This was an unannounced inspection which took place on 03 and 04 December 2018.

We last inspected Passmonds House in March 2018 when we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014). The service was in breach of Regulation 15 of the above act as we found concerns in relation to infection control, poor standards of hygiene and, maintenance of the premises. We issued a warning notice in respect of this breach, asking them to comply with the regulation by 17 August 2018. We also found that there were insufficient staff to meet the needs of the service, which was a breach of Regulation 18 of the Health and Social Care Act (2008) Regulations 2014. Following the inspection, the provider sent us an action plan which stated how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings. During this inspection, we found significant and major improvements had been made and the service was no longer in breach of the regulations.

Passmonds house is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Passmonds House provides accommodation and support for up to 33 people. Twenty-two of the rooms have en-suite facilities. The home is comprised of two units over two floors, with lift access to the upper floor and ramps to all entrances. At the time of our inspection there were 31 people living at Passmonds House.

A registered manager is a person who has registered with the Care Quality Commission (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.' At the time of our inspection the service had a manager who was in the process of registering with CQC.

Structural repairs and reorganisation of the basement area had been carried out to ensure that this area was safe and clean, and the registered manager had introduced more stringent measures to control and prevent the spread of infection. The housekeeping hours had been increased and a cleaning schedule had helped to improve the standards of hygiene and cleanliness of the service.

Care records showed that risks to people's health and well-being had been identified. These included specific risks, for example where a person’s behaviour could cause a risk to themselves or other people who used the service, and we saw that appropriate actions were recorded in care plans to minimise the risk of injury and followed up by staff. Environmental hazards had been assessed and where risks had been identified, appropriate measures were in place to minimise these risks. However, as we toured the building we found some cleaning and grooming items which could be harmful if used incorrectly had not been properly secured.

Staff understood how to keep people safe from harm, and the service had a safeguarding policy which helped to protect vulnerable people from abuse. Accidents and incidents were monitored and checked, and systems were in place to ensure that all medicines were stored correctly and managed by trained staff who were mindful when managing medicines to ensure that they were administered safely.

The service had good recruitment processes to ensure only suitable staff were employed. People told us that they were supported by staff who knew them well, and that there were enough staff to meet their needs. From looking at the training record and speaking with staff, we found some changes had been made since out last inspection to ensure staff were properly trained.

We saw staff worked well together and communicated effectively. They were attentive to any changes in people’s needs and passed on i

This was an unannounced inspection which took place on 20 and 21 March 2018. The inspection was brought forward as we had received concerns about the risk of infection at the service.

We last inspected Passmonds House in February 2017 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014) in that medicines were not always managed safely and recruitment procedures did not ensure suitable candidates were selected to work at the home. At this inspection we found improvements had been made in both these areas, and the service was no longer in breach of these regulations. However, we found concerns in other areas. We found that there were insufficient staff to meet the needs of the service, which was a breach of Regulation 18 of the Health and Social Care Act (2008) Regulations 2014.

We also identified concerns in relation to infection control, poor standards of hygiene and, maintenance of the premises. This meant there was a breach of Regulation 15 of the Health and Social Care Act (2008) Regulated Activities 2014.

A Warning Notice was sent to the registered provider requiring them to comply with Regulation 15(1)(a)(c) (d) (e) and (2) of the Health and Social Care Act (Regulated Activities) Regulations 2014. They appealed publication of the warning notice, however this was not upheld. The registered provide must make sure the poor standards of hygiene are resolved before 17 August 2018.

We made three further recommendations regarding training, capacity and care plan reviews. We found the training provided to staff did not provide them with sufficient information to carry out their duties; staff were not always aware when a person was lawfully being deprived of their liberty; and care plan did not take all recorded information into account.

Passmonds house is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Passmonds House provides accommodation and support for up to 35 people in two double and 31 single rooms. Twenty-two of the rooms have en-suite facilities. At the time of our inspection nobody shared a double room. It is comprised of two units over two floors, with lift access to the upper floor and ramps to all entrances. At the time of our inspection there were 30 people living at Passmonds House.

'A registered manager is a person who has registered with the Care Quality Commission (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.' At the time of our inspection the service had a manager who was in the process of registering with CQC.

People who used the service were safeguarded against potential harm, and they told us that they felt safe at Passmonds House. When we spoke with staff they told us they were confident they would report any issues of malpractice to their manager, and we saw that the service responded to issues of poor practice.

We saw and were told by staff that they were sometimes overstretched, which meant that there was little time during the day for work on an individual basis with people who used the service. However, staff showed a good knowledge of the individuals they supported, their needs and preferences, and respected their religious and cultural beliefs.

We saw records which showed people received supervision, but this needed greater structure and frequency. During our inspection we saw staff and managers communicated well with each other to ensure tasks were completed, and that people took responsibility for their own work. The staff cooperated well with each other to share the workload equally.

Attention was paid to people’s diet and nutritiona

This was an unannounced inspection, which took place on the 9 and 10 January 2017. At our last inspection in December 2015 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were needed to the standard of accommodation provided and the training and development of staff. The service had also been without a registered manager since August 2015. The provider sent us an action plan telling us what action they had taken to meet the regulations. During this inspection we checked to see if the breaches in regulation were now met.

Passmonds House provides accommodation and support for up to 35 people. The home has been extended to offer accommodation, in two double and 31 single rooms. 22 of the rooms have en-suite facilities. The home also provides three lounges and two dining rooms. The home is set in its own grounds adjacent to Denehurst Park and is approximately 1½ miles from Rochdale town centre. Parking is provided to the front of the house. Ramped access is provided to all entrances. At the time of the inspection there were 28 people living at the home.

The service had a manager who had completed their registration with the Care Quality Commission in November 2016. 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 this inspection we identified two breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

All information and checks required when appointing new staff were not in place ensuring their suitability for the position so that people were kept safe.

Clear and accurate records were not maintained to show that people received their prescribed creams and thickeners safely and effectively. Suitable arrangements were in place with regards to the management of people’s oral medicines.

We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where people lacked mental capacity steps were taken to ensure decisions were made in their best interests.

Staff were aware of their responsibilities in protecting people from abuse and were able to demonstrate their understanding of the procedures and confirmed they had completed or were scheduled to complete relevant training.

We found staff received on-going training and support essential to their role so they were able to do their job safely and effectively. Adequate numbers of staff to meet people’s individual needs were in place.

People were supported by staff in a friendly and respectful manner. Staff responded promptly when people asked for assistance and were seen to support people in a patient and unhurried manner. People’s visitors told us that staff were kind and considerate and they were always made welcome when visiting the home.

A range of opportunities were made available for people to participate in activities both in and outside the home promoting their independence and choice.

Care plans were person centred and contained good information about the current needs, wishes and preferences of people. Where risks had been identified, additional plans and monitoring had been put in place so that staff could quickly respond to people’s changing needs.

People were offered adequate food and drink throughout the day. Where people’s health and well-being was at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

People told us and records showed that

Passmonds House provides accommodation and support for up to 35 people. Poppy unit, situated on the first floor is a designated unit for people living with dementia. The home has been extended to offer accommodation, in two double and 31 single rooms. Twenty-two of the rooms have en-suite facilities. The home also provides three lounges and two dining rooms. The home is set in its own grounds adjacent to Denehurst Park and is approximately 1½ miles from Rochdale town centre. Parking is provided to the front of the house. Ramped access is provided to all entrances.

We last inspected this service on 14 January 2015 and found the service did not meet the regulations for safety and suitability of premises, Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities); Regulations 2010, consent to care and treatment, Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010; Records, Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010; and staff training Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We issued requirement notices that required the provider to make the necessary improvements in relation to the safety and suitability of premises, consent to care and treatment Following this inspection the service sent us an action plan to tell us how they were going to meet the regulations.

The service did not have a registered manager. The person in charge had applied to register with the Care Quality Commission and was awaiting her disclosure and barring service check to be returned before her application could be submitted. 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.

This inspection was brought forward due to concerns raised by a member of the public. The concerns raised were people being moved around in wheelchairs without footrests, which we found on inspection, the quality of food and people not having choice when going to bed. We did not find the quality of the food was poor or people did not have choice of when they went to bed.

During this inspection we found two breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

People who used the service said they felt safe at this care home. Staff had been trained in safeguarding topics and were aware of the need to report any suspected issues of abuse.

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

We found the ordering, storage, administration and disposal of medication was safe.

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.

People told us the food served at the home was good and they were offered choices about what they ate. We saw there was a good supply and choice of food.

New staff received induction training to provide them with the skills to care for people. All staff were well trained and supervision sessions had begun with the new manager to discuss and training or work based issues they felt they needed to discuss.

The 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. There had been seven DoL’s notifications in the last twelve months.

The home was warm, clean, well decorated and generally fresh smelling although three rooms had a strong odour of urine. We were told the people in these rooms were incontinent. The garden was accessible for people with mobility problems and safe for people with dementia to use in good weather.

The home was reasonably well decorated and furnished. However some bedrooms contained broken items of equipment and one communal area was being used as a store room.

Electrical and gas appliances were serviced regularly. Each person had an individual emergency evacuation plan and there was a business continuity plan for any unforeseen emergencies.

We observed there was a good interaction between staff and people who used the service. There was some good natured banter exchanged during the day between staff and people who used the service.

We observed that staff were caring and protected people’s privacy and dignity when they gave personal care. We saw that staff gave people choice such as what clothes they wanted to wear and people came into the lounge later in the morning because they wanted a lie in. We did not see people being put to bed before we left at 18:30.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and were reviewed. Some work needed to be done to try to ensure all people who used the service (or a family member) had had the chance to agree to their care and support.

We saw that people who used the service and their families were able to attend meetings to have a say in how the home was run. The manager was also planning to send out quality assurance questionnaires to further obtain their views.

Policies and procedures were updated regularly and management audits helped managers check on the quality of the service.

We carried out this inspection to check whether Passmonds House had taken action to comply with the Warning Notices served on them in July 2014 and action identified during their last inspection in June 2014.

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?

Below is a summary of what we found. The summary is based on our observations, during the inspection, speaking with people who used the service and their relatives, speaking with the staff supporting them, and from looking at records.

Safe

At this visit we found that medicines handling had improved. The home’s medicine policy had been further reviewed and regular audits were completed to help ensure that medicines were safely handled.

An updated fire risk assessment had been completed. The provider had taken action where immediate action was required so that people living and working at the home were kept safe.

Effective

Records showed that staff sought additional advice and support where it had been identified people were at increased risk due to their changing health needs. This included referral to dieticians and district nurses so that people received the treatment and support needed to maintain their health and well-being.

Caring

People were seen spending time in one of the lounges or in the privacy of their own rooms. The atmosphere within the home was relaxed and interactions with staff were polite and friendly.

Responsive

We saw that where concerns had been identified in people’s health care needs, such as weight loss or pressure care, advice and support had been sought from relevant health care professionals. This helped ensure people received the support and intervention required.

Individual care plans were in place for people living at the home. Plans had been reviewed and showed how people wished to be cared for. The manager was introducing new care plan documentation so that information was personalised about people’s needs and preferences.

Well-led

The provider had developed audit systems to monitor and review the service and experiences of people living at Passmonds House. These included; staff training, care records, infection control systems, environment, accident and incidents, medication and complaints. This helps to review the quality of service people receive and identify where further improvements could be made.

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?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and their relatives, speaking with the staff supporting them, and from looking at records.

Is the service safe?

Systems were in place to support people when consenting to their care, particularly where people lacked the capacity to do this for themselves. This helped to protect the rights of people.

At this visit we found that medicines handling had improved. The home’s medicine policy had been reviewed and regular audits were completed to help ensure that medicines were safely handled. The two people we spoke with did not raise any concerns about their medicines with us. However, we found that written guidance about how people’s individual medicines needs would be met was not consistently in place; to help ensure that they receive the most benefit from their medicines.

The care records we looked at did not contain enough information to show how people were to be safely supported and cared for. Care records showed that people's health was not always assessed and monitored to ensure their health and welfare was protected.

Is the service effective?

Enough staff were available to safely and effectively meet the needs of people.

People's care records showed that their preferences, likes and dislikes had been clearly documented and their support had been provided in accordance with their wishes.

Is the service caring?

We saw that interactions between people and staff were polite and friendly. The staff we spoke with showed they had a very good understanding of the needs of the people they were looking after. People looked clean and well cared for.

The people we spoke with were complimentary about the care provided. We were told, “They [the staff] are kind and helpful”.

Is the service responsive to people’s needs?

People living at the home were supported in accessing health care professionals, such as GP’s and district nurses so that their current and changing needs were met.

A recent meeting had been held with people who used the service and their relatives. This gave people the opportunity to be kept informed of any developments within the home, and also to express their views, about the service and facilities provided.

Is the service well-led?

Recent changes had taken place with regards to the management of the home. The present manager had yet to make application to register with the Care Quality Commission (CQC).

Systems to show that the service was effectively monitored and reviewed were not in place. This did not ensure people received a good quality service.

Servicing and checks had been completed to the equipment and facilities provided. Action identified to some areas had not been addressed minimising the risk to people living and working at the home.

As part of this inspection we looked at what progress had been made following our last visit to the home on the 12 September 2012.

We spent some time observing the care provided by staff. We also spoke with people who live at the home and their visitors. Comments received were positive. People and their visitors told us; “Can’t fault the staff, they are lovely and very caring”, “No complaints about the food, there’s always plenty of choice”, “[the staff] always appear to be busy” and “They [the staff] keep in contact with me if there’s anything I need to know”.

New documentation was being completed when assessing and planning people’s care. Information provided clear instruction for staff about the needs and wishes of people.

Suitable arrangements were in place with regards to meeting the nutritional needs of people.

A lot of work had been carried out to improve the appearance of the home. Completion of the refurbishment will ensure people are provided with a good standard of accommodation.

Suitable arrangements were in place when recruiting new staff. Systems to offer on-going training and support for staff had also been developed. Staff spoken with felt supported in their work.

Systems to monitor and review the quality of service provided had been developed. This information helped to identify where improvements were needed, action required was planned for.

The new manager was making arrangements to register with the Care Quality Commission (CQC).

The purpose of our visit to Passmonds House was to look at concerns about inadequate night staffing levels and support arrangements in the event of emergencies.

Through discussion with staff and on examination of the staff rotas we found that consistent staffing levels were provided throughout the night.

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.

Staff said they were not aware of the policies and procedures in place to guide them in the event of an emergency arising however what they told us showed that they were aware of what to do so that people were kept safe.

Staff had access to all medication held at the home and were administering prescribed pain relief when required. However the staff we spoke with had not been suitably trained to do so.

Immediately following our visit the provider confirmed with us what action had been taken to address the shortfalls identified.

During our inspection we spoke with five people living at the home and two visitors. People spoke positively about the care and support provided by staff. We were told, “the carers are wonderful”, “there’s no problem if we need anything, they help us”, “I’m very happy here” and “nothing is too much trouble”.

One person spoken with said they had moved into the home several months prior to our visit. They told us “I wasn’t sure what to expect when I moved in but it’s been heaven” and “I don’t know what I would have done without them”.

From our observations we saw that staff appeared to have a good understanding of people’s needs. Staff were polite and respectful and offered lots of encouragement.

We also spoke with two visitors. They told us that they had no issues with the care provided for their relative. They felt staff were supportive and responded promptly to any requests. Visitors felt they were made very welcome and staff were friendly.

During our visit we also looked at what opportunities were offered to people to provide variety to their day. We were told by staff that activities were provided during the afternoon. These included bingo, crafts, board games, singing and nail care for example. An entertainer visited the home on a regular basis, so did the hairdresser and members of the local church. Arrangements were made for the delivery of newspapers and magazines. Some people preferred the privacy of their own room, which was respected.

This was an unannounced inspection, which took place on the 14 January 2015. We carried out an inspection in June 2014 and found the provider was not meeting all the regulations we reviewed. The provider was issued with warning notices instructing them to make the necessary improvements so people were kept safe. We carried out a further inspection in September 2014 to check if the necessary improvements had been made. We found the provider was meeting the regulations we reviewed at that time.

Passmonds House provides accommodation and support for up to 35 people. Poppy unit, situated on the first floor is a designated unit for people living with dementia. At the time of our inspection there were 29 people living at the home. The home has been extended to offer accommodation, in two double and 31 single rooms. Twenty-two of the rooms have en-suite facilities. The home also provides three lounges and two dining rooms. The home is set in its own grounds adjacent to Denehurst Park and is approximately 1½ miles from Rochdale town centre. Parking is provided to the front of the house. Ramped access is provided to all entrances.

At the time of the inspection the manager was not registered with the Care Quality Commission. We were told an application had been submitted. 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 told us they felt safe living at Passmonds House. Relatives we spoke with confirmed they had no concerns about the safety of their family members. We saw that interactions between people and staff were polite and friendly. The staff we spoke with showed they had a very good understanding of the needs of the people they were looking after.

People were cared for by sufficient numbers of staff. Staff received on-going basic training and support to enable them to do their job. However appropriate training in the specific needs of people living at the home, such as dementia care and mental health needs had not been provided ensuring staff had the knowledge and skills needed to effectively support people.

We saw improvements were needed to enhance the standard of accommodation provided and the suitability of the environment for people living with dementia to promote their well-being and freedom of movement.

Care records we looked at had been reviewed and updated to reflect people’s support needs. However records did not show that people’s wishes and preferences had been gathered or that people were involved and consented to the care and support they received.

We found the management of people’s medication was safe. We saw people were supported to access health care professionals, such as GP’s, community nurses and dieticians so their current and changing health needs were met.

The manager and staff were able to demonstrate their understanding of 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. Staff were also able to tell us what they would do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

Systems had been implemented to show the service was being monitored and reviewed. People told us the manager and staff were approachable and felt confident they would listen and respond if any concerns were raised. However information requested by CQC prior to the inspection had not been received. The homes ‘Statement of Purpose’, which was amended during the inspection, reflected the changing needs of people living at the home but staff training in specific areas of care had not been provided. We saw that relevant checks had been made when employing new staff, suitable arrangements were in place in relation to fire safety and the servicing of equipment was undertaken so that people were kept safe.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to appropriate staff training, the development of personalised care plans and the standard of accommodation and suitability of the environment to promote peoples well-being. You can see what action we told the provider to take at the back of the full version of this report.