Four Seasons Residential Care Home is a large detached house located in Littleborough, Rochdale. Personal care and accommodation is available for 16 people. There are 16 single rooms, with 12 rooms having en-suite toilet facilities. There were 13 people accommodated at the home during the inspection.

At the last inspection of March 2017 the service was rated as requires improvement overall with well-led in inadequate. These were five breaches in the regulations. Regulation 9 HSCA RA Regulations 2014 Person centred care. Care plans were not developed to meet people's identified needs. Regulation 12 HSCA RA Regulations 2014 Safe care and treatment Medicines were not managed safely. Regulation 17(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Failure to complete and return a PIR. Regulation 17 (2 (d) (ii) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2017 because fire drills were not recorded and Regulation 18 (4A) of the Care Quality Commission (Registration) Regulations 2009. Failure to notify the CQC of people subject to a DoLS and other required notifications. The service sent us an action plan to show us how they intended to improve the service. The service had improved and met the regulations at this inspection.

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.

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.

There were sufficient numbers of staff to meet people’s needs.

The administration of medicines was safe and people received their medicines when they needed them. 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 did not contain any offensive odours. The environment was maintained at a good level and homely in character.

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. This helped to protect the health and welfare of staff and people who used the service.

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 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 person in charge 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 independent professionals.

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 people were treated in a way that was suitable to their age, sex, gender and background.

We saw from our observations of staff and records that people who used the service were given choices in

This was an unannounced inspection that took place on the14 March 2017. Four Seasons Residential Care Home is registered to provide accommodation for up to 16 people who require personal care. It is a two storey detached property set in well maintained gardens. It is situated close to Littleborough Village and the open countryside. There are 16 single bedrooms with 12 rooms having en-suite toilet facilities There were 15 people using the service at the time of the inspection.

The home had a manager registered with the CQC who was also the registered provider. The registered manager was present on the day of the inspection. A registered manager is a person who has registered with the CQC 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 last inspected Four Seasons Residential Care Home on 1 February 2016 where we found there were several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the lack of appropriate arrangements in place for consent to care and treatment, the management of medicines, safeguarding procedures, the lack of staff supervision, inadequate quality assurance systems, fire safety and unsafe equipment. Following the inspection the registered manager sent an action plan informing us that they had taken action to ensure the regulations had been met.

During this inspection we checked to see if the previous breaches of the regulations had been met. We found the registered manager had not met all the regulations.

We found that the management of medicines continued to be unsafe as there was no guidance in place for ‘when required’ medicines were prescribed, medicine keys, including controlled drug keys, were not kept securely, prescription doses had been altered and there was no evidence to show why staff had done this. This placed the health and welfare of people who used the service at risk of harm.

The registered manager had failed to act in accordance with the principles of the Mental Capacity Act 2005 (MCA). People’s rights were not protected as the registered manager had not made the necessary Deprivation of Liberty Safeguard (DoLS) applications to the supervisory body.

Following the last inspection the registered manager had taken action to have the portable electrical appliances tested (PAT) and a fire risk assessment undertaken. During this inspection we found they were overdue. There was no evidence to show that they had been undertaken again. Information was sent to the CQC several weeks after this inspection. The information sent confirmed that the fire risk assessment had been undertaken however no information had been received to confirm that the PAT testing had been done.

During this inspection we also found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. This was in relation to;

A lack of appropriate arrangements in place to ensure the safety of people who used the service. There was no business continuity plan in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and water supply. There were no personal emergency evacuation plans in place for people who used the service This placed the health and safety of everybody who lived, worked and visited the home at risk of harm.

Records that were necessary for the management of the home were not always in place. This was in relation to the recording of fire checks and fire drills.

People's care records did not contain enough information to guide staff on the care and support they required. We found that risks to people's health and well-being had been identified, such as poor nutrition, falls, and the risk of

This was an unannounced inspection which took place on 1 February 2016. The service was last inspected in September 2014 when we found it to be meeting the regulation we reviewed.

Mrs Wendy Collinson is registered to provide accommodation at Four Seasons Residential Care Home for up to 16 older people who require personal care. Four Seasons Residential Care Home is a large detached property located in Littleborough, Rochdale. There are 16 single rooms, with 12 rooms having en-suite toilet facilities. At the time of this inspection there were 16 people using the service.

There was a registered manager in place at the home who was also the provider of the service. 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 registered manager was unavailable on the day of the inspection due to illness. However, we spoke with them by telephone on 4 February 2016.

During this inspection we found five breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

People told us they felt safe in the service. Records we saw confirmed staff had completed safeguarding training. However, staff we spoke with were not always clear about how to report any safeguarding concerns they might have. During the inspection we became aware of one incident which should have been reported to the local authority to ensure people were protected from the risk of abuse. The deputy manager submitted the referral at our request.

During the inspection we noted there were sufficient numbers of staff available to meet people’s needs. However, two people we spoke with told us they considered staffing levels in the afternoons and evenings could be increased.

The recruitment processes in the service were not always sufficiently robust to protect people from the risk of unsuitable staff being employed. One staff personnel file we reviewed did not contain two references as required by the service’s own policy and procedure.

Systems to ensure the safe management of medicines needed to be improved. Medication administration record (MAR) charts did not always show that people had received their medicines as prescribed. The registered manager had not introduced a tool to assess the competence of staff to safely administer medicines as required by the local authority. Medication audits had not been completed since September 2014.

All areas of the home were clean. Procedures were in place to prevent and control the spread of infection. However, the provider had not taken the necessary action to ensure people were protected in the event of an emergency at the service. The safety of small electrical appliances had not been checked on an annual basis as required by law.

Staff had not received the supervision and appraisal required to help ensure they were able to carry out their role effectively. However, none of the people we spoke with during the inspection expressed any concerns regarding the skills staff demonstrated when providing care.

Although staff had received training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), staff we spoke with demonstrated limited understanding of how this legislation was relevant to their practice. The registered manager had failed to take the necessary action to ensure the rights of people were upheld when they were unable to consent to their care in the home.

People told us they enjoyed the food in the home. We saw systems were in place to monitor and review the nutritional and health needs of people who used the service.

Care records we looked at showed that risks to people’s health

The purpose of this inspection was to check that the provider had made the required improvements following the last inspection of 20/06/2014. During our inspection visit we spoke with the deputy manager and the administrator. We also looked at medication records and audits completed by the registered manager in order to monitor the quality of the service provided.

We found that people were being their medication at the right time in relation to food. We saw that records for the management of medication were clear and accurate. This helped to prevent mistakes from being made.

We found that the registered manager had put in place an effective system for monitoring the quality of the service provided. Audits completed regularly included infection control, the environment and health and safety.

During our inspection visit we spoke with three people who used the service, the relatives of three people who used the service, three members of staff and the deputy manager. We also looked at records to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

We saw that people were treated with dignity and respect. One visitor told us their relative with a dementia was happy and safe at the home. Members of staff had received training in safeguarding vulnerable adults and understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Members of staff had received training about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards to understand when an application should be made, and how to submit one.

We saw that the home was clean, tidy and free from offensive odours. One visitor said, “The home is always clean and tidy and never smells.”

We saw that medication administration records were not always completed accurately. Although there was no evidence of any medication errors a lack of clear records increased the risk of mistakes being made. We found that some medication was not always given at the right time in relation to food.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medication.

Is the service effective?

People’s health and care needs were assessed with them or their relatives and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly and amended to reflect people’s changing needs.

We found that people’s care records included an assessment of their nutritional status so that appropriate action was taken if any problems were identified. All the people we asked told us that the meals were good. One visitor said, “The meals are beautiful home cooking.”

Discussion with care workers and examination of records confirmed that a rolling programme of training was in place so that all members of staff were kept up to date with current practice.

Is the service caring?

We saw that members of staff were attentive to people’s needs and offered appropriate encouragement and assistance when necessary.

People who used the service told us they liked living at the home and received the care and support they needed. The relative of one person who used the service said, “The quality of care is outstanding.” Another visitor said, “It’s smashing, I’m really pleased with the care.”

People’s personal preferences, interests and diverse needs had been recorded in their individual care plans.

People who used the service and their representatives were given the opportunity to complete satisfaction questionnaires approximately every four months. The manager evaluated these surveys in order to identify any areas for improvement.

Is the service responsive?

Leisure activities were routinely organised at the home. These included reminiscence, music and movement, bingo, sing a long’s and arts and crafts. People from the local Church visited weekly to sing hymns for people who wished to practice their faith in that way. One visitor said, “The staff often sit and chat to people.”

All the people we asked told us they were happy with the care and facilities provided at the home but would complain to the manager if necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The quality assurance system required further development in order to ensure that all aspects of the care provided at the home were properly monitored. The manager had not identified and addressed the shortfalls we found during this inspection.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of service provision.

Care plans contained information about people’s personal preferences. People were asked for their consent for the use of their photograph.

During our previous inspection in August 2013 we identified that a number of the provider's policies and procedures were out of date and required review. This was to ensure they remained appropriate and up to date. Although some work had been undertaken to address this it had not been completed.

We spoke to a visitor at the home who told us he was involved in the care planning process for the person he was visiting and felt that the standard of care was good.

The visitor felt the environment was “First class” and told us “The staff always keep it spotless and clean up all the time”. He was happy with the room and said it felt comfortable, light and airy.

The visitor told us that staff were “Cheerful, obliging and always helping people when needed”.

We did not speak to any people using the service on the day of inspection. There were no visitors at the home on the day of inspection.

During our visit we spent sometime speaking with people living at the home and their visitors. We asked them about their experience of living and visiting the home.

People told us that they were very happy living at the home, that they received a good standard of care and were well cared for. People felt that the home was more ‘homely’ due to it being a small home.

People also commented, “The activities are enjoyable for everyone”, “ The food is excellent, plenty of choice”, “You can’t fault them and what they do”, “The home is always kept clean and tidy, there’s never an odour”, “I’m able to come and go as I please” and “Lots of good home cooked food and baking”.

Visitors commented, “My mum gets all the care she needs” and “We’ve been more than happy with our relatives care”.

We were told by a visiting health professional, “If I request anything it’s always organised for my next visit” and “I’ve never had any issues with the home”.

Staff spoken confirmed they received on-going training and support. They also told us, “We work well as a team, it’s very settled”, “Good communication between everyone”, “I’m very happy working here” and “It’s a very relaxed home but we know if things need doing what is expected of us.