This inspection was carried out on 6 and 7 November 2018 and the first day was unannounced.

Hadfield House is a large converted Victorian house, overlooking Alexandra Park and within one mile of Oldham Town Centre. There are two storeys with bedrooms on both ground and first floors. Set back from the road, the home has gardens to the front, and a secure paved 'sensory garden' at the side containing raised beds, garden furniture and lighting which was directly accessible from the dining/lounge area. The service is registered to provide personal care and accommodation for up to 28 people living with dementia and mental health conditions. At the time of our inspection there were 26 people living at the home.

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

We last inspected the service on 3 and 4 October 2017, when we rated the home requires improvement overall and identified breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment; premises and equipment; fit and proper persons employed and good governance. Following the inspection, the provider sent us an action plan which stated the breaches would be addressed. At this inspection we found significant improvements in all areas.

At this inspection we found that the provider had improved the environment in order to mitigate risks to the health and safety of service users and was compliant with this regulation. Mobile hoists were no longer being used for people living at the home and therefore were no longer causing an obstruction. All first-floor windows had restrictors fitted during the last inspection, we saw restrictors were still in place. We found that any cupboards that stored hazardous chemicals were kept locked.

Medicines were stored and managed safely. We found there were plans in place to administer ‘when required’ medicines to inform staff when and how to administer medicines that were not required routinely. Creams were stored appropriately.

We recommended that the service review the recording of thickeners used to adapt the consistency of fluids, to ensure that records were more detailed. The registered manager put new documentation in place during the inspection.

Staff employed since the last inspection had been recruited safely and the service had completed all the necessary checks to ensure that staff were suitable to work with vulnerable people.

Audits were taking place to monitor and improve the quality of the service provided. The service had a clear record of actions recorded and reviewed on a regular basis by the registered manager.

At the last inspection we found the provider did not have a formal risk assessment in relation to legionella. However, we found the provider had completed routine sampling to help control the risks of legionella and carried out appropriate water temperature checks and flushes. The provider had carried out an assessment and was taking the necessary steps to reduce the risk of exposure to legionella.

We recommended that the provider review best practice in relation to formally assessing the risks of legionella and carry out a written risk assessment. The provider had started this process before we completed the inspection.

There was a registered manager in place. 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 manager had been registered since October 2010.

The service used the local authority safeguarding procedures to report any safe

This inspection was carried out on 3 and 4 October 2017 and was unannounced.

Hadfield House is a large converted Victorian house, overlooking Alexandra Park and within one mile of Oldham Town Centre. There are two storeys with bedrooms on both ground and first floors. Set back from the road, the home has gardens to the front, and a secure paved ‘sensory garden’ at the side containing raised beds, garden furniture and lighting which was directly accessible from the main lounge. The service is registered to provide personal care and accommodation for up to 28 people living with dementia and mental health conditions. At the time of our inspection there were 27 people living at the home.

We last inspected the service on 3, 4 December 2015 and 9 February 2016, when we rated the home requires improvement overall and identified breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment, premises and equipment and good governance. At this inspection we found the provider was still not meeting the regulations. We found ongoing breaches in relation to premises and equipment, safe care and treatment and good governance. We have also identified a new breach of the regulations in relation to fit and proper persons employed. You can see what action we have told the provider to take at the back of this report. We have also made a recommendation in relation to the provider reviewing good practice guidance on developing dementia friendly environments and made a further recommendation to ensure the registered provider appoints a competent person to undertake a legionella risk assessment.

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. 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.

Medicines were not always stored and managed safely. We found there were no plans or 'when required' (PRN) protocols in place to inform staff when and how they should administer people medicines that were not required routinely. During the tour of the home we found pain relief gel was inappropriately stored in a person’s bedroom. During sampling of medicines we found an antibiotic solution had expired and was incorrectly stored in the medicines cupboard, which meant the person could have taken this expired medication. We passed on this information to the registered manager who said they would investigate this further.

The provider did not have an effective recruitment and selection procedure in place and did not carry out all the relevant checks when they employed staff.

During our tour of the building we noted several potential safety hazards. We found on the first floor 12 bedroom windows did not have the appropriate restrictors in place; to prevent the window opening to be restricted to 100 mm or less, as outlined in Health and Safety Executive guidance. During the inspection the provider ensured window restrictors were fitted in all first floor bedrooms, this meant the risk was addressed. We found the linen store room on the first floor stored hazardous substances, such as cleaning products and hair perm solution and had been left unlocked. We found two hoists were stored in two people’s bedrooms and one person had an old armchair that was directly blocking their toilet. The inappropriate storage presented as a possible trip hazard.

During this inspection, we found other issues affecting the safety of the environment. The provider did not have a risk assessment in relation to legionella. However, we found the provider had completed routine sampling to help control the risks of legionella. Legionella is a type of bacteria that can develop in water systems and cause Legionnaire's disease th

During this inspection of Hadfield House we spoke in private with four people who used the service and four members of staff. At the time of our visit 24 people were living at the home.

People were treated with respect and had their dignity maintained.

Peoples’ care needs were recorded and reviewed on a regular basis. People were involved in discussions about how best to meet their needs, and were confident their views were listened to. Comments from people using the service included "if we questioned [the way in which our care needs were met] they [staff] would respond and in the right way".

Medication appeared to be safely stored and appropriately administered. People told us they were confident they got the right medication at the right time.

Staffing levels appeared appropriate to meet the needs of the people living at Hadfield House. People using the service told us they did not have to wait unnecessarily for any support they needed.

There were effective systems in place to monitor and assess the quality of the service provided. These included ascertaining the views of the people living at the home.

During our visit to Hadfield House we spoke with three people who were using the service and two people who were visiting their relatives.

All the people who we spoke with were positive about their experience of the service provided. People told us that staff were always available, with one person saying they were "very attentive". A visitor told us that staff "never put requests off and always see to me immediately".

People told us they felt safe living at the home and they were confident that any complaints would be listened to and dealt with appropriately.

Not everybody who we talked with could recall being specifically involved in a structured quality assurance process. However people did tell us they felt involved in discussions about the service.

We asked people what they thought the best thing was about Hadfield house. Comments included "the atmosphere – very friendly"; "they look after [X] to a level that I find acceptable" and "it's home. You treat it like your home."

This inspection was carried out over three days on the 3 and 4 December 2015, and 9 February 2016. Our visits on the 3 December and 9 February were unannounced.

Our inspection was brought forward following concerns raised by the local authority about the general safety of people who used the service.

We last inspected the service on the 5, 8 September 2014, we found the service was meeting all the regulations that we reviewed.

Hadfield House is a large converted Victorian house, overlooking Alexandra Park and within 1 mile of Oldham Town Centre. There are two storeys with bedrooms on both ground and first floors. There are also some attic rooms which are generally used for storage, and accessed through a separate stairway which is generally kept locked. Set back from the road, the home has gardens to the front, and a secure paved ‘sensory garden’ at the side containing raised beds, garden furniture and lighting was directly accessible from the main lounge. Staff said that in fine weather the door leading out into the garden was left open so that people could walk freely between the two areas.

The service is registered to provide personal care and accommodation for up to 28 adults and older people with Dementia and Mental Health conditions.

The home had a manager who has been registered with the Care Quality Commission (CQC) who was present on all days 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 2008 and associated Regulations about how the service is run. The manager has been registered since October 2010

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the safety of the premises and information held about people. You can see what action we told the provider to take at the back of the full version of this report.

We also made a recommendation relating to staff references. See the comments in the main body of the report.

The home did not have processes to ensure that systems could maintain accurate, complete and contemporaneous records for the people who used the service and therefore were unable to assess, monitor and mitigate the risks associated with the health, safety and welfare of these people.

When we looked around the building we saw that grab rails were used to store objects which would cause an unnecessary hazard to anyone who required the use of handrails. There was also an electric wire hanging from a grab rail to the floor which caused a trip hazard.

We saw that disposable razors had been left in a communal bathroom increasing the risk to the health and safety of people who used the service.

Staff recruitment files did not always contain sufficient details to ensure the suitability of staff to work with vulnerable people.

People who used the service told us they felt safe, and that they thought there were enough staff available to support them. A member of staff told us “We treat people as individuals; we get to know them and what they like, being sensitive to their feelings. We make sure they have their glasses and hearing aids, and get to know them as individuals.”

The home had good procedures in place for staff to identify and raise any safeguarding concerns, and staff showed a good understanding of how abuse could occur.

The building and equipment were safe and secure. We saw that the home was clean and that cleaning rotas were in place and being followed to ensure that all areas were kept clean and hygienic, including kitchen and laundry areas.

We looked at Procedures to manage people’s medicines safely and to control the risk of infection.

We saw that systems were in place to ensure that all medicines were stored correctly and dispensed by staff trained to ensure that medicines were dispensed and recorded in line with policies and procedures.

The staff we spoke with had a good understanding of people’s individual needs and the support they required, and we found that care was delivered consistently by a team of workers who knew how to support people and meet their assessed care needs. We saw that care was delivered to people using the service in accordance with their needs and wishes, and we found that there was enough information in people’s care records to guide staff on the care and support needs required. All care records had been reviewed and included detailed risk assessments for risks such as falls, moving and handling, pressure relief and nutrition, with clear plans in place to show how to minimise the risk.

The people we spoke with believed that the carers were competent and knowledgeable.

People told us that they liked the meals and we saw that the food looked appetising and hot and was in sufficient quantities.

Staff were attentive to people’s health care needs and where needs were identified they sought appropriate medical attention.

One visitor described how the staff knew how to care for their relative and commented “there’s nothing they wouldn’t do for him here, it’s the next best thing to home’’ Visiting professionals we spoke to were impressed with the quality of care. They informed us that Hadfield House will accept people who are difficult to place and help them to settle, improving their quality of life.

People who used the service told us that staff responded to their needs and provided them with support when they required it.

We saw that there was little staff turnover. Care was delivered by a stable and consistent staff team who spent time with the people who used the service, and knew them well.

We saw that there were a wide variety of activities on offer to people who used the service.

The service’s complaints policy and procedure were prominently displayed in the main hallway of the home.

There were policies and procedures in place to support the daily running of the home and help to make sure that staff were clear about their duties when they were involved with all aspects of people’s healthcare and wellbeing.