We carried out an inspection of Garswood House Residential Care Home on the 24 and 25 October 2018, the first day of inspection was unannounced. This was the first time the home had been inspected since it re-registered with the Care Quality Commission in November 2017, due to a change in ownership.

Garswood House Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Garswood House is a large purpose-built home on the outskirts of Ashton in Makerfield. It is registered to provide care and support for up to 40 older people. Services include a 10 bed specialist household for older people living with dementia and a 30 bed residential unit. Day care and respite are also provided. At the time of inspection 38 people were living at the home.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The home had a clear management structure in place with the registered manager being supported by a deputy manager. The home was further supported by the area manager and provider’s compliance manager, who were regular visitors to the home. Staff told us the registered manager was a visible presence in the home and was “always happy to help out.”

People living at the home told us they felt safe and well cared for. Relatives we spoke with also had no concerns about the safety of their family members and spoke positively about the standard of care provided. We found staffing levels were sufficient to meet people’s needs and keep them safe.

The home had appropriate safeguarding policies and procedures in place, with instructions on how to report safeguarding concerns to each of the local authorities who commissioned services from them. Staff had received training in safeguarding vulnerable adults and demonstrated a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

The home was clean, free from odours with effective infection control procedures in place. Hand hygiene guidance and equipment was located in bathrooms and toilets and personal protective equipment (PPE) such as gloves and aprons were available for staff to use to help prevent the spread of infections.

We found medicines were stored, handled and administered safely and effectively. Staff who administered medicines had received training and had their competency assessed. Medication Administration Record (MAR) charts had been completed correctly, as had topical medicine charts, which are used to record the administration of creams and lotions. We found guidance for ‘as required’ (PRN) medicines such as paracetamol were in place, to ensure people were given these medicines safely and when needed.

The staff we spoke with displayed a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We found the home was adhering to the principles of the MCA. DoLS applications had been submitted appropriately for people deemed to lack capacity to consent to their care and treatment. We saw best interest meetings had been conducted to support decision making where people lacked capacity to make these decisions and had no legal representative to do so.

Staff spoke positively about the training provided. Training completion was monitored and promoted, to ensure staff’s skills and knowledge remained up to date. Staff told us they received regular supervision and annual appraisals,