This unannounced inspection was carried out on 26 and 27 June 2018. Hulton Care Centre is a two-storey detached building in Middleton, Greater Manchester. It is registered to provide accommodation for up to 28 people who require personal or nursing care. At the time of our inspection there were 27 people living in the home.

The service had a registered manager in place at the time of our 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.

We last inspected Hulton Care Centre in May 2016. At that inspection we found a breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) in that the recruitment records for new staff did not contain enough information to determine their suitability to work with vulnerable people. At this inspection we found that safe recruitment policies had been adopted, with all employment checks undertaken. The service was no longer in breach of the regulations.

People who used the service were supported in a friendly, relaxed and comfortable environment. They told us that they felt safe, and staff working at Hulton Care Centre understood how to ensure people’s safety and protect vulnerable adults from abuse. Potential environmental risks were assessed as an ongoing process to help prevent any accidents or injuries occurring.

The service used a dependency tool to determine how many workers would be required to meet people’s needs safely, and we saw that there were adequate staffing levels with a good mix of registered nurses and care assistants. Staff were well trained and induction methods allowed them to get to know the people who used the service and how they liked their needs to be met. Regular training and supervision sessions allowed staff to update their knowledge.

The home was clean and odour free. Staff understood how to prevent the spread of infection and were observed using personal protective equipment. There was a supply of disposable gloves and aprons available, and colour coded cleaning equipment minimised the risk of cross infection.

When accidents and incidents occurred, these were appropriately recorded and reviewed so that future reoccurrences could be avoided. We saw that there were safe systems in place to manage and administer medicines, with checks on a daily basis to minimise errors occurring. Care records indicated regular contact with health professionals such as doctors, district nurses, and occupational therapists. The service was attentive to peoples nutritional needs, and followed advice from Speech and Language therapists and dieticians to ensure that food was served following their instructions. The weather during our inspection was hot, and people were regularly offered a supply of cold drinks.

People’s choices were respected, and where they lacked capacity best interest decisions were clearly documented in case notes. Where people were unable to give their consent to receiving care and support, the appropriate deprivation of liberty orders were in place. Care plans gave good instruction to staff to ensure needs were met, and when we spoke with care staff they could tell us about the people they supported, but care plans did not always record their background, culture or preferences.

The service made good use of the space available; communal areas were well planned to allow separate areas for different social interactions. Although there was a lack of storage space for large equipment such as mobile hoists, when not in use these were stored where they would cause the least obstacle. Bedrooms were personalised and decorated in accordance with the person’s wishes. People were treated with kindness and respect. The service had recently achieved a Daisy award

Hulton Care Centre is a two storey detached house in a quiet location close to the centre of Middleton. It is registered to provide accommodation for up to 30 people who require personal or nursing care. At the time of our inspection there were 25 people living in the home.

This was an unannounced comprehensive inspection, which took place on 19 May 2016.

During this inspection, we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not robust recruitment procedures in place.

You can see what action we have told the provider to take at the back of the full version of the report.

Systems for recruitment of staff were not always safe. One staff file did not contain any references and two other staff files did not detail a full employment history, including a written explanation for any employment gaps.

Arrangements were in place to ensure people’s rights and choices were protected when they were unable to consent to their care and treatment in the service. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service was working within the principles of the MCA. However Deprivation of Liberty Safeguards (DoLS) authorisations could not be located during our inspection, but were found following the inspection and subsequently seen by the inspection team.

The service had 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. People who used the service and staff were complimentary about the registered manager and said the service was well run.

The registered manager and staff knew people well and were able to tell us about their likes and dislikes and how people liked support to be provided. Staff were patient, reassuring and friendly in their interaction with people who used the service.

People told us they felt safe at Hulton Care Centre. Policies and procedures were in place to safeguard people from abuse and staff had received training in safeguarding vulnerable adults. Staff were able to tell us how to identify and respond to allegations of abuse. They were also aware of the responsibility to ‘whistle blow’ on colleagues who they thought might be delivering poor care to people.

Safe systems were in place for the management and administration of medicines. People had access to a range of health care professional to ensure their health needs were met.

There were sufficient staff to meet people’s needs and staff received the induction, training, support and supervision they required to be able to deliver effective care.

Risks to people’s health and wellbeing were identified and direction was given to staff on how to reduce or eliminate those risks. Care records were detailed; person centred and contained good information about people’s support needs, preferences and routines. Care records were reviewed regularly. People who used the service and their relatives had been involved in planning and reviewing the care provided.

All areas of the home were clean. 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 such as utility failures. Personal emergency evacuation plans had been developed and regular checks were in place to ensure staff were aware of the action they should take in the event of a fire at the service.

People told us that they enjoyed the food. We observed the food to be plentiful and well presented. Systems were in place to help ensure people’s nutritional needs were met. We observed people being appropriately supported to eat their meals.

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During our visit, we were not able to speak in detail with people who lived at Hulton Care Centre, due to medical conditions. We spoke with two of the twenty five people using the service and three relatives of people who lived at the home. They shared some of their experiences and their relatives’ experiences at the home. We spoke with three members of staff of different grades.

This is a summary of what we found.

Is the service safe?

We saw that people were being cared for in an environment that was safe and clean.

Staff personnel records contained the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living there.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure that people in care homes and hospitals are looked after in a way that does not restrict their freedom inappropriately. The safeguards should ensure that a care home or hospital only deprives someone of their liberty in a safe and correct way. This would only be done when it is in the best interests of the person and there is no other way to look after them. There were no authorisations restricting the freedom of anyone living at the home at the time we visited. The provider had policies and procedures in place and the DoLS Code of Practice was available for staff to refer to. Relevant staff understood when an application should be made and how to submit one.

Is the service effective?

The relatives we spoke with told us that they were happy with the care their family member received and that their needs had been met. They spoke positively about the care their family member received and the staff who supported them. It was clear from what we saw and from speaking with staff that they had a good understanding of the care and support needs of the people using the service. We saw from the training records we viewed that staff had received training to enable them to meet the needs of the people living at the home.

Is the service caring?

We saw that the staff showed patience and gave encouragement when they were supporting people and that people were able to do things at their own pace and were not rushed.

Is the service responsive?

People’s needs had been assessed before they moved into the home. The records we saw confirmed that people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Throughout our visit we found the atmosphere was calm and relaxed. We observed how the staff and the people who used the service worked together and it was clear that there were good relationships between them.

We saw that people’s rooms were spacious, light and clean. All rooms were en-suite. People had personalised their rooms with their personal belongings. Their names were on the doors. One room was dedicated to end of life care and had facilities for relatives to stay with their family member. There was a dining area, an activities area and two lounges. These were spacious and light with large windows and doors leading to the gardens. The gardens were large with seating areas. There was a lift and a ramped entrance for easy access.

Is the service well-led?

We found from speaking with staff that they had a good understanding of the home’s values. They told us about their roles and responsibilities and they were clear about these. We saw that quality assurance processes were in place to make sure that the provider monitored the care provided and made improvements where necessary. For example, satisfaction surveys had been completed by people using the service and their families. The results had been analysed and comments had been acted on.

A variety of information was displayed, such as the names of the manager, nurse in charge and team leader for the day, names of staff who acted as co-ordinators for first aid, moving and handling and end of life care. We also saw a mission statement, philosophy of care, a dignity statement and a suggestions box.

During our inspection we spoke with four people who lived at the home and three people visiting their relatives. People told us they were happy with the care they or their relative received. People told us; “The staff they have are pretty good. I do feel I’m treated as an individual”, “The staff seem to care about me”, “I’d talk to the new manager if things weren’t right” and “Generally staff know me and what I like and don’t like”.

We were made aware prior to our visit that a change in management at the home had taken place. The manager was making arrangements to register with the Care Quality Commission.

We spoke with three members of staff. Staff spoke positively about the appointment of the manager. Staff said they were happy in their work and that management fully supported them and encouraged them to develop their skills. One member of staff told us; “There’s been loads of improvements” and “Morale was poor, but things are a lot better now”.

People were involved and consulted with about their care and support. Records directing staff in the safe delivery of care where kept up to date so that they accurately reflected the individual needs and wishes of people.

A satisfactory system was in place for checking the quality of care and the facilities that the service provided.

People were protected against the risk of unsafe or inappropriate care and treatment because records required to protect their safety and wellbeing were accurate and up to date.

During our visit on the 24 July 2012 we spent some time speaking with people living at Hulton Care Centre and their visitors. People spoke positively about the staff and the care provided. People commented; “the staff are on the ball”, “the carers are very good”, “I like living here” and “the carers are lovely”.

One person told us they had been able to bring some of their own furniture when they moved to the home. They also said that they chose to spend the majority of their time in their own room and this was respected by staff. They said staff would regularly check on them to make sure they were all right and they always responded if they pressed their call bell.

We also spent some time observing care practices and how staff interacted with people. We saw that staff spoke to people in a quiet and respectful way. Staff offered support and reassurance when assisting people to move with the aid of equipment.

People told us that they were happy with the care they received and the manager and staff were very approachable if they needed anything. One person said “you can't fault them”. Another person said, “If I need anything the carers help me” and “they always make sure I’m alright”.

One of the visitors spoken with told us “they keep me informed if there’s anything I need to know”. They also said their relative “is looked after very well” and they were “very settled”.

In April 2012 the home was awarded the ‘Dignity in Care Award’ by the local authority based on the care and support offered to people living at Hulton Care Centre.