This inspection took place on the 12 December 2017 and was unannounced. There were 70 people using the service on the day of our inspection.

London and Manchester Healthcare Limited (known locally as Gainsborough House) is a residential nursing home near the centre of Warrington and is registered to provide accommodation with care for up to 72 people. Rooms are over three floors, single occupancy and all have en-suite facilities. Assisted bathrooms are also available on each level of the home. There are a range of public areas including lounges and dining rooms on each floor. There are communal secure gardens with good access from the building.

The home 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was lots of positive feedback about the home and caring nature of staff from people who used the service and their relatives.

People and their families described the care as safe. Staff had been trained to recognise signs of abuse and knew the actions they needed to take if abuse was suspected. People were protected from avoidable harm as risk assessments had been carried out, were regularly reviewed and staff understood the actions needed to minimise identified risks. People were involved in decisions about how their risks were managed and had their freedoms and choices respected.

There were enough staff to meet people's needs and they had been recruited safely. The recruitment process included obtaining employment references and carrying out a criminal record check. Staff were well trained to enable them to carry out their roles effectively.

Staff felt valued and supported by management and by each other and made sure that people's needs and preferences were at the forefront of what they did. Staff received regular on-going training and supervision and had opportunities for professional development. Nurses received training that kept their clinical skills up to date.

People had been involved in decisions about how they would like their care needs met and these were regularly reviewed. Care and support plans provided clear information about people's care needs and staff understood the actions needed to support people and had been kept updated with any changes. People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in place supported this practice.

People and their families described staff as caring, kind and patient and we observed relaxed, friendly interactions between people and the staff. Staff demonstrated a good understanding of people's individual communication needs and supported people in ways that enabled them to be involved in decisions and express their wishes. People had their independence, privacy and dignity respected.

People were offered choices of meals and snacks throughout the day and information about likes, dislikes, allergies and special diets had been shared with the catering team.

People had opportunities to maintain hobbies and interests and keep in touch with family and friends. Numerous activities took place both within the home and in the local community.

The service was extremely well managed by an accomplished, experienced and highly motivated registered manager. The registered manager and staff were proud of where they worked and committed to delivering a high standard of care. Staff spoke positively about their roles and the teamwork and described how they had embraced the organisation's values.

The culture of the home was open and transparent and people who used the service, their families and the staff team felt able to raise any issues with the management team. Communi

The people we spoke to living at the home were complimentary about their care. One said "They are very nice,very kind.". Another person said " I am very happy here." One relative said "We cannot fault the quality of the care we get from staff."

People felt that they were consulted and involved in their care.One relative said "They communicate with me very well."

The home worked cooperatively with a range of healthcare providers. One relative said "When my mother had a fall they called someone in very appropriately."

During our visit the home was clean and tidy and had clear systems in place to reduce the risk of infection.

The staffing levels we observed were appropriate to the needs of the people living in the home. The staff we spoke to commented that they only had to ask the manager if they felt they were short staffed and bank staff would be brought in. One member of staff said "I'm proud to say I work here."

There was a complaints procedure in place which staff felt confident to follow. One person said "I've got no complaints" and another "If I had any concerns they are very accessible."

The people we met with appeared relaxed, comfortable and at ease with the staff. It was also evident that the staff members had a good understanding of what was important to each person and how to care for them.

The people using the service who were able to tell us said that they were happy living in the home. Comments included; “I am fine and being looked after well” and “I have no complaints at all, the staff are really kind.“ Visiting relatives told us; “The staff are very friendly and keep you informed” and “The staff are really good.”

We asked a visiting relative and her relation who lived in the home about the staff working there, they told us, “Lovely here, love the people, wonderful. There are little touches.” Another relative said; “The staff are brilliant.”

The manager and deputy both “walk the floor” on a regular basis to make sure everything is going well. Residents and relatives forums are held regularly and there is also a “spouse group” who meet regularly [This is a support group for the partners of people using the service who have dementia].

The inspection was unannounced and took place on the 12 January 2015. An arranged visit to complete the inspection was then undertaken on the 20 January 2015.

This home is actually registered as London and Manchester Healthcare Ltd and the first line of the address is Gainsborough House Nursing Home. This is an administrative issue that occurred when the home was first registered in August 2011. Everyone refers to the service as Gainsborough House so this is the name used throughout this report.

The last inspection took place on the 11 February 2014 when Gainsborough House Nursing Home was found to be meeting all the regulatory requirements looked at and which applied to this kind of home.

The home is required to 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The current registered manager is due to retire and the provider has appointed a new manager who had applied for registration with the CQC. They will take over the day to day management of the home when the current manager retires.

Gainsborough House is a privately owned care home. It is located on the corner of Chester Road/Gainsborough Road in Lower Walton which is on the outskirts of Warrington. The home provides accommodation with nursing for up to 72 people. It is divided in to three 24 bedded units arranged over three floors. The ground floor accommodates people who need nursing care [Picasso] and the first and second floors cater for people living with some degree of dementia Matisse and Renoir]. On the day of our inspection visit there were 72 people living in the home.

We saw that the service had a safeguarding procedure in place. This was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

We looked at the recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that the appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

The provider had their own induction training programme that was designed to ensure any new staff members had the skills they needed to do their jobs effectively and competently.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that it was up to date.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

There was a flexible menu in place which provided a good variety of food to the people using the service.

The care plans were reviewed monthly so staff knew what changes in care provision, if any, had been made. The files we looked at all explained what each person’s care needs were. This helped to ensure that people’s needs continued to be met.

Staff members we spoke with were positive about how the home was being managed. Throughout the inspection we observed them interacting with each other in a professional manner. All of the staff members we spoke with were positive about the service and the quality of the support being provided.

There was an internal quality assurance system in place. This included audits on care plans, medication, weight losses, accidents, incidents and complaints.

In addition to the above there were also a number of maintenance checks being carried out weekly and monthly. These included the water temperature, the proper operation of window restrictors as well as safety checks on the fire alarm system and emergency lighting. Individual fire safety risk assessments were also completed for each person and these were kept in the care files.