The inspection took place on 15 and 22 June 2017 and was unannounced on the first day.

Hamilton Rest Home provides residential care for 23 older people. The home is situated within a residential area of Whitefield in the Bury and is next to a park. Car parking is available at the rear of the home. Accommodation within the home is situated on the ground and first floor. There is a chair stair lift providing access to the first floor. There were 17 people living at the home at the time of our inspection.

At the last comprehensive inspection in January 2016, the service was rated ‘Requires Improvement’, with two requirements and two warning notices issued in relation to regulations. We returned to the service in April 2016 and carried out a focused inspection in relation to the two requirements and two warning notices. We found action had been taken to address the shortfalls found at the comprehensive inspection in January 2016. The service was rerated ‘Good’.

The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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 saw documentation that the registered provider had made every effort to find a suitable registered manager and on two occasions had been let down by applicants after they had agreed to take on the role. However because there is no registered manager in place we have placed a limiter on the ‘well led’ section of this report as requires improvement.

Staff were able to tell us of the action they would take to protect people who used the service from the risk of abuse. They were confident that the registered provider and senior staff would take the right action to protect people.

Recruitment checks were carried out to ensure suitable people were employed to work at the home with vulnerable people. Our observations and discussions with staff and people who lived at the home confirmed sufficient staff were on duty both day and night.

Risk assessments were in place to help minimise any potential risk of harm to people during the delivery of their care and support. These had been reviewed on a regular basis.

People told us that they liked the home. We had a walk around parts of the building and found it had been maintained and was clean and tidy. Plans to make on-going improvements to the home were in place.

Arrangements to check the homes electrical fittings were in place and we were informed by the provider following our visit that a satisfactory electrical report had been received.

We found medication procedures at the home were overall safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Comments from people who lived at the home were all positive about the quality of meals provided. We observed regular snacks and drinks throughout the day were provided between meals to make sure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met.

People who lived at the home spoke positively about the staff who supported them. The atmosphere was homely, relaxed and friendly.

People who lived at the home told us they were encouraged to participate in a range of activities that had been organised. It was respected that not everyone wanted to join in and that was their choice.

People who used the service knew how to raise a concern or to make a complaint. We saw information to support they were dealt with by the service.

People spoke positively about the registered provider who in turn gave us information that supported they highly valued the staff team and the support they gave to people who used the s

This was an unannounced inspection which took place on 12 April 2016. We had previously inspected the service on 19 January 2016 when we found four breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. We issued the provider with two warning notices in relation to the regulations regarding safe care and treatment and the governance systems in the service. We issued two requirement notices in relation to the safety of the premises and staff training and supervision.

Following the inspection the provider sent us a plan of the actions they intended to take to meet the relevant regulations. This inspection was carried out to check that the provider had met the warning notices and the requirement notices. We found the necessary improvements had been made. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Hamilton Rest Home’ on our website at www.cqc.org.uk.

Mrs Janet Walters is registered to provide accommodation at Hamilton Rest Home for up to 23 older people who require personal care. Hamilton Rest Home is a large detached property situated on a main road in Whitefield. It is within easy reach of local shops, public transport and the motorway network. Accommodation is provided in mainly shared rooms. At the time of this inspection there were 16 people using the service.

When we undertook the inspection the service did not have a registered manager in place. The manager had been in post since January 2016 and had submitted an application to register with CQC as manager at Hamilton Rest Home. We were advised that the manager was interviewed regarding their application to register with CQC later on the day of the inspection and their application was subsequently approved on 15 April 2016. Therefore from the date of 15 April 2016 the service had a registered manager in place.

Improvements had been made to the premises to protect people from the risk of burns from hot pipes and radiators. All pipework and radiators had been covered and individual risk assessments were in place to inform staff of the action they should take to protect people when moving around the building. The manager and provider were undertaking weekly health and safety checks to help ensure the safety of everyone who lived and worked in the home.

Medicines were stored safely and staff responsible for administering medicines had completed refresher training. All staff had been assessed to ensure they were competent to administer medicines safely.

Care records showed that risks to people's health and well-being had been identified and regularly reviewed. We saw that plans were in place to help reduce or eliminate the identified risks.

The manager had introduced arrangements to ensure that staff received the training and supervision they required to carry out their roles effectively. Staff we spoke with told us they considered the training was of good quality. Staff also told us that they were supported to develop their skills and knowledge by undertaking additional responsibilities within the home, with support from more experienced staff.

The manager had introduced a system of robust quality monitoring procedures to help ensure that people received safe and effective care. The manager and provider demonstrated their commitment to continuing to drive forward improvements in the service.

This was an unannounced inspection which took place on 19 January 2016. This was the first inspection since the provider had registered the service with the Care Quality Commission (CQC) in September 2015.

Mrs Janet Walters is registered to provide accommodation at Hamilton Rest Home for up to 23 older people who require personal care. Hamilton Rest Home is a large detached property situated on a main road in Whitefield. It is within easy reach of local shops, public transport and the motorway network. Accommodation is provided in mainly shared rooms. At the time of this inspection there were 20 people using the service.

The service did not have a registered manager in place. A registered manager is a person who has registered with 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 were told that the previous registered manager had left the service in November 2015. A new manager had commenced employment at the service on the day before this inspection. They were experienced in managing residential care services and told us they intended to apply to register as manager for Hamilton Rest Home.

During this inspection we found four breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because improvements needed to be made to the premises in order to ensure the safety of people who used the service. Staff had not received recent training to ensure they were able to deliver effective care. Arrangements to ensure the safe management of medicines and to identify and manage risks to people who used the service needed to be improved. The provider also did not have robust quality monitoring systems in place. You can see what action we have told the provider to take at the back of the full version of the report.

People who used the service told us they felt safe in Hamilton Rest Home. Visitors we spoke with said they were happy with the care their relative received and had no concerns about their safety.

Staff had been safely recruited and there were sufficient number of staff available to meet people’s needs in a timely manner. Staff had received training in safeguarding adults. They were aware of the correct action to take should they suspect or witness abuse. They told us they would also be confident to report poor practice should they observe this taking place.

Staff told us they received an induction when they started work at the service. Systems were in place to record the training staff had completed and any supervision or appraisal sessions. However, records we reviewed showed some staff had not completed training in areas such as infection control and moving and handling since 2014. Staff had also not received supervision since the registered manager left the service in November 2015.

People we spoke with told us that the staff at Hamilton Rest Home were kind and caring. During the inspection we observed kind and respectful interactions between staff and people who used the service. We saw that people who used the service were encouraged to discuss the care they wanted at the end of their life with their relatives and staff.

Staff showed they had a good understanding of the needs of people who used the service. However, care plans did not always contain accurate information about people’s current needs. Advice received from a speech and language therapist (SALT) had also not been fully included in the care plan for one person who used the service. This meant there was a risk people might not always receive safe care.

Although we found evidence that people received their medicines as prescribed, systems relating to the stock control and storage of medicines needed to be improved.

We saw that all areas of the home were clean. Staff wore personal protective equipme