We undertook an inspection of Mahogany Care Home on 26 and 28 October 2018. The first day of the inspection was unannounced and the second day was by arrangement with the management.

Mahogany Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Mahogany Care Home is a purpose-built home and benefits from all ground floor accommodation. The home provides residential and nursing care for up to 51 people. The home has two large communal lounges, a tea room and dining area. There is also an internal courtyard and garden area with seating. At the time of the inspection there were 39 people living at the home.

The home was last inspected on 10 and 14 July 2017, when we rated the home as ‘requires improvement’ overall and in all the key questions. We also identified five breaches in four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to person-centred care, dignity and respect, good governance and staffing (two parts of the regulation). We also made a recommendation in relation to covert medicines.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; safe, effective, responsive and well-led to at least good. We reviewed the progress the provider had made as part of this inspection.

At this inspection, the provider had made significant improvements and addressed four of the five breaches identified in July 2017. We identified one continued breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance. You can see what action we took at the back of the full version of this report.

Prior to our inspection, the provider had been open and honest regarding the position of the home and the outstanding actions required. They had provided an updated action plan in August and September 2018 detailing progress made and identified areas where further improvement was required. The issues found during the inspection had already been raised through the providers own internal monitoring system.

At the time of the inspection the home did not have a registered manager. The registered manager had left in August 2018. The home was being supported by a home manager and the providers head of quality and governance at Whilst undertaking the inspection we were informed a new manager had been appointed and they were currently working their notice at another home. We were told they would be applying to register with CQC upon commencing in post. 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 living at the home told us they felt safe. Relatives expressed no concerns about the safety of their family members and were positive about the level of care provided. We saw the home had appropriate safeguarding policies and procedures in place, which were aligned with the local authority safeguarding tier system for reporting. Staff had received training in safeguarding vulnerable adults, which was refreshed annually. Staff demonstrated a good understanding of how to identify and report any safeguarding or whistleblowing concerns.

Staff were recruited safely with references from previous employers being sought and DBS (Disclosure Barring Service) checks undertaken. This ensured staff appointed were suitable to work with vulnerable adults.

Staffing levels were determined by the needs of people living at the home and there w

This comprehensive inspection was unannounced and took place on 10 July 2017.

At our last inspection on 01 February 2016, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014in respect of; safe care and treatment (two parts of the regulation), staffing and good governance.

The home was rated as requires improvement overall and in the key lines of enquiry (KLOEs) for; safe, effective, responsive and well-led. The home was rated as good in caring.

At this inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regards to; person-centred care, dignity and respect, governance and staffing (two parts of the regulation). We also made a recommendation in relation to covert medicines. You can see what action we told the provider to take at the end of the full version of this report.

Mahogany Care Home provides residential or nursing care for up to 51 people and benefits from all ground floor accommodation. There were 44 people living at the home at the time of our inspection, including people living with a diagnosis of dementia. The home is situated in a residential area close to Wigan town centre and local amenities.

At the time of the inspection there was a registered manager in post, but they had resigned and were working their last day of notice at the time of the 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.

At the time of the inspection, the head of quality assurance, regional support manager and interim manager were facilitating our visit. A manager had been appointed and was expected to commence in post in August 2017. The interim manager would be providing daily oversight until the new manager arrived at the home.

People who used the service and the majority of relatives told us they felt the service was safe. The provider was no longer in breach of regulation 12; safe care and treatment which meant they were now meeting the requirements of this regulation.

We received a poor response from people living at the home, staff and visitors with regards to the staffing levels at the home. Whilst a formal dependency tool was used to determine staffing numbers, the agreed numbers of staff on duty each day was not consistent. We were told this impacted on the timeliness of the care provided which had compromised people’s dignity.

There were appropriate risk assessments in place with guidance on how to mitigate risk. Staff recruitment was robust with appropriate checks undertaken before staff started working at the home.

Staff demonstrated a good understanding of abuse and local safeguarding procedures.

We found DoLS (Deprivation of Liberty Safeguard) applications had been made as required but staff were not always aware of the people subject to DoLS.

Staff training had improved since our last inspection, but supervision and appraisal had previously been raised as an area of concern and the provider could still not demonstrate that this was being provided as regularly as outlined in the the homes supervision policy and procedure.

We found the staff had worked closely with other health professionals and appropriate referrals had been made when concerns were identified.

People confirmed they were given choices regarding their care. However, the care plans we looked at did not demonstrate that people had been involved in the planning of people’s care and whilst reviews were done, they were signed off by staff and did not involve people living at the home. People told us they didn’t know what a care plan was.

People and staff spoke fondly of each other. People we spoke with gave staff high praise and said that their priv

This comprehensive inspection was unannounced and took place on 01 February 2016.

We last inspected this home on 20 March 2014, when we found the service to be compliant with all regulations we assessed at that time.

Mahogany Care Home provides residential or nursing care for up to 51 people and benefits from all ground floor accommodation. There were 42 people living at the home at the time of our inspection, including people living with a diagnosis of dementia. The home is situated in a residential area close to Wigan town centre and local amenities.

At the time of our inspection, there was no registered manager in post. The previous manager had been in the process of registering with the Care Quality Commission but had left the post suddenly on 06 January 2016 and retracted their application to become the registered manager.

At the time of the inspection, the operations manager was overseeing the daily management of the home and informed us that a new manager had been recently appointed. The new manager would be commencing at the home when all recruitment documentation had been received. 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.

During the inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014in respect of: Safe care and treatment; Staffing; and, Good governance. You can see what action we told the provider to take at the back of the full version of this report. We also made three recommendations.

People had risk assessments in place to help ensure any risks were minimised. We saw appropriate actions had been taken to help mitigate risks following incidents and to reduce the potential for further re-occurrence.

During the inspection we checked to see how the service managed and administered medication safely. We found people were not always protected against the risks associated with medicines, because the provider could not consistently demonstrate there were arrangements in place to manage medicines safely. We found medication that had not been available for one person since 27th January 2016. We also identified a person whose cream had been applied inconsistently and not in line with their prescription. We also found that a person had been receiving creams without sufficient records being kept.

We saw one person’s nutritional needs were met through the use of a Percutaneous Endoscopic Gastrostomy (PEG) feed. We saw that the person commenced their feed in the required position but we observed that this person did not maintain the position and had slipped further down the bed. The staff call bell was not in reach of the person to alert staff. This meant by not maintaining the required angle during the feed, this person was exposed to a risk of aspiration. We alerted a member of staff about this and asked that the person be repositioned. We received confirmation following the inspection that hourly observations had been implemented whilst the person was receiving the PEG feed.

Prior to conducting the inspection, we received information of concern regarding insufficient staffing levels during the month of December 2015. The operations manager acknowledged this during our inspection but confirmed that staffing levels had been increased since the previous manager’s departure. During the inspection, we found sufficient numbers of staff to meet people’s needs but questioned whether staffing levels were sustainable and would be maintained when the new manager was in post. We made a recommendation that the provider implements a dependency tool to ensure that sufficient number of suitably qualified and experienced staff are deployed within the service to meet people’s