The inspection took place on 9 May 2018 and was unannounced. At the previous inspection on 10 March 2017 we identified one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because risk assessments and risk management plans had not always been updated to reflect people’s changing needs, particularly in relation to their risk of falls. At this inspection we found that risk assessments were now being updated regularly and included meaningful information about people’s changing needs.

Half-Acre House is based in Rochdale and provides personal care and accommodation in 25 single occupancy bedrooms over two floors. The home has a number of communal areas as well as large grounds. At the time of the inspection there were 24 people using the service.

Half Acre 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.

There was a manager in place who was in the process of registering with the Care Quality Commission (CQC). 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.

People we spoke with told us they felt safe at the home. The service had up to date policies relating to safeguarding adults and children and whistle blowing. Staff had undertaken training and were confident to report any concerns.

The recruitment system was robust and there were sufficient staff to help ensure people’s needs were met. General and individual risk assessments were in place and were reviewed and updated regularly.

Medicines systems for ordering, storage, administration, recording and disposal were robust. Up to date health and safety and fire evacuation policies and procedures were in place. The home was clean and there were no malodours anywhere in the building.

There was evidence of a thorough induction for new staff and further training was on-going. Care files included a good range of health and personal information and food and fluid charts were implemented and completed appropriately where required.

Nutritional and hydration requirements were addressed appropriately. People told us they enjoyed the food and they were given a good choice of food and drink.

The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

We observed care throughout the day and saw that staff demonstrated a commitment to providing care with compassion and kindness. People’s privacy and dignity was respected by staff and we saw them offering care interventions in a discreet and sensitive manner.

Records were stored securely and appropriate information was given to prospective users of the service and their relatives. People were involved in care planning and reviews of care.

Care was person-centred and people’s preferences, likes and dislikes were respected. There was a range of activities, events and trips out on offer at the home and people were encouraged to participate in meaningful activities during the day. Residents’ and relatives’ meetings were held regularly.

Complaints were responded to appropriately and the service had received a number of verbal and written compliments. Some staff were undertaking end of life training to help ensure people nearing the end of their lives would be cared for according to their wishes.

Staff felt supported in their roles. Staff appraisals were undertaken annually and staff meetings took place on a regular basis.

The service worked in partnership with local professionals and agencies. The business manager a

This was an unannounced inspection which took place on 10 March 2017. The service had previously been inspected in December 2014 when we found it to be meeting all the regulations we reviewed.

Half Acre House is a large detached house which provides accommodation for up to 25 older people in single en-suite bedrooms. At the time of this inspection there were 24 people living in the home.

The service had two registered managers in post who shared the responsibility for managing 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.

During this inspection we identified one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because risk assessments and risk management plans had not always been updated to reflect people’s changing needs, particularly in relation to their risk of falls.

People were very happy with the care and support they received. They told us staff were exceptionally kind and caring and that nothing was too much trouble for them. We saw the service placed great emphasis on the importance of treating people with dignity and respect; this was confirmed by our observations throughout the inspection. We noted a Dignity Action Day had recently been held in the service. During this day a ‘Dignity Tree’ had been developed with people who used the service to record what they considered was important to ensure their dignity was always promoted and respected; this was displayed prominently in the home as a constant reminder for staff.

Staff had received training in safeguarding adults from abuse. They were able to demonstrate their understanding of the correct action to take if an allegation of abuse was made to them or if they suspected that abuse had occurred. Staff told us they would be confident to use the whistleblowing policy that was in place should they witness poor practice in the service.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff. We saw that staff received the essential training and support necessary to enable them to carry out their role effectively and care for people safely.

We found the system for managing medicines was safe. Records we reviewed showed staff worked in cooperation with health professionals to help ensure that people received appropriate care and treatment. A visiting GP told us the service was in their opinion the best in the local area and they would be happy to be cared for there if they required residential care in the future.

People were cared for in a safe and clean environment. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care.

People’s care records contained enough information to guide staff on the care and support required. Care records had been regularly reviewed with people who used the service and, where appropriate their families, being involved in the review process.

Systems were in place to help ensure people’s health and nutritional needs were met. People who used the service told us the quality of the food was very good. We observed that, where necessary, staff offered people gentle support and encouragement to eat.

Staff told us they enjoyed working in Half Acre House. They told us the provider and managers set high standards for the care people should receive in the home. We noted there was a focus on ensuring people’s health and well-being was promoted through the provision of meaningful activities, including creative therapies and engagement with the local community.

Staff told us the registered provider and managers in the service were approachable and supp

Half-Acre House is based in Rochdale and is registered to provide personal care and accommodation for up to 25 older people. There are 25 single occupancy bedrooms over two floors. There were 25 people living in the service at the time of our inspection. The home has a number of communal areas as well as large grounds. This was an unannounced inspection which took place on 9 December 2014.

We last inspected this service on 27 December 2013 and found the regulations we assessed were being met.

The home had two registered managers in post. Registered managers are people who have 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.

People who used the service and the visitors we asked told us that half Acre House was a safe place to live. Staffing levels were sufficient to meet the needs of people who used the service.

Safeguarding procedures were robust and members of staff understood their role in safeguarding vulnerable people from harm.

We found that recruitment procedures were thorough so that people were protected from the employment of unsuitable staff.

We saw that people were supported to take their medicines as prescribed. Members of staff responsible for the administration of medicines had received training and their practice was regularly assessed to ensure correct procedures were followed. However, care plans lacked guidance for staff to follow about when people should be given medicines prescribed to be taken ‘when required.’

We noted that the risk of falling was not clearly identified in people’s care plans. Clear guidance for staff to follow about how to prevent the formation of pressure sores was not recorded in the care plans of two people who used the service.

Members of staff told us they were supported by management and received regular training to ensure they had the skills and knowledge to provide effective care for people who used the service. Senior members of staff had also completed training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) so they knew when an application should be made and how to submit one.

All the people we asked told us the meals were good. Snacks and drinks were readily available throughout the day and night. We found that people’s weight and nutrition was monitored so that prompt action could be taken if any problems were identified.

People were registered with a GP and had access to a full range of other health and social care professionals.

Throughout the inspection we saw that members of staff were respectful and spoke to people who used the service in a courteous and friendly manner. People who used the service told us they liked living at the home and received the care and support they needed.

We saw that care plans included information about people’s personal preferences which enabled staff to provide person centred care. These plans were reviewed regularly and updated when necessary to reflect people’s changing needs.

Leisure activities were routinely organised within the home and in the local community. People who used the service told us there were plenty of things to do.

People who used the service and their representatives were encouraged to express their views about any aspect of the care and facilities provided at the home at their regular meetings.

A copy of the complaint’s procedure was displayed on the back of each bedroom door. People who used the service told us they didn’t have anything to complain about. No complaints had been made to CQC or the local authority during the last year.

We saw that systems were in place for the registered managers to monitor the quality and safety of the care provided. Audits completed regularly covered all aspects of the service provided.

People who used the service and their visitors told us the home was very well run and they would recommend it to others.

We spoke with one person who was residing at the home. They told us they had settled in well and staff had supported them in the move. They told us the environment was good and clean and they were happy with their room.

The person who we spoke with told us that the staff were “excellent” and “nothing was too much trouble for them”.

We found the environment in the home to be clean, safe and well maintained. The premises were found to be safe, secure and fit for purpose.

We found that people were cared for by staff that had been appropriately inducted, trained and supervised.

Records were stored in a safe manner and access was restricted to the appropriate staff.

During the visit, we spoke with two people who use the service. They told us they enjoyed living at the home and felt safe there. The people told us that the staff always asked for permission before they delivered care.

The people we spoke with told us they were happy with the care they received. They told us the staff discussed their care needs with them on a regular basis.

They told us they had no concerns around the administration of medication and one person told us “I have not come to any ill effects yet.”

They also told us that they had no concerns about the care they received and would speak to the registered manager if they had any concerns.

We visited this home unannounced, which means people did not have any prior knowledge of the site inspection. During the course of the inspection we spoke individually with the manager, administrator, a number of people living at the home, three visitors, and a number of care staff, as well as ancillary staff.

People living at the home told us staff were respectful and treated them with dignity. One person said, "Mums been here since last year. It was the best decision,” another said, "I come and visit at various times, and I am always made to feel welcome.” All the people we spoke to said good things about the way they were treated by all members of staff.

People we spoke to throughout the inspection process were very satisfied with living there. They told us it is a relaxed and homely environment. They told us they do not feel rushed and can use the home as they choose. They specifically liked the way visitors call in at any time. We saw this occur throughout the time spent at Half Acre House. All three visitors we spoke to told us they were very happy with the way their relatives are cared for. Comments included, “My relative could not be in safer hands.” Also, “The staff are just wonderful.”

Responses from staff and residents were all very positive and reflected how the home is run in the best interest of the people who live there. Other comments from people included, "When I came the other day my relative was watching his favourite sport, he was really enjoying it.” A staff member said, "I have been here for a long time, it is a really good place to work. Very rewarding.”

We asked other agencies about this service before we visited. They told us they have visited the service and made some recommendations for good practice, which we saw the service are putting in place.