About the service: Gorsey Clough Nursing Home is a residential care home that is registered to provide personal and nursing care to 50 people. At the time of the inspection there were 31 people using the service.

People’s experience of using this service:

At this inspection we found the evidence supported the overall rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

Risks were well managed. Where people had behaviours that might challenge the service these were being identified, monitored and well managed.

People’s health needs were being met and medicines were managed safely.

The home was clean, and improvements had been made to areas of the building, including the development of a new dementia care unit.

Care records were person-centred and reflected people’s current needs.

Staff received the training and support they needed to carry out their roles effectively. Staff had been safely recruited and there were sufficient numbers of staff to provide people with the person-centred support they needed.

Staff interactions were polite, friendly and good humoured. People received support in a discreet, patient and unhurried manner.

Everyone was very positive about the manager and the improvements they had made at the home.

The manager had introduced a range of quality monitoring and auditing. Although we saw significant improvements had been made, we have not rated the well-led key question as 'good'. There is a history of non-compliance. To improve the rating to 'good' would require the embedding of audit systems and a longer-term track record of sustained improvement and good practice.

The manager had a clear vision of what the service should be. They were very enthusiastic, had a good knowledge base and an understanding of people’s needs. They spoke with passion about promoting the rights of people and improving quality and people’s experiences of the service. The provider and staff we spoke with shared this commitment to continue with the improvements.

Rating at last inspection: At the last comprehensive inspection published on November 2018 we found the service to be Inadequate in safe and well-led and requires improvement in effective, caring and responsive. This gave the service an overall rating of Inadequate. We identified nine breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. We also identified one breach of the Care Quality Commission (Registration Regulations 2009. This was because the service had not sent in statutory notifications as required. The service was placed in special measure and a warning notice for governance was issued. At this inspection we found the required action had been taken and the breaches of regulations and the warning notice were met. The service has been removed from special measures.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection was unannounced and took place on the 26 and 27 September 2018.

Gorsey Clough Nursing Home is a ‘care home with nursing’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

Gorsey Clough Nursing Home is a large detached property which provides accommodation for up to 50 older people. The accommodation is situated over two floors with lift access. At the time of this inspection there were 44 people living in the home.

We last carried out a comprehensive inspection of this service on 22 November 2016. At that inspection it was found to be Good overall.

At this inspection we identified nine breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full report. We are currently considering our options in relation to enforcement in response to some of the breaches of regulations identified. We will update the section at the back of the inspection report once any enforcement work has concluded.

Medicines were not all managed effectively. Some medicines including creams and thickeners were not being stored properly and administration of them was not being recorded.

Equipment was serviced, but health and safety checks including fire and water checks were not completed. The provider had not addressed actions identified in the last fire and legionella risk assessment.

On the first day of our inspection there was a malodour throughout the home and areas of the home were visibly dirty. Suitable arrangements were not in place to ensure people were protected from the risks of cross infection.

Although recruitment was on-going there were insufficient staff on rota to provide people with the support they needed. The provider did not have a systematic way of assessing staffing needs. Staff spoke politely towards people, however we found that interactions were often task orientated. Staff were unable to spend time with each person, as they needed to provide support to someone else. People’s dignity was not always protected because of this.

Checks were completed before staff started to work at the home. Staff received supervision but not all staff had received all the training they needed to carry out their roles effectively.

The provider had not ensured that staff had acted in accordance with the Mental Capacity Act 2005. Best interest decisions were not all documented. Staff did not have a good understanding of MCA and DoLS.

Records relating to managing peoples challenging behaviours were not sufficiently detailed and there was no analysis or review of incidents. Care records did not include complete and accurate information about people’s current and changing needs.

There was a lack of systems to monitor and improve the quality of the service. We found governance systems were incomplete and not sufficiently robust to ensure best practice was followed and compliance with regulations.

The service is required to notify CQC of events such as accidents, serious incidents and safeguarding allegations. The service had not notified CQC of all events they are required to.

We have also made two recommendations.

We found that safety belts had been purchased for wheeled shower chairs, however they had not been fitted. We recommend the provider follows appropriate Medical Devise Alerts and Health & Safety Executive guidance, and that risk assessments and best interest decisions be undertaken where necessary.

Confidential information was left accessible to people. We recommend the service reviews its system for recording daily activities to ensure peoples confidentially is maintained.

We received mixed v

Gorsey Clough Nursing Home provides nursing care and accommodation for up to fifty people living with dementia. The home is situated outside the village of Tottington, which is approximately three miles from Bury town centre. The home is a large detached property in its own grounds. Accommodation is provided over two floors and can be accessed via a passenger lift. Communal rooms are available on the ground floor. These include a large lounge/dining room and two smaller lounges.

This was an unannounced inspection which took place 22 and 23 November 2016. The inspection was undertaken by two adult social care inspectors.

The service was last inspected on 8th September 2015. During that inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. This resulted in us making three requirement actions. Following the inspection in September 2015 the provider wrote to us to tell us what action they intended to take to ensure they met all the relevant regulations. During this inspection we checked if the required improvements had been made. We found that action had been taken to make improvements and the requirement actions had been met.

Staff had received training in and understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked the mental capacity to make certain decisions appropriate arrangements had been made to ensure their rights were protected. People had access to independent advocates (IMCA) to help support them when specific decisions needed to be made about their care and support. We found that that where decisions were being made in people’s best interest some records of options considered were not always complete. We recommend the service considers current good practice guidance to ensure that they comply with the principles of the MCA.

Staff received a programme of induction, supervision and on-going training to help ensure they were able to deliver safe and effective care. Staff spoken with confirmed they were supported in carrying out their role. Nursing staff felt supported, but did not receive regular clinical supervisions. We recommended the provider reviews arrangements for the clinical supervision of nurses based on good practise guidance.

People’s support needs were assessed before they moved into Gorsey Clough Nursing Home. Care records contained information about people’s support needs, preferences and routines. Risk assessments were in place for people who used the service and staff. Care records we had been reviewed regularly and had been updated when people’s support needs had changed. People, and where appropriate, their relatives had been involved in planning and reviewing the care provided.

The service had a registered manager. They had been absent since March 2016 and would be leaving the service in January 2017. 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. Interim management arrangements had been put in place and the owner was starting to recruit a new registered manager.

Staff had received training in safeguarding adults. They were aware of the correct action to take if they witnessed or suspected any abuse. Staff were aware of the whistleblowing (reporting poor practice) policy in place in the service. They told us they were certain any concerns they raised would be taken seriously by senior staff in the service.

People we spoke with told us the staff were caring. We found that all the staff we spoke with were able to tell us about the people who used the service. They knew their likes, dislikes, support needs and things that were important to them. We observed staff offering support a

Gorsey Clough Nursing Home provides nursing care and accommodation for up to fifty four people living with dementia. The home is situated outside the village of Tottington, which is approximately three miles from Bury town centre. The home is a large detached property in its own grounds. Accommodation is provided over two floors and can be accessed via passenger lift. Communal rooms are available on the ground floor. These include a large lounge/dining room and two smaller lounges.

This was an unannounced inspection carried out on the 8th September 2015. At the time of the inspection there were 47 people living at the service.

The home had a manager who was registered with the Care Quality Commission. 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 last inspected the home on 15th April 2015. During that inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. This resulted in us making six requirement actions. Following the inspection in April 2015 the provider wrote to us to tell us what action they intended to take to ensure they met all the relevant regulations. During this inspection we checked if the required improvements had been made.

We found the service had made improvements since our last inspection; however we found 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 this report.

Staff did not receive appropriate support and supervision to enable them to carry out their roles.

We found the provider was not always meeting the requirements of The Mental Capacity Act 2005 (MCA). These provide legal safeguards for people who are unable to make their own decisions. Appropriate arrangements were not in place to assess whether people were able to consent to their care and treatment. The provider was meeting the requirements for the Deprivation of Liberty Safeguards (DoLS).

We found that significant events or changes in people’s needs were not always recorded and care plans and risk assessments were not always up dated following changes. This meant that we could not be sure people were receiving person centred care that met their needs.

However we found care records contained detailed information about people’s likes, dislikes and preferences. Risk assessments were in place for people for areas of identified risk and for the general environment.

Improvements had been made in the recruitment process. Staff were safely recruited. During our inspection we saw sufficient staff to meet people’s needs. The registered manager told us that they were trying to recruit three additional care staff to enable them to increase care staff from six to seven throughout the day.

We saw that since our last inspection more training had been provided. Staff were well trained and had the skills and knowledge they needed to carry out their jobs.

People we spoke with were positive about the care and support offered. During the inspection we found that significant improvements had been made in the care and support people received. We saw staff communicated with people effectively and they responded promptly, calmly and sensitively. People were supported in a gentle and unhurried manner. Staff we spoke with knew the needs of the people they were supporting very well.

Improvements had been made in the way prescribed medicines were managed. Safe systems were in place for the storage, administration and recording of medicines. People were prescribed creams that were to be applied to their skin. We saw that staff were not always recording on the appropriate charts when they had applied them.

The home was clean and tidy. The bedrooms were being redecorated and improvements to the building and facilities were planned; including a larger treatment room and bathroom.

Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with emergencies such as catering disruption, gas or electricity failure. Suitable arrangements were in place in relation to fire safety and servicing of equipment so people were kept safe

Policies and procedures were in place to safeguard people from abuse. Staff were trained and aware of how to identify and respond to allegations or signs of abuse.

People were offered a choice of suitable and nutritious food and drink throughout the day.

People were supported to access health care professionals where necessary.

Visitors spoke positively about the registered manager and how they ran the service. Staff told us the management of the service had improved since our last inspection. Staff told us registered managers were approachable and supportive and they had more access to the registered manager now.

We found significant improvements had been made in systems to assess, monitor and review the quality of the service.

The registered manager had a system in place for dealing with complaints about the service. We also saw that there was a system in place for gathering people’s views and suggestions on the service and that these were acted upon.

Gorsey Clough Nursing Home provides nursing care and accommodation for up to 59 people living with dementia. The home is situated outside the village of Tottington, which is approximately three miles from Bury town centre. The home is a large detached property in its own grounds. Accommodation is provided over two floors and can be accessed via passenger lift. Communal rooms are available on the ground floor. These include a large lounge/dining room and two smaller lounges.

This was an unannounced inspection carried out on the 15 April 2015. At the time of our inspection there were 46 people living at the service

The home had a manager who was registered with the Care Quality Commission. 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 last inspected the home in September 2013. We found the provider was meeting all of the regulations we reviewed at that time.

During this inspection we found breaches of the Health and Social Care Act 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.

We saw that care practices did not always demonstrate people were supported in a dignified manner promoting their autonomy and involvement.

Relevant checks had been completed when recruiting new staff. However records could be enhanced further to show a thorough process was followed. Staffing levels were kept under review however records did not always accurately reflect the numbers of staff on duty at all times. Further opportunities were being made with regards to staff training. Systems to support staff in the delivery of their role needed improving, so that people receive safe and effective care and support.

Whilst people’s medicines were stored securely, we found people were not protected against the risk of unsafe care and treatment as the management and recording of people’s prescribed medicines was not accurate and complete.

Individual care plans were in place for each person. Records provided information about people’s likes, dislikes and preferences. Risk assessments were completed where areas of concern had been identified however information did not guide staff on how to minimise potential risks to people so that their health and well-being was maintained.

Those people with the mental capacity to make decisions had not been consulted with about their care and support. Staff were not provided with clear information about how people were to be cared for, particularly where risk had been identified so that people were protected against unsafe or inappropriate care and their rights were protected.

We saw effective systems to monitor, review and assess the quality of service were not in place so that people were protected from the risks of unsafe or inappropriate care.

The registered manager had a system in place for the reporting and responding to any complaints brought to their attention.

Opportunities to participate in activities in and outside the home were provided however not everyone was able or wanted to join in what was offered.

People were offered adequate food and drink throughout the day. Where people’s health and well-being was at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

Suitable arrangements were in place in relation to fire safety and the servicing of equipment was undertaken so that people were kept safe. All areas of the home were clean, well maintained and accessible; making it a safe environment for people to live and work in.

People’s visitors told us that staff were kind and considerate and they were always made welcome. We saw staff respond quickly to calls for support from people in the lounges. Staff were seen to support people in a patient and unhurried manner. Staff respected people’s privacy and were seen knocking on bedroom doors before entering.

During the inspection members of senior staff we spoke with were able to clearly demonstrate their understanding of their role and what was expected of them.

The majority of people living at Gorsey Clough Nursing Home had complex needs and were not able to tell us about their experiences. We spoke with two people. Their comments included “Staff always dress me and help me to choose what I wear. I like being dressed nicely” and “I’m happy and content here. Nobody bothers us. I feel very safe here”. We observed people being treated in a dignified way. We spoke with four relatives who were visiting. They spoke positively of the home. Their comments included “They are compassionate and even in the poor state [my relative] is in they treat them with dignity” and “I’ve always found there seems to be enough staff here and they seem to know what they are doing”.

We saw that all areas of the home were clean. All staff were trained in the prevention and control of infection, and regular audits were carried out to monitor the standards throughout the home.

We saw the staffing rota and all the staff we spoke with confirmed they had access to additional staff at short notice if necessary. We saw evidence of the training that had been completed for staff. All the staff we spoke with confirmed they had regular supervision meetings with their manager.

An annual satisfaction survey took place for people living at the home, relatives, staff and visiting professionals. Action plans were put in place where improvements could be made. Other regular audits were completed to monitor the quality of the services provided.

During our inspection we saw that where a person had the legal right to make decisions on behalf of a person living at Gorsey Clough Nursing Home, the home had obtained verification of this to protect people’s rights. Where people did not have the capacity to make their own decisions best interest meetings were arranged appropriately.

The home had appointed a nutrition champion, and we saw that people were referred to a dietician if there was any concern about their weight or ability to consume a nutritious diet. Nutrition care plans were updated regularly and food charts were correctly completed.

The home involved the safeguarding team at Bury Council and the Care Quality Commission (CQC) appropriately when they had any concerns about people.

The home had a robust recruitment procedure to ensure staff had the appropriate experience and were of good character.

Although we spoke with people during this inspection, most were unable to tell us about their experiences due to their complex needs. However, we saw the responses from the home's satisfaction survey completed by relatives in June 2012. People living at the home were also asked to give their opinion.

People living at the home commented "It's a really nice place. I never want to leave" and "People are very kind to us all".

Comments from relatives included "Overall I consider the service provided to be very good", "Everyone at Gorsey Clough has been most helpful and caring" and "Overall very happy with care, staff caring and competent".

People were very complimentary about the care their relatives received. Some of the comments were:

“I am satisfied with everything”.

“They are looking after my relative very well”.

“They are absolutely fantastic, they are spot on”.

“My relative always looks presentable and clean shaven”.