Littleborough Home for the Elderly is registered to care for older people. It is a purpose built detached building set within its own grounds in the centre of Littleborough Village. It is very close to shops, public transport and the motorway network but within easy reach of open countryside.

At the last inspection in May 2015 the service was rated Good. At this inspection we found the service remained Good.

This inspection visit took place on 27 September 2017 and was unannounced.

People who lived at the home told us staff were all caring, kind and respectful. One person who lived at the home said, “The staff are so caring and kind.”

The registered manager had procedures in place to minimise the potential risk of abuse or unsafe care. Staff spoken with were able to identify different types of abuse and had received training in safeguarding adults.

Medicines were stored in a clean and secure environment. We observed staff followed correct procedures when they administered medication during the day of our visit. They fully completed associated records so people received their medication on time and correctly. In addition medication audits were now in place regularly to ensure procedures were monitored.

People who lived at the home had access to healthcare professionals and their healthcare needs were met. We saw the management team had responded promptly when people had experienced health problems.

The management team had sufficient staffing levels in place to provide support people needed. We found by our observations and talking with people who lived at the home staff were not rushed and able to spend time supporting them. This was confirmed from our discussions with staff members.

The service had safe infection control procedures in place and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff told us the management team were supportive in their work and approachable should they wish to discuss any issues. They felt a part of the team to improve the home for people who lived at the home.

People who lived at the home were complimentary and told us they enjoyed meals provided and choices available. One person who lived at the home said, “What a good cook, try her home made cakes they are lovely.”

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

People who lived at the home had access to advocacy services. This ensured their interests were represented by professionals outside of the service to act on their behalf if needed.

People who lived at the home told us staff were all caring and respectful. Relatives and friends made positive comments about the kindness showed to their relatives who lived at the home in surveys returned in 2017.

Staff knew people they supported and provided a personalised service in a caring and professional manner.

The registered manager had a complaints procedure which was made available to people on their admission to the home and their relatives. No complaints had been received.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff and ‘resident’ meetings to seek their views about the service provided and their opinions to improve the home. They also had a suggestion box in the hallway of the building for people to pass any comments about the home.

This was an unannounced inspection which took place on 6 May 2015. We last inspected the service in January 2015 when we found there was a breach of five of the regulations we reviewed. We issued warning notices in relation to breaches of regulations regarding the administration of medicines, complaints and quality assurance processes in the service. We also made compliance actions that required the provider to make improvements in relation to supporting staff and respecting and involving people who used the service.

Following the inspection in January 2015 the provider sent us an action plan telling us what steps they were going to take to ensure compliance with the regulations. This inspection was undertaken to check that all the required improvements had been made.

Littleborough Home For the Elderly (HFE) is registered to provide accommodation for up to 26 people who require support with personal care. At the time of this inspection there were 20 people living at the service.

There was a registered manager in place at Littleborough HFE. 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 registered manager was supported by a management team including a manager who was responsible for the day to day running of the service; this manager was in the process of registering with CQC as manager for Littleborough HFE to allow the current registered manager, who is also the provider to deregister. A deputy manager and care manager were also in post.

We found that systems regarding the administration of medicines had been improved. Medicines were stored securely. Staff responsible for administering medicines had received training for the task and were regularly assessed to ensure they were able to administer medicines safely.

Staff had received training in how to protect vulnerable adults. They were aware of the potential signs of abuse and of the action they should take should they have any concerns about a person who used the service.

Staff were safely recruited and there were sufficient numbers of staff on duty to meet people’s needs in a timely manner. We observed staff were caring in their approach towards people who used the service.

Suitable arrangements were in place in relation to fire safety and the servicing of equipment was undertaken so that people were kept safe in Littleborough HFE.

The training, supervision and appraisal systems in the service had been improved. Staff told us they received training relevant to their role and had opportunities to discuss their personal development and work practices with managers in the service. All the staff we spoke with spoke positively about the support they received from managers, in particular the care manager.

Care records had been improved and care plans clearly documented people’s needs. We saw evidence that the processes for involving people who used the service and, where necessary their relatives, had been improved.

Managers in the service were aware of their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Although care staff were able to tell us how they supported people to make their own choices and decisions wherever possible, two staff told us they felt they would benefit from additional training in the Mental Capacity Act.

Systems were in place to ensure people’s health and nutritional needs were met. People who used the service were generally positive about the food provided in Littleborough HFE. We noted the chef was in the process of reviewing the meals which people who used the service preferred in order to update the menu.

We found people had opportunities to comment on the service provided in Littleborough HFE. People told us they would feel confident to raise any concerns and considered staff would listen to them. We noted the arrangements for recording and investigating complaints had been improved.

Quality assurance systems in the service were effective. A number of audits were undertaken and action plans were in place to help ensure all actions identified as necessary were completed. Managers in the service were clear about their responsibilities for continued improvements in the service.

Significant improvements had been made to the way the service was led. However, these needed to be further embedded to demonstrate consistency and sustained improvement in the quality of the service provided.

Littleborough Home for the Elderly is registered to care for older people. It is a purpose built detached building set within its own grounds in the centre of Littleborough Village. It is very close to shops, public transport and the motorway network but within easy reach of open countryside.

At the last inspection in May 2015 the service was rated Good. At this inspection we found the service remained Good.

This inspection visit took place on 27 September 2017 and was unannounced.

People who lived at the home told us staff were all caring, kind and respectful. One person who lived at the home said, “The staff are so caring and kind.”

The registered manager had procedures in place to minimise the potential risk of abuse or unsafe care. Staff spoken with were able to identify different types of abuse and had received training in safeguarding adults.

Medicines were stored in a clean and secure environment. We observed staff followed correct procedures when they administered medication during the day of our visit. They fully completed associated records so people received their medication on time and correctly. In addition medication audits were now in place regularly to ensure procedures were monitored.

People who lived at the home had access to healthcare professionals and their healthcare needs were met. We saw the management team had responded promptly when people had experienced health problems.

The management team had sufficient staffing levels in place to provide support people needed. We found by our observations and talking with people who lived at the home staff were not rushed and able to spend time supporting them. This was confirmed from our discussions with staff members.

The service had safe infection control procedures in place and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff told us the management team were supportive in their work and approachable should they wish to discuss any issues. They felt a part of the team to improve the home for people who lived at the home.

People who lived at the home were complimentary and told us they enjoyed meals provided and choices available. One person who lived at the home said, “What a good cook, try her home made cakes they are lovely.”

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

People who lived at the home had access to advocacy services. This ensured their interests were represented by professionals outside of the service to act on their behalf if needed.

People who lived at the home told us staff were all caring and respectful. Relatives and friends made positive comments about the kindness showed to their relatives who lived at the home in surveys returned in 2017.

Staff knew people they supported and provided a personalised service in a caring and professional manner.

The registered manager had a complaints procedure which was made available to people on their admission to the home and their relatives. No complaints had been received.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff and ‘resident’ meetings to seek their views about the service provided and their opinions to improve the home. They also had a suggestion box in the hallway of the building for people to pass any comments about the home.

The inspection team included an inspector and an expert by experience. The team gathered evidence to help us answer our five questions; 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?

Below is a summary of what we found. The summary is based on our observations during the visit, speaking with five people who used the service, four members of staff, the assistant manager and one professional visitor. In addition we spoke with two relatives, one of whom was also the activity coordinator at the home, and looked at records.

Is the service safe?

We spoke with five people who used the service. They did not express any concerns about their safety in the home.

People were not protected against the risks associated with the unsafe management of medicines. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Recruitment procedures were not sufficiently robust to ensure people were protected against the risks of unsuitable staff. This is a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Improvements needed to be made to ensure people were cared for in premises which were adequately maintained. This is a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service effective?

People were assessed by a manager from the home before they were admitted to help ensure their individual needs could be met.

To ensure that safe and effective care was provided, staff continued to update their skills and knowledge with regular training and updates.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. However we found two care files contained inaccurate information in relation to the care people required. This meant people might be at risk of receiving inappropriate care and is a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service caring?

We saw limited evidence of positive interactions between most staff and the people who used the service. Most people we spoke with did not make any comments about the quality of staff. However, one person told us, “The old staff used to care and have a word with you, but the new staff don’t seem to bother".

Is the service responsive to people’s needs?

People who used the service were offered limited opportunities to make decisions about the care and support they received. This is a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Information in the care records showed that the staff at the home involved other healthcare professionals in the care and support of people in the home.

Is the service well-led?

The home had a manager who was registered with the Care Quality Commission and was qualified to undertake the role. However, from information gathered during the inspection, we found people might not fully understand who was legally responsible for the care provided at Littleborough HFE.

Quality assurance processes in place in the home were ineffective and did not adequately protect people against the risks of unsafe or inappropriate care. This is a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Regular meetings were held with staff. These provided the opportunity for staff to discuss any concerns or practice issues in the home. Staff told us they enjoyed working in Littleborough HFE and felt supported by the manager.

We spoke with several people living in the home and asked them if the care and support they received was to their satisfaction. They said, “It’s lovely here, better than I ever imagined. We have good food and we are not tied to any strict times for things”. “I really am looked after very well. If I ring for the staff in the night they come straight away. I have a lot of pain sometimes with arthritis, so I ring when I want my pain killers. If you’re not well they ring for your GP on the same day. They don’t mess about with your health. A first class service all round”. And, “It’s really good here. We are looked after very well. I go to bed when I want; sometimes it is 10:30pm, that’s after they have made me tea and toast. I like to have a chat with the staff, no complaints”. People said staff spoke to them with respect and they were kind.

People visiting said, “He only does what he wants to do. His speech isn’t very good but they seem to understand what he is saying”. “She is quite vulnerable but she can make her wishes known and will only do what she wants to do”. “They are always pleasant to people and never impatient, I’ve never seen any different and I visit often”.

Staff were trained to support people at risk of falling, developing pressure ulcers or who may not eat enough. Professional help was sought when needed.

People were cared for by staff that were supervised and trained. People had opportunities to give their views about their care and treatment.

The purpose of our visit to Littleborough Home was to look at concerns that had been raised in relation to inadequate night staffing levels. Concerns had also been raised about the lack of support arrangements in place in the event of emergencies arising during the night.

Through discussion with staff and examination of the staff duty rosters we found that sufficient staff were on duty at all times to meet the needs of the people using the service.

Staff told us that no formal ‘on-call’ support system was in place however they were able to access additional support during the night should this be needed. Following our visit we were told that more formal ‘on-call’ arrangements had been put into place.

At our visit in October 2012, we had some concerns about the management of medicines in the home. This inspection was carried out to check whether improvements had been made.

We found that medicines were generally recorded and saw that care workers administered medicines safely and appropriately. Information was available to care workers that enabled them to support people living in the home to take and use their medicines appropriately.

We spoke with two people living in the home who described the care workers as ‘kind’, ‘caring’ and ‘lovely’.

During our visit to Littleborough Home in August 2012 we identified that the systems for managing medicines and for recruiting staff were not as safe as they should have been, so we issued a compliance action in respect of each area of concern. The provider sent us an action plan telling us what they had done to put things right.

During the visit of 8 October 2012 we returned to check compliance. We did not speak to people using the service. We spent our time checking to see if the medicines were being handled safely. We also checked to see if the way that staff were recruited was safe. We found there had been some improvement in the way that medicines were being handled but further improvements were needed. The recruitment of staff was safe.

Whilst we were in the home we spoke with three people using the service and with three visiting relatives.

People told us the following:

“The staff are polite and respectful”.

“They are kind and considerate”.

“I trust the staff”.

“They are patient and caring”.

“Look after me well”.

“Wonderful”.