The home is a large detached property in its own grounds, surrounded by open countryside. All accommodation is on the ground floor. The service provides accommodation and personal care for up to 22 older people, some of whom are living with dementia. At the time of our inspection there were 20 people living at the home.

This was an unannounced inspection which took place on the 15 and 16 March 2017. The inspection was undertaken by one adult social care inspector and an expert by experience.

The service was last inspected in March 2015 when it was rated as Good.

The service is required to have 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. The service had a registered manager in place who was present during this inspection.

People who used the service, their visitors and staff we spoke with were very positive about the registered manager and the way the service was managed. People told us the registered manager was approachable, friendly, easy to talk to and kind. During our inspection we observed they interacted politely with everyone and people responded well to them.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them. Staff were confident the registered manager would deal with any issues they raised.

Recruitment procedures were in place which ensured staff had been safely recruited. There were sufficient staff to meet people’s needs. Staff received the training, support and supervision they needed to carry out their roles effectively.

Medicines were stored safely and securely and procedures were in place to ensure people received medicines as prescribed.

The service had an infection control policy; this gave staff guidance on preventing, detecting and controlling the spread of infection and staff received training in infection prevention and control. Staff had access to and wore person protective equipment when undertaking person care tasks.

Accidents and incidents were appropriately recorded. Risk assessments were in place for the general environment. Appropriate health and safety checks had been carried out and equipment was maintained and serviced appropriately.

People had their health needs met and had access to a range of health care professionals and records were kept of any visits or appointments along with any action required. People at risk of poor nutrition and hydration had their needs regularly assessed and monitored. People told us they liked the food, it was home cooked and they were always offered choices.

Peoples support needs were assessed before they moved into Stansfield Hall Care Home. Care records were written in a person centred way and contained good information about people’s support needs, preferences and routines. Risk assessments were in place for people who used the service and staff. They described potential risks and the safeguards in place. Care records had been reviewed regularly and updated when people’s support needs had changed. People and their relatives had been involved in planning and reviewing the care provided.

The home was clean and homely. Recent improvements had been made to the decoration, furnishings and fittings of the home.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. The registered manager was meeting their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people's rights were considered and protected.

All the people we spoke with were positive about the support they received and the caring attitude of the staff. People

Stansfield Hall Care Home is situated in Littleborough and is registered to provide personal care and accommodation for up to 22 older people. There were 18 people living in the service at the time of our inspection. This was an unannounced inspection which took place on 10 March 2015.

We previously inspected this service on 29 April 2014 and found that the service had breached four of the six regulations assessed. We issued compliance actions that required the provider to make the necessary improvements in relation to safeguarding people who use services from abuse, management of medicines, assessing and monitoring the quality of service provision and records. The provider sent us a report setting out the actions they intended to take to achieve compliance with the regulations.

We inspected this service again on 11 July 2014 and found that the provider was compliant with the four regulations we assessed.

The home had a new manager who started working at the home 1 September 2014 and has almost completed the process to become registered with the Care Quality Commission. 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 and the visitors we asked told us that Stansfield Hall was a safe place to live. Staffing levels were sufficient to meet the needs of people who used the service.

Safeguarding procedures were robust and members of staff understood their role in safeguarding vulnerable people from harm.

We found that recruitment procedures were thorough and protected people from the employment of unsuitable staff.

We saw that people were supported to take their medicines as prescribed. However, care plans lacked guidance for staff to follow about when people should be given medicines prescribed to be taken ‘when required.’

Although equipment used at the home was usually serviced regularly small electrical appliances which must be tested annually had not been tested since August 2011.

The registered manager expressed her intention to address these issues as matter of urgency.

Members of staff told us they were supported by management and received regular training to ensure they had the skills and knowledge to provide effective care for people who used the service. Seven members of staff had also completed training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) so they knew when an application should be made and how to submit one.

All the people we asked told us the meals were good. Snacks and drinks were readily available throughout the day and night. We found that people’s weight and nutrition was monitored so that prompt action could be taken if any problems were identified.

People were registered with a GP and had access to a full range of other health and social care professionals.

Throughout the inspection we saw that members of staff were respectful and spoke to people who used the service in a courteous and friendly manner.

We saw that care plans included information about people’s personal preferences which enabled staff to provide care which was person centred and promoted people’s dignity and independence.

Leisure activities were routinely organised within the home. A church choir regularly visited the home to sing hymns for people who wished to practice their faith in that way.

A copy of the complaint’s procedure was displayed near the front door. People who used the service told us they didn’t have anything to complain about. No complaints had been made to CQC or the local authority during the last year.

The manager was approachable and supportive and had made changes to improve the environment and the care provided.

We saw that systems were in place for the manager to monitor the quality and safety of the care provided. Audits completed regularly covered all aspects of the service provided.

The purpose of this inspection was to check that the provider had made the required improvements following the inspection of 29 April 2014 when compliance actions were issued.

During our inspection visit we spoke with the visitors of one person who used the service, one care worker and the manager. We also looked at care records and audits completed by the manager.

We found that improvements had been made in the management of medication. Up to date policies and procedures for the management of medication were available. Medication administration records were up to date and accurate.

Systems were in place to monitor all aspects of the care and facilities provided at the home. The home had been without a manager who was registered with the Care Quality Commission (CQC) for over one year. The home was currently being managed by the manager from another care home owned by the same provider. However, a person suitably qualified to manage the home had been identified and the recruitment process was on-going.

We saw that care planning had improved and people’s care plans contained the required information in order to ensure people received the care and support they needed. One visitor told us they had seen their relative’s care plan and said, “The staff are very good.”

During our inspection visit we spoke with three people who used the service, the relatives of two of these people, four members of staff and the manager. We also looked at records to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Safeguarding procedures were in place and members of staff understood their role in safeguarding the people they supported. Several members of staff had received training about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards to understand when an application should be made, and how to submit one.

The provider has not responded to requests for information about the outcome of an investigation after allegations had been made against a member of staff. Although the member of staff has left the home this means that appropriate action may not have been taken to protect vulnerable people from harm if the allegations were upheld.

Three people who used the service told us they liked living at the home. One person said, “The staff are pretty good.”

Members of staff had received training in the management of medication and knew how to safely give medicines to people who used the service. However, we found that prescribed medication for pain relief was out of stock for one person and they had been given Paracetamol from a supply medication available for ‘homely remedies’.

There was no system in place to make sure the provider and members of staff learn from events such as accidents and incidents. This increases the risk of harm to people and fails to ensure that lessons are learned from mistakes.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the issues we have raised.

Is the service effective?

People’s health and care needs were assessed with them if possible, or their relatives and they were involved in reviewing their plans of care. One visitor told us they were regularly involved in reviewing and updating their relative’s care plan. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

However, a care plan was not in place for a person admitted to the home within the last few weeks. This meant that staff did not have the detailed information they needed to consistently meet this person’s needs.

We found that people’s weight and appetite were usually monitored. However, one person who should have been weighed weekly had not been weighed for more than three weeks. When any problems were identified advice was sought from the doctor and dietician.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation keeping care records.

Is the service caring?

We saw that care workers were attentive to people’s needs and offered appropriate encouragement and assistance when necessary. The relative of one person said, “People here get fantastic treatment, staff do the job with grace.”

People who used the service and their relatives were given the opportunity to express their views about the care provided by regularly completing satisfaction questionnaires. The questionnaires were evaluated by the manager and action was taken to address any issues raised.

Is the service responsive?

Leisure activities were organised at the home. These included arts and crafts, quizzes, sitting outside when the weather permitted and watching television. People were also encouraged to pursue their own interests and hobbies. We saw that one person was reading a magazine and one care worker was sitting in the lounge and chatting to one lady. People from the local Church visited weekly to sing hymns for people who wished to practice their faith in that way.

People were encouraged to express any concerns or make a formal complaint at any time with members of staff or the manager. A senior care worker told us there had not been any recent complaints.

Is the service well-led?

All members of staff had access to the 'Whistle Blowing' procedure. This ensured that members of staff knew the procedure to follow and their legal rights if they reported any genuine issues of concern.

The home had been without a registered manager for over one year and the home currently managed by the manager from another care home owned by the same provider. However, discussion with this manager confirmed that a new manager had been appointed and was due to start working at the home within the next few weeks.

The quality assurance system required further development in order to ensure that all aspects of the care provided at the home were properly monitored.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of service provision.

We spoke with the Manager, two members of care staff, two people who lived at the home and a relative. We spent time observing people’s routines and looked at people’s care records.

Everyone we spoke with made positive comments about the care people received. One person told us “I like it here” and “They [the staff] are very good”. We saw that there were activities planned to entertain people over the Christmas period. We saw staff assisted people in a warm, friendly and unhurried manner.

We saw food provision was generally good and people’s dietary requirements had been considered. People made positive comments about the food available.

We found that the home worked with other professionals involved in people’s care. We also saw that there were systems in place to support staff and the Manager was in the process of updating staff training.

The Manager did not have sufficient time to carry out their duties. There were not effective systems in place to monitor and review the quality of the service provided to ensure people received safe and effective care.

People’s care records were not kept securely and they were not as up to date or as accurate as they should have been.

During the visit, we spoke with one person who used the service and the relatives of another person using the service. They told us the staff kept them involved and discussed any changes to their care on a regular basis.

The people we spoke with told us they were happy with the care they received. They told us the staff were organised, helpful and friendly. The relatives of one person told us they were happy with the level of activities that were available for people at the home.

The people we spoke with told us they had no concerns with their medication and that medicines were given on time. They told us they felt the staff were consistent and stable, with a very low turnover of staff. They also told us they felt this was the best staff regime they had seen at the home and that the Manager had the full support of the whole staff team.

The people we spoke with told us that they had no concerns about the care they received and would speak to the Registered Manager if they had any concerns.

The evidence for this review of compliance was obtained without visiting Stansfield Hall Care Home. We therefore did not speak with people living at the home.

When we visited Stansfield Hall Care Home we spoke with six of the people who lived there and three of their visiting relatives. All without exception praised the staff for the kindness and care.

People told us that they were treated with dignity and respect and were involved in decisions about their care so they had confidence that their needs would be met in the way they wanted them to be.

They told us that they felt safe and well cared for and made many positive comments about the staff and the standard of care provided.

One of the people who lived at the home told us that they thought themselves lucky. They said that the staff are lovely and the care is marvellous. They told us that they were involved in decisions about their care and have residents meetings so they can air their views.

One person’s relatives told us that the home is excellent. They said "it more than met their expectations and as far as the standards of care are concerned it exceeded them". They told us that they were welcomed and felt involved. They knew about their relatives care plans and were more than happy with arrangements for their care and support.