Little Heaton Care Home is registered to provide personal care and accommodation for up to 25 people. The home is located in Middleton, is close to local transport links and has a variety of shops and other amenities close by. There were 25 people accommodated at the home on the day of the inspection.

At the last inspection of July 2017, the service was found to be in breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities). Regulation 17 because not all records relating to the care and welfare of people who used the service were up to date and Regulation 19 because recruitment procedures were unsafe. The service sent us an action plan to show how they were going to meet the requirements. At this inspection we found the service had made the necessary improvements.

Although the service did not have a person registered as manager at the time of the inspection we were shown documentary proof that the registration of a person with the Care Quality Commission was nearing completion and awaiting the necessary certificate. A registered manager is a person who has registered with the 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 made a recommendation that best practice guidance be sought around gaining a person’s last wishes at the end of their lives.

The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Recruitment procedures were robust and ensured new staff were safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. The competency of staff to administer medicines was checked to ensure they were safe.

The home was clean, tidy and homely in character. The environment was maintained at a good level.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business contingency plan for any unforeseen emergencies.

There were systems in place to prevent the spread of infection. Staff were trained in infection prevention and control and provided with the necessary equipment and hand washing facilities. This helped to protect the health and welfare of staff and people who used the service.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of their responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw from our observations of staff and records that people who used the service were given choices in many aspects of their lives and helped to remain independent where possible.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and the plans and care regularly reviewed.

Plans of care were in

Little Heaton Care Home is registered to provide personal care and accommodation for up to 25 people. The home is located in Middleton, is close to local transport links and has a variety of shops and other amenities close by.

We last inspected this service in August 2016. The service met all the regulations we inspected. At this unannounced inspection of 26 and 27 August 2017 we found two breaches in the regulations; Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Not all records were up to date and Regulation: 19 Fit and proper person’s employed. Not all staff had written references or an application form. You can see what action we have told the provider to take at the back of the full version of the report.

We conducted this inspection earlier than planned because some concerns were raised about the environment and lack of management support. Whilst there was a problem with two rooms (with action taken to fix it) the environment was satisfactorily maintained. The interim manager raised the hours she worked at the home to help support staff.

The service did not have a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager from another service within the group was spending two days a week at the service. Following the inspection the manager said they would increase their hours to 30 per week. We were also told the newly appointed area manager would spend some time at the home.

We looked at five staff files. Three files contained all the documents that showed these staff had been recruited robustly. However, one file contained no written references and another did not have any references or an application form. This meant two people may have been employed without proper checks to ensure people were safe to work with vulnerable adults.

Some of the records we looked at, for example three of five care plans were up to date. However, one had not been reviewed regularly and one since June 2016. We recommended that the provider look at best practice with regard to the regular review of all care plans and update the plans accordingly. Some risk assessments such as for pressure sore prevention had also not been regularly reviewed.

The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Whilst the administration of medicines was safe some record keeping could be improved.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities. This helped to protect the health and welfare of staff and people who used the service.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and were encouraged to eat and drink to ensure they were hydrated and well fed.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received an induction, training was provided and staff had an opportunity to discuss their careers and training needs during supervision.

We observed there were good interactions between staff and people who used the service.

People were give

Little Heaton Care Home is registered to provide personal care and accommodation for up to 25 people. The home is located in Middleton, is close to local transport links and has a variety of shops and other amenities close by.

The service were last inspected in February 2016 when the service required improvement in three domains. The service needed to gain valid consent to care and treatment for people who used the service, to ensure staff had been trained sufficiently and for a person to be registered as manager. The service returned an action plan to the Care Quality Commission to say how they were going to meet the required actions.

The service now had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix had been updated and showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

People who had capacity gave their consent to care and treatment. The registered manager arranged best interest meetings to protect the rights of people who lacked mental capacity to ensure their rights were protected.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

There were sufficient staff to meet the needs of people who used the service.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

People who used the service told us the food was good. We observed one mealtime which was a social occasion with staff talking to people and encouraging them to take a good diet. People’s weights were recorded and professional help was sought for any person who was nutritionally at risk.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies. There were regular fire alarm tests and staff fire safety training to help protect the health and welfare of people.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

We observed there were good interactions between staff and people who used the service. People told us staff were kind, knowledgeable and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

There was a record kept of any complaints and we saw the manager took action to investigate any concerns, incidents or accidents to reach satisfactory outcomes. There had not been any complaints since the last inspection.

There were su

Little Heaton Care Home is registered to provide personal care and accommodation for up to 25 people. The home is located in Middleton, is close to local transport links and has a variety of shops and other amenities close by.

The service did not have a registered manager. The current manager had applied to the Care Quality Commission (CQC) to become registered and was awaiting an interview. A service cannot be rated as good in this domain if there is no manager registered with the 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 a 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 carried out an unannounced comprehensive inspection in October 2015. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This resulted in us serving two warning notices and making five requirement actions. The overall rating for this service was ‘Inadequate’ and the service was therefore placed in 'Special measures'. A service in “Special measures” is kept under review and inspected again within six months. The expectation is that a service found to have been providing inadequate care should have made significant improvements within this timeframe.

The warning notices stated that the service must be compliant with these regulations by 05 November 2015. The service sent us an action plan informing us what action they intended to take to ensure they met all the regulations.

At this inspection we found improvements had been made to the service. The service will be expected to sustain the improvements and this will be considered in future inspections.

At this inspection although there were improvements we found two breaches in the regulations. You can see what action we told the provider to take at the back of the report.

Staff we spoke with were aware of safeguarding issues and had policies and procedures to guide them, including the contact details of the local authority.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare. The local authority infection control officer had visited the home twice in the last few months. Whilst some recommendations needed to be completed it was reported there were many improvements made between the visits.

There had been many improvements in medicines administration, which was now safe. We highlighted two minor possible hazards.

Most people who used the service said food was good. People were given a nutritious diet and had choices in the food they were offered.

Some staff had been trained in the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). The manager was aware of his responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals. Five applications had been granted at the time of the inspection.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

New staff received induction training to provide them with the skills to care for people. Staff files showed some staff had undertaken sufficient training (not all records showed this) to meet the needs of people and were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there was a good interaction between staff and peopl

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive to people's needs?

• Is the service well-led?

Is the service safe?

People were protected against the risk of unsafe or inappropriate care. This was because their care records provided good information to guide staff on the care, treatment and support required.

Is the service effective?

People's health and care needs were assessed before they were admitted to the home to ensure their individual needs could be met.

Is the service caring?

We saw that people were relaxed and had a friendly rapport with the staff.

Is the service responsive to people's needs?

Information in the care records showed the staff at the home involved other health and social care professionals in the care and support of the people who used the service.

Is the service well led?

The home had a manager who was registered with the Care Quality Commission and had the necessary skills and experience to undertake the role.

Care practices such as infection control, the management of medicines and care records were monitored to ensure people were cared for safely.

Is the service safe?

We were able to speak to three of the people who used the service and three family members. All of whom told us that they were happy with the service being provided. One of the people who lived at the home told us, “I knew as soon as I came through the door that it would be ok, I felt comfortable and at ease”. A family member said, “I think the home is fine and that my X is looked after ok”. Another family member told us, “I am very pleased with the care, they are very good and I can’t fault the care given”.

We observed during our visit that people were treated with respect whilst the staff team were carrying out the daily care. We also observed that equipment was used such as a hoist to transfer people from chair to wheelchair.

Training was in place to protect the people who lived at Little Heaton Care Home such as moving and handling, safeguarding adults and first aid. The training was provided through Rochdale Local Authority and other professional training companies. This helped to ensure that the staff team had the qualifications and skills to meet people's needs. National Vocational Qualifications (NVQ) in Health and Social Care had also been obtained.

Training had been given to the staff team with regard to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards. There was also a poster displayed in the corridor outside the general office explaining the MCA and how it affects people.

Little Heaton Care Home was clean and free from unpleasant odours. There were soap dispensers and paper towels available in all bedrooms and toilets etc.

We also saw that various safety checks had been completed. These included gas, electricity and passenger lift safety certificates. Some work had been required with regard to the electric and passenger lift which the manager had organised to be completed.

It came to our attention during the inspection that there had been an incident involving medication which had put the person’s health at risk. This was being investigated by Rochdale Local Authority Safeguarding Unit.

We also found that the daily record of one person’s health and wellbeing was unsatisfactory. The reason for this was that it did not inform people that the person was having health problems and therefore there was no information regarding action that had been taken and the outcome of that action. This lack of information in the daily record may have put the person’s health at risk.

Is the service effective?

One of the people we spoke with told us, “The GP is called straight away if something is wrong and the district nurse visits to change my dressings”.

The family members we spoke with said that they were kept informed about their relative’s care. They also told us that if they had any concerns they were comfortable with talking to the manager or the care workers. One family member told us, “They always get the GP when necessary; I have no worries and I am kept informed; always told when I visit if there is anything of concern”.

A passenger lift and stair lift assisted people to reach the upper floors. There was equipment available such as hoists and assisted baths.

Healthcare professionals such as GP, district nurse and dietician visited the home as requested. Notes were made of the visits on the person's care plan.

Is the service caring?

No one we spoke with said that they had any concerns about the care provided. One person told us, “I can have my meal in my room and the cook comes up and has a chat with me and tells me what they have on the menu. There is a choice of two or three dishes”. They also went on to say that the staff team are, “Kindness itself night and day; I have never seen anyone lose their temper, they are very patient and I am very happy and contented”. The person also told us that entertainers, dominoes and quizzes took place and an ‘exercise to music’ class was held on a Friday morning.

A family member said that they could talk to the manager if they had any concerns. Another said, “The home is very good and I have no complaints about the staff; all very nice and very friendly”. One of the people who lived at the home said, “If I was not happy I could talk to the staff; I can’t imagine going back home and doing housework etc.

Is the service responsive?

We saw that people's needs were assessed before they were admitted to the home to ensure that their needs could be met. We saw that risk assessments and care plans were in place that reflected the person's care needs to ensure that they received appropriate care. A family member told us that they had attended the most recent review and were aware of the care plan.

People we spoke with told us that the GP was contacted straight away if something was wrong and that the district nurse visited to change dressings etc.

We were told by a family member that the dietician was due to visit their relative to undertake an assessment of their changing care needs.

The care plans contained information from GP, district nurse and other health care professional’s visits.

Is the service well-led?

Little Heaton Care Home is owned by a company that have six homes in total. There is an Area Manager employed who is responsible for the two homes that are located in the North West region. A Registered Manager is responsible for the day to day care of the people who lived at Little Heaton Care Home. The registered manager has a National Vocational Qualification (NVQ) level 5 in Management and has 15 years’ experience.

We were told by the manager that questionnaires were distributed to the people who used the service in order to obtain their views and opinions about the service. The results were analysed and displayed in the entrance hall for everyone to see.

The manager had recently organised a staff meeting which had been well attended and a team leader meeting. Also an impromptu resident meeting had also taken place when menus and trips out had been discussed.

We were told by people and families who used the service and the staff team that they could talk to the managers if they had any concerns about the care being provided.

We became aware during our inspection that regular audits of medication records and care plans were not taking place. The care plan/risk assessments were reviewed by the senior team however the overall quality was not currently being audited. We were also informed that no infection control audit had been undertaken.

We discussed the lack of auditing and quality monitoring with the manager. The manager informed us that a deputy manager was being employed who would assist the manager to implement systems to quality audit the documents and records. The manager also informed us that they were to seek advice from the Infection Control Nurse regarding infection control audits.

It is essential that care plans as a whole, the administration of medication and infection control audits are regularly audited and monitored. This is to ensure that people are safe and not being put at risk from unsafe practice.

The Registered Manager had been in post since September 2013. They told us they were in the process of making significant changes to the way the home was managed and the way care was delivered to people. The Registered Manager told us their priority was to provide person centred care that enabled people and promoted choice.

We found that people’s care needs were assessed and their care plans were regularly reviewed. We found people who use the service, or their representatives were involved in planning their care. The people we spoke with about the service were positive about the care received. One person said “I’m getting a lot of help here; I’m getting all the help I need”. During our visit we observed staff caring for people in a way that supported their needs, wellbeing and safety.

We saw that the provider had systems in place to help protect and safeguard vulnerable people from the risk of abuse. Most of the staff had received safeguarding training and further training for staff had been arranged with the Local Authority.

We found that the provider had systems in place to support and train staff. The Registered Manager told us since commencing in post, staff training and support was one of their priorities. We saw that they had introduced measures to improve staff training and support. We spoke with a member of staff who said they had received adequate training and felt supported in their role.

We found generally records were up to date and held securely.

During our visit to Little Heaton Care Home we spoke with three people using the service. They were very complimentary about the staff and the care provided. We were told they felt there was enough staff on duty to care for them, the staff were kind and patient and they were given their medicines on time. Some of their comments were:

"They are all very good".

“I like it here and the staff are all very nice”.

“It’s all above board here, it can’t be faulted”.

“l am well looked after, couldn’t wish for anything better”.

Little Heaton Care Home is registered to provide personal care and accommodation for up to 25 people who do not need nursing care.

We carried out this inspection following a safeguarding concern regarding medications and whistleblowing alert that stated training, staffing ability and food provision were of concern. Following the inspection visit we also received information from a whistle-blower regarding complaints they had made and medication concerns.

This unannounced inspection took place on 25 September 2015 and 1 October 2015

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Peoples view’s about the service they received were mixed. While some people were very happy, others were not as happy. In addition, our observations and the records we looked at did not always match the positive descriptions some people had given us.

During the inspection, we spoke with nine people living at the service, two relatives, eight staff and the registered manager. 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 service was not consistently respecting and involving people who use services in the care they received. For example all the care plans viewed did not show the person’s choices and personal preferences. The care plans did not involve the person or their relative when they were written and their views were not reflected in the care plans. People told us they had no input into the menus or activities.

Staff members were not always following the Mental Capacity Act (2005) for people who lacked capacity to make decisions. For example people’s mental capacity was not assessed and there was no information available in the service for the staff that helped them support a person with fluctuating capacity. We saw inconsistent approaches from staff with some staff explaining to people before they undertook a care action, other staff failed to give the person any information about the care and support they were about to deliver.

We saw that people’s health care needs were not accurately assessed and that risks such as poor nutrition were not assessed. People’s care was not planned or delivered consistently. In some cases, this put people at risk and meant they were not having their individual care needs met. Records regarding care delivery were not consistently accurate or up to date leaving people at risk of not having their individual needs monitored or met.

Neither the registered manager nor the registered provider identified, investigated or responded to people’s complaints. Complaints were not recognised or addressed by the service.

Staff members were inconsistent in their approach for safeguarding with some staff able to explain in detail how they reported any safeguarding concerns. When we looked at how staff put this into practice, we saw that three safeguarding concerns had not been dealt with or reported to social services and CQC. The lack of reporting safeguarding concerns appropriately potentially placed people who lived in the service at risk. We asked the registered manager to report the safeguarding concerns identified at the inspection to the local authority and to CQC appropriately.

People who lived in the service did not consistently receive their medicines in a safe manner that met their individual needs. Staff did not have the correct information or training to give medicines when needed and this meant that people would not be able to receive their medicines safely when needed.

Staff training was underdeveloped with large gaps in the training of staff particularly around dementia care needs, medicines training, mental capacity, moving and handling and safeguarding. The majority of staff had been appropriately checked before starting work with the exception of one member of staff who had not been checked for their suitability to work in the service before undertaking voluntary work.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that where required, DoLS applications had been made and the manager understood when an application should be

made and how to submit one.

The arrangements that the provider had in place to check the quality of the service were not in place as such the providers’ arrangements meant service users’ views or their relatives did not influence the service provided and complaints were not appropriately addressed or responded too.

Overall, we found significant shortfalls in the care provided to people. We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. We will publish what action we have taken later. Where regulations have been breached information, regarding these breaches is at the end of this report.

As the overall rating for this service was ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.