed.

We found that people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. We saw that staff received the essential training and support necessary to enable them to do their job effectively and care for people who used the service safely.

People who used the service and their relatives told us they felt the staff had the skills and experience to meet their needs. People who used the service told us they were happy with the care and support they received and spoke positively of the kindness and caring attitude of the staff.

We found the systems for managing medicines were safe and that people who used the service received their medicines in a safe and timely manner.

We saw the service worked in cooperation with other health care professionals ensuring that people who used the service received appropriate care and treatment.

We found that systems were in place to maintain the safety of the premises. All areas of the home were clean and well maintained. Policies were in place to help prevent and control the spread of infection.

We saw systems were in place in case of any emergency that could affect the running of the home and the wellbeing of people living at the home and staff working at the home.

People’s care records contained detailed information to guide staff on the care and support people required. Risks to people’s health and well-being had been identified and plans were in place to help reduce any risks. People who used the service and/or their relatives were involved and had been consulted about the care records. This helped to ensure that the wishes and preferences of people were considered and acted on.

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

People who used the service were provided with a varied nutritionally well balanced diet and suitable hydration was offered. The home received regular fresh food supplies.

The provider had systems in place to help ensure that people received safe and effective care. Regular checks were undertaken on aspects of running the home. Meetings with people who used the service, their relatives and staff were held so people were able to comment of the quality of the service provided.

We found a well maintained purpose built three storey home that was undergoing some refurbishment in communal areas. The home was clean, tidy and bright with no malodour.

There were dining rooms on each floor and people were encouraged to eat there if possible to engage with others in the home. Relative and visitors were welcome at all times and were observed to be made welcome. One relative told us they regularly came and had a meal with their X.

We found staff had a pleasant manner and spoke to people in a way that maintained people's dignity and self-respect.

We found staff had access to policies and guidance to support the safe running of the service.

We found that staff had a good awareness of safeguarding issues and could explain how they would raise any concerns.

We sampled nine care records during our inspection, three from each area of the home, all of which all contained photographs of the person using the service. Records were paper based; they were accurate and well maintained. All entries and care plans were signed by the person receiving the care to demonstrate involvement and agreement.

People told us: "I like it here, the staff are always cheerful, this is not just for your benefit they are always this happy". "The girls and lads are always busy but not too busy to stop and make sure you don't want anything. They smile all the time and are polite to everyone". "I ask and I get you cannot fault it here".

We found Farnworth Care Home had completed its refurbishment to the ground floor and the area was clean and tidy.

Each floor was independently staffed but staff had rotated between the floors to share good practice. Staff we spoke with had found this to be a positive experience. Staff told us that the staggered meal times that had been trailed was proving to be effective.

People we spoke to told us: "I am happy here the food is good" "I didn't want breakfast today so will have some fruit"

Staff told us: "Some people do not want to eat breakfast so we will offer them something later in the morning". "X usually has something at this time but not today but I will try him again and he will have something later". "We have had some extra training and it has helped us". "We have tried to use the feedback from the last CQC visit as a positive way of making changes to our practice".

Farnworth Care Home was undergoing refurbishment to the ground floor when we visited. The home was clean, tidy and had a large enclosed garden space to the rear for people to access.

All floors were laid out in the same way, this assisted people who moved floors for reason of dependence to have an understanding of the layout and not become disorientated.

Each floor was staffed independently and staff numbers were appropriate to the levels of dependency observed.

Rooms on the second floor had been decorated in line with guidance from the Dementia Awareness Society with familiar items and artifacts to help the person with their memory.

Relatives told us: "My X has been here a while he is well looked after and I think he likes it here". "My X is happy here, we couldn't give her the care she needed, it was a big decision for us but it was the right one". "I came here first then my X came 3 months later we are settled now and well cared for, the girls will do anything for you".

People told us: "It's a good as being at home but you have support if you need it". "Nursing care here is second to none". "They know what I need and always come when I buzz for them, I am very happy here". "If you have to be in a home then here is great".

We did not speak to people who used the service as part of this review.

During our visit to Farnworth Care Home we spoke with people on the residential care unit and the nursing unit. We observed care taking place on the dementia care unit. One person told us “It’s like being at home” and another said “The care is wonderful and the ladies (staff) are brilliant”. We heard “I have a call bell but I just shout if I want something and someone comes”.

People told us that they could bring furniture from home and have their rooms as they liked them. One person said they had their own telephone line so they could speak to their family whenever they liked.

One person that we spoke with said that staff had arranged for her to attend a family wedding. They did not think it would be possible but all the arrangements were made and a senior care worker accompanied them on the day.