This inspection took place over three days on 30, 31 August 2017 and 21 September 2017. However, publication of this inspection report was delayed due to legal representations made to the Care Quality Commission (CQC) by the registered provider.

The first day of inspection was unannounced, which meant the service did not know we were coming. The second and third day was by arrangement. We were required to return to the service on the third day in order to gather additional information. This was due to circumstances beyond the control of the lead inspector or the service.

Timperley Care Home is a purpose built home in a residential area of Timperley, near Altrincham. There are bedrooms on two floors. Each floor has its own dining area and two lounges, there is a hairdressing salon situated on the first floor next to the passenger left. All bedrooms are single with their own en-suite shower facilities. There is an enclosed accessible, secure garden off one of the lounges on the ground floor.

Timperley Care Home is registered with the CQC to provide accommodation to a maximum of 56 people who require nursing or personal care. At the time of our inspection, 51 people were accommodated, one person was in hospital and the home had four vacancies. Ground floor accommodation is dedicated to people living a diagnosis of dementia. First floor accommodation is specific to people with more general nursing needs, but some people also live with dementia.

We last inspected Timperley Care Home on 23 and 25 January 2017. During that inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. This resulted in an overall rating of ‘requires improvement.’

In respect of this inspection, the scheduling of our return visit was brought forward as a result of information of concern received by CQC. This information related to the homes management of falls, staffing levels and the fact the previous registered manager had left.

During this inspection, we found three new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. These related to the safe recruitment and selection of staff, staff training and meeting people’s nutritional and hydration needs. You can see what action we have taken at the back of the full report.

Due to the nature of the service provided at Timperley Care Home, we were unable to gather the views of the vast majority of people who used the service. However, during the inspection we completed a Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with visiting relatives to ascertain their views on the quality of care being provided.

In response to concerns raised with CQC about how the service managed specific incidents such as accidents, incidents and falls, we reviewed a wide range of information including accident reports, risk assessments and quality assurance audits. Following this review, we were satisfied safe systems and procedures were operating in the home which sought to keep people safe.

With regards to staffing levels, we looked again to staff rosters, the dependency tool used by the home and we spoke with staff, management and relatives. On the basis of the evidence gathered, we were satisfied that staffing levels were sufficient to meet the needs of people accommodated at the time of our inspection.

We looked again at the homes approach to the safe recruitment and selection of staff and found this was not consistent. This meant the service was not able to consistently demonstrate the suitability of candidates to work with vulnerable groups before an offer of employment was made. This has resulted in a breach of regulation.

At our last inspection, we found people’s medicines were not always managed safely. Since our last inspection, the provider had introduced a new and comprehensive system for m

This inspection took place over two days on 23 and 25 January 2017. The first day was unannounced, which meant the service did not know we were coming. The second day was by arrangement.

The previous inspection took place in July 2016 when we rated the service as “requires improvement”. We found breaches in six areas of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. Following our previous inspection, the service submitted and action pal dated 15 July 2016 stating how they would meet the requirements identified. At this inspection we found improvements in these areas.

Timperley Care Home is a purpose built home in a residential area of Timperley, near Altrincham. There are bedrooms on two floors. Each floor has its own dining area and two lounges, there is a hairdressing salon situated on the first floor next to the passenger left. All bedrooms are single with their own en-suite shower facilities. There is an enclosed accessible, secure garden off one of the lounges on the ground floor.

Timperley Care Home offers primarily nursing care for up to 56 people. The home specialises in care for people living with dementia. At the time of our inspection there were 55 people living at the service.

At the time of this inspection the home was managed by a registered manager who was registered with CQC in. 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.

We found some people’s medicines were not managed and administered in a safe and proper way, which meant there was a risk of people not receiving their medicines as required.

Waste management at the service was not being managed appropriately. This increased the risk of cross infection or vermin infestation.

There were sufficient staffing levels on duty throughout our inspection. The recruitment process was robust, however were found despite the staff receiving appropriate training. Staff were not receiving regular supervision which provides staff with the opportunity to raise concerns and identify any additional training needs they may have.

Staff knew how to keep people safe and people we spoke with felt they were safe with the care and support they received from staff at Timperley Care Home. Safeguarding incidents had been reported and accidents were recorded and action taken to minimise the risk of reoccurrence.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions for themselves.

We observed caring interactions between people and staff who knew them well. Care plans reflect people’s current needs and were regularly reviewed and updated as required. People’s care files contained details about their wishes in respect to end of life care.

At the time of inspection there was no activities coordinator in post due to outstanding checks to ensure they were safe to work with vulnerable people. This meant that at the time of the inspection there was limited activities being undertaken with people living at Timperley Care Home.

The service had a formal complaints procedure in place, but this was not available in different formats to support people living with dementia to understand. Any complaint received was recorded and acted on in a timely manner.

The service now had clear records detailing the audits which had been completed and showing any actions taken when issues had bene identified. We had received a high number of notifications in relation to people living at Timperley Care Home, having falls. We noted the service was now monitoring these falls, looking for possible causes and making re

This inspection took place over two days on 4 and 5 July 2016. The first day was unannounced, which meant the service did not know we were coming in advance. The second day was by arrangement.

The previous inspection took place in February 2015 when we rated the service as “requires improvement”. We found a breach of the regulation relating to failure to apply the principles of the Mental Capacity Act 2005. Following our report the manager at the time submitted an action plan dated 18 June 2015 stating how they would meet the requirements of the Mental Capacity Act 2005 in future. At this inspection we found improvements in this area.

Timperley Care Home is a purpose built home in a residential area of Timperley, near Altrincham. There are bedrooms on two floors. Each floor has its own dining area and two lounges. All bedrooms are single rooms with en-suite shower facilities. There are two enclosed accessible secure gardens.

Timperley Care Home offers primarily nursing care for up to 51 people. The home specialises in care for people living with dementia. On the first day of this inspection there were 50 people living in the home. There was building work in progress to create five additional bedrooms and expand the dining rooms.

At the date of this inspection there was no registered manager in post. 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.

We found that the staffing levels had decreased since our previous inspection, although the numbers of people and their needs had not changed. This was a breach of the regulation relating to staffing levels.

There had been a number of serious safeguarding incidents in the months prior to our visit. In one case a person living in the home had left the building unnoticed and been found several hours later. Two staff had falsely recorded that the person was present in the home, after they had left the building. This was a breach of the regulation relating to keeping people safe. There had also been a number of concerns raised about failure to prevent and treat pressure sores. Several of these concerns had been discussed at strategy meetings. At this inspection we checked and saw that appropriate action had been taken to make sure lessons had been learnt and risks to people reduced as a result of action taken by the provider.

The building was kept clean but we had received reliable information that a staff member’s dog had been allowed to wander freely and soil the floor, on a regular basis. This was a breach of the regulation relating to infection control.

Medicines were administered and recorded appropriately.

Recruitment records showed that checks were made to ensure people who were unsuitable were not recruited. Staff were trained to recognise and report signs of abuse. Where necessary firm disciplinary action was taken against staff in order to protect people.

The building was well maintained. There was ongoing building work to extend the home.

In contrast with the previous inspection Timperley Care Home was now implementing the Mental Capacity Act 2005 and had applied for authorisations under the Deprivation of Liberty Safeguards (DoLS). Best interests meetings were held and well documented.

The home had been subject to criticism by a coroner in April 2016 for not keeping accurate records about whether a person had a DoLS authorisation, but we saw a file listing all applications and authorisations.

Training was arranged for new recruits and on an ongoing basis for existing staff. There was regular supervision and staff were supported with performance development plans.

The dining rooms were small but due to be extended. People were supported to eat appropriate diets and their

This unannounced inspection took place on 3 February 2015. The previous inspection was on 4 March 2014, when we looked at certain areas as a result of concerns raised. The last full inspection had been on 24 June 2013. On both these previous inspections we found the service was complying with regulations in the areas we looked at.

Timperley Care Home is a care home offering both residential and nursing care for up to 51 people. On the day of our visit there was one vacancy.

The service 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.

The building was a modern purpose-built care home which was well maintained and offered a safe environment. There were sufficient numbers of staff on duty and more staff were being recruited to fill vacancies. The recruitment processes were robust. Staff were well trained in safeguarding and the registered manager reported safeguarding incidents. The administration of medicines was safe and monitored effectively.

We found that Timperley Care Home was not always correctly applying the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards which form part of that Act. Mental capacity assessments had in some cases either not been carried out or carried out incorrectly. We found that this meant people were not always being protected. This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 11 of the Health and Social Care 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of the full version of the report.

We found that staff attended to people's needs. Family members told us they were pleased with the care being given. The home had earned a Dignity in Care award.  Several members of staff had followed a programme in end of life care. 

Care plans were held on a computer system which had some advantages but created the risk that they were not personalised. We found there were some activities but that some people would benefit from a greater range of purposeful activity.

The registered manager had not submitted a Provider Information Return which we had requested. There were good systems of audits and oversight by senior managers. Under the registered manager there was strong leadership and staff had a clear sense of the organisation's values.

On the day of our inspection we were informed the home was at full capacity. We looked at staffing levels and how the service was being managed because of concerns we had received.

We found there were enough staff and observed people being supported in a way that met their needs and promoted their wellbeing and safety. The atmosphere was calm, comfortable and relaxed.

We found the service to be well led and person centred taking into account individual needs as well as more complex care needs associated with dementia care.

Family members told us they had no concerns with the care or support their family member received and believed the service was so "calm and peaceful" due to the "kindness and love" shown by the staff and management.

We spoke with seven people who used the service all were complimentary about the care they received. Comments received were “They are very, very kind to me and there are lots of them (the Carers)

Our expert by experience observed lunch was simple but nutritious. Staff spoke with people in a respectful manner.

We spoke with four visiting relatives. One person told us “I think my X is well looked after. She likes the carers and enjoys the food.”

The staff we spoke with were aware of whistle blowing procedures and they would be confident to use these procedures if they suspected abuse. One person we spoke with told us “Whistleblowing is when you suspect care is not right and you can go to a higher authority for example the Care Quality Commission”.

We looked around the home and saw most areas were clean and tidy and free from clutter. We spoke with visiting relative and received complimentary feedback. One person said “I was here yesterday and this room was as clean as it is now. They are very good.”

We spoke with two visiting health professionals who gave positive feedback. One person said “I have been coming for years, things are much smoother when the manager is here, the staff are more knowledgeable and open”.

People who used the service we spoke with told us “I don’t have a complaint, but I would talk to my carer”. A visiting relative told us “If I had a complaint, I would talk to the manager.”

During our visit to Timperley Care Home we spoke with five visitors (all of whom were relatives of people using the service) and six people who used the service. Most of the people who used the service who we spoke with had their relative with them.

Overall people who we spoke with were positive about the service provided at Timperley Care Home.

Not all of the people who we asked could recall being formally involved in a review of their care plan. However, everybody we spoke to described a culture where staff were approachable and always willing to be involved in discussions about care. Comments included "The nurses are fantastic. You talk to them and you get feedback"; "You can ask anybody anything." And "I would be able to discuss anything and would be listened to."

People told us they felt safe living at the home. One relative said "if I had any problems [relative] wouldn't be here."

People who we spoke with said they were enough staff on duty, although two people commented that they sometimes had to wait for attention longer than was desirable. These delays were spoke of as inconvenient rather than seriously problematic or posing a risk. People spoke very positively about the staff. Comments included "very nice staff they are like good friends"; "all the girls are nice and if there is anything you need they are there and say yes" and "staff will go out of their way".

Everybody who we asked told us that they would feel able to complain if necessary and they were confident that their complaint would be listened to and acted upon.

Some people living at Timperley Nursing Home were unable to directly express their views about their medication due to a variety of complex needs.

One person confirmed that nurses supported them to take their medicines and applied their creams for them, when needed. But, they expressed concern that they had “missed (one of their medicines) for three nights”. Records showed that the medicine was not in stock.

We observed that when a care worker reported that one person was expressing pain, nurses promptly went to assess them. We saw that home remedies were kept to allow the prompt treatment of minor ailments.

People we spoke with told us that their medicines came at the right times every day. One person confirmed that they had enough information about what their medicines were for. People choosing to self-administer medication told us they were supported to do so.