This unannounced inspection took place on 29 August 2018.

St Catherine's Care Home Horwich, Bolton is a purpose built two storey care home. The home is close to Horwich town centre and close to a bus route and the motorway network. The home provides nursing care or personal care for 30 people and cares for 30 people living with dementia in a separate area of the home called Pike View. On the day of the inspection there were 58 people living at the home.

St Catherine's 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.

This last inspection took place 7 December 2017 and the overall rating was Requires Improvement. We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to Person centred care, dignity and respect, safe care and treatment, medication, governance and staffing.

At the inspection on the 29 August 2018 we found that some of the breaches had been met. However, we found continued breaches in medication, person centred care and governance. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service had a registered manager in place. 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 an appropriate safeguarding policy and procedure in place, staff had undertaken safeguarding training and had a good understanding of how to report any concerns.

Staff recruitment was robust and staffing levels were good on the day of the inspection. There was a good induction programme for new staff and training was on-going.

There had been improvements to the overall cleanliness of the building. There was a rolling programme of refurbishment following the installation of a new heating system. The hot water in some of the bathrooms was extremely hot and could be potentially dangerous to people. Medicines were not safely managed.

Health and safety certificates were in place and general risk assessments and individual risk assessments had been completed.

People told us the food was ‘awful’ and we found choices were limited. This was due to the catering contractors that the home was instructed they had to use. The mealtime experience could have been improved. People were waiting for long periods of time to receive assistance with their meals.

People had mixed views about the care provided at the home, some people thought that care was task orientated and staff had not enough time to spend with people who used the service. We saw visitors were welcome at any time.

There were up to date policies on privacy, whistleblowing, medication and confidentiality. Residents’ and relatives’ meetings were held; however, these were poorly attended. The registered manager held a ‘drop in’ meeting so people could speak with her if they wished.

Some of the care files we looked at did not always show evidence that collaborative needs had been assessed and there was limited evidence to suggest people’s preferences had been addressed.

There was an up to date complaints procedure in the reception area and this was also in the information provided to people living at the home and their relatives.

The service was working within the legal requires of the Mental Capacity Act 2005 (MCA) and the deprivation of Liberty Safeguards (DoLS).

People we spoke with said the registered manager was approachable. We saw evidence of staff supervisions and appraisals.

St Catherine’s Care Home Horwich, Bolton is a purpose built two storey care home. The home is close to Horwich town centre and close to a bus route and the motorway network. The home provides nursing care for 30 people and care for 30 people living with dementia in a separate area of the home called Pike View.

This inspection took place on 07 December 2017 and was unannounced. The last inspection took place on 10 January 2017 and the overall rating was good.

St Catherine’s 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.

The service had registered manager in place. 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 this inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medication, infection control, governance, staff training, mitigating risk, person centred care and dignity. You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.

Systems were in place to ensure staff were safely recruited. Staff told us they received the training and supervision they needed to be able to carry out their roles effectively. Staff completed an induction on commencing work at the home.

The training record provided by the registered manager highlighted there were gaps in essential training for staff.

People who used the service and their relatives told us they felt safe and their relatives were well cared for.

We found that medicines were not managed safely and people did not always get their medicines in a timely manner.

We found that the home was not clean and systems were not being adhered to reduce the risk of cross infection in the home.

Health and safety checks were in place with regard to equipment and servicing of appliances.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People who used the service told us staff were kind and caring. We observed staff interacted well with people throughout the day. People’s privacy was respected. However, people’s dignity was not always maintained. For example it was noted that faeces was on bedding and mattresses in people’s rooms when beds had been made and not cleaned.

We saw a good range of information in care plans, including care plans for pressure ulcers and wound care. These were not all completed accurately and fully. Care plans had been reviewed as required.

There was a range of activities provided both in the home and trips out to local venues

The service had an up to date complaints procedure for receiving, handling and responding to complaints.

A service user guide was available. This provided information about the home and the care people could expect to receive.

This unannounced inspection took place on 10 January 2017. The home is a purpose built two storey building in the Horwich area of Bolton. Car parking is available at the front of the home. The home is close to local amenities and public transport. St Catherine’s provides nursing care and care for people living with dementia.

The home is registered to provide care and support for 60 people. The home is split in to two areas. On the day of our inspection 28 people were living in Pike View, which is on the ground floor and provides nursing care for people living with dementia. On the first floor there were 25 people who required nursing care.

The home has a registered manager 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 and associated Regulations about how the service is run.

The home has a large reception area with appropriate information to inform people about the home and the services provided. The last inspection report and the home’s CQC ratings were displayed on the notice board.

During this inspection we found that medicines were being administered in a safe and timely manner. The home worked with other healthcare professionals to ensure that people received appropriate care and treatment.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) although staff spoken with were not clear of what this meant.

Staff were able to demonstrate their understanding of the whistle-blowing procedures and they knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

We found people were cared for by sufficient numbers of suitably skilled staff who were safely recruited. We saw that staff received essential training and support necessary to enable them to do their job effectively and care for people safely.

People we spoke with told us they felt the staff had the skills and experience to meet people’s needs. People spoke positively about the kindness and caring attitude of the staff.

We saw that there were risk assessments in place for the safety of the premises. All areas of the home were clean and well maintained. Procedures were in place to prevent and control the risk of cross infection.

People’s care records contained enough information to guide staff on the care and support required. The care records showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate risk. People were involved and consulted about the development of care plans. This helped to ensure people’s wishes were considered and planned for.

Staff spoken with had a good understanding of the care and support that people required. We saw that people looked well cared for and there was enough equipment available to promote people’s safety, comfort and independence.

Food stocks were good and meals were varied and nutritionally balanced. People told us the food was very good and nicely presented.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided. Regular checks were undertaken on all aspects of the running of the home and there were opportunities, such as surveys and meetings for people to comment on the facilities of the service and the quality of the care provided.

We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service

St Catherine’s Care Home provides residential, nursing and dementia care for up to 60 people and is owned by Tameng Care, which forms part of Four Seasons Health Care. There is a separate area of the home to care for people who are living with dementia known as Pike View. On the day of our inspection there were 60 people living at St Catherine’s Care Home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt safe at the home and with the staff who supported them. However, we encountered several instances of uncleanliness in the dementia unit of the home. This included dirty window ledges and sticky floors in the communal area of the dementia unit. There were also drink stains on one cabinet where spillages had occurred and not cleaned up.

There were robust recruitment procedures in place and we observed their to be sufficient staff available to meet the needs of people who lived at the home.

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) with systems in place to protect people’s rights under the Mental Capacity Act 2005. This legislation protects people who lack capacity and ensures decisions taken on their behalf are made in the person’s best interests and with the least restrictive option to the person's rights and freedoms.

People received the information they needed to help them to make decisions and choices about their care. People’s views and wishes were incorporated into their plans of care. Care plans showed they had been discussed with the person or their representatives at regular intervals and were updated as required.

We observed the lunch periods in each of the three units of the home and observed good interactions between staff and people who used the service. We saw that staff understood people’s care requirements and there were sufficient numbers of staff available to assist people with their nutrition and hydration.

During our visit we spoke with six people who used the service, three relatives and three members of staff. We also spoke with the entertainers who were visiting the home. They told us, “We have played at this home on numerous occasions. We are always made very welcome”.

People who used the service told us, “I have been here for about seven years. I am treated with respect”. Another said, “The dinners are nice and staff help me eat my dinner. The staff are very kind to me”.

One relative spoken with told us “The management and the staff are very good. It’s very friendly here”. Another said, “I looked at other care homes and felt this was far the best. The family are very happy with the care”.

Another relative told us,” We visit every day; we have seen the care plan and signed it. My X has gained weight which is brilliant. I have no problems with the care. My X is always clean and if I mention anything to the staff they attend to it immediately. I have seen some changes here and they are all positive. It’s now a five star”.

We looked at six care records and found they contained enough information to show the care and treatment and support required.

We found people who used the service were asked for their consent to care and treatment and the staff acted in accordance with their wishes.

We saw sufficient numbers of staff were on duty. Staff spoken with told us they received training relevant to their role and they felt supported by the manager.

We saw regular monitoring of the records and services provided were in place to protect people who used the service from any risks or unsafe care.

As part of our inspection we spent sometime speaking with six people living at the home, either individually or as part of a group, two visitors and five staff members.

As some of the people living on one of the units at St Catherine’s had some degree of confusion or a dementia type illness, they were not able to tell us about their experiences of living at the care home. It was evident from our observations staff understood people’s needs and were helpful and polite when assisting people.

We also spoke with a group of people on the residential unit. They told us; “I’m very thankful I am here”, “They [the staff] provide great satisfaction” and “They care about what they do”. Visitors also commented, “It’s very settled, there are some good staff”, “The manager is very approachable”, “Nothing is too much trouble” and “They call me or I call them if there’s anything we need to discuss”.

We found that clear documentation was in place detailing how people were to be supported, taking into consideration their individual needs and wishes.

Records showed that where possible people had been consulted with about their care and support. Suitable arrangements were in place to assist those people who lacked capacity to make decisions for themselves.

The home provided suitable aids and adaptations to meet the physical needs of people.

Systems to monitor and review the service were in place ensuring people received a good standard of service.

The people we spoke with said that they felt well cared for and there was always someone available to assist them when they requested it. We heard that people took part in activities and parties had been arranged for Christmas. We were also told that a conservatory that had previously been cold was now warm and snug.

During our visits we spoke with people living on the residential unit at St Catherine’s Care Home. People told us that since our last inspection they had been offered keys to their bedrooms and these had been ordered. They said that they had also been asked for their opinion about the food service. One person said “On the whole I think the food is all right”, and another person told us that if they did not like the meal that had been provided staff would make them something else.

Several positive comments were seen in the comments book provided for visitors to write in. These included “Thank you St Catherine’s staff. Our family could not manage without you”.

During our visit we spoke with people living on the residential unit at St Catherine’s Care Home. Some people on the nursing unit were very ill and some were asleep, but we did speak to relatives who were visiting them. The people on the dementia care unit were unable to answer any questions or comment on the home and the care they received due to the nature of their illness.

People told us “Staff are very good; we have a good laugh with them". One person said “We have trips out. We have been to Blackpool and staff take us shopping". We were also told “I have been here about four years, its OK; they look after us very well”. One person told us “You sometimes have to wait a bit (for help or care) but you expect that".

We heard that in general people liked the food and said there were always choices. One person said “I don’t like eggs so they make me cheese and tomato instead", and another told us “I like to get up early and as soon as I come in (the dining room) they are ready for serving you".

Comments made by visiting relatives included “The care is far better here than what [our relative] was getting at the hospital, they are making sure that [our relative] is not in any pain", and “I have no complaints, everything is fine". Another visitor told us that they were happy with their relative’s care and the food was lovely.

People on the residential unit commented that they would like to have keys to their rooms because their daytime activity rooms are on a different floor and items had gone missing from their bedrooms.