The inspection took place on 15 March 2018 and was unannounced. The last inspection was undertaken on 21 January 2016 when the service was rated as ‘Good’. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Wilfred Geere House is a care home which provides a respite service. There are also some ‘discharge from hospital’ step down beds, the aim of which is to help people to return to their own home or move in to other care settings. At the time of the inspection there was one person at the home on a long term placement. 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.

Wilfred Geere House accommodates up to 30 people in one adapted building.

There was 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.

People we spoke with told us they felt safe at Wilfred Geere House. There were appropriate safeguarding policies in place and staff had undertaken training.

Staff had been safely recruited. Staffing levels were flexible and there were sufficient staff to meet the needs of the people who used the service.

Systems for the handling of medicines were safe. Individual and general risk assessments were in place and health and safety records were complete and up to date. Infection control procedures were adhered to throughout the home.

People were given a thorough assessment of needs prior to admission and care files included relevant information around health needs and personal preferences. The service was working within the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Monitoring charts for issues such as food and fluid intake were completed as required. Nutritional requirements were recorded and adhered to and people were given choices with regard to meal options.

Staff were given a thorough induction and training was on-going. Staff supervisions, appraisals and observations of practice were undertaken on a regular basis.

Throughout the day we witnessed staff interacting with kindness, patience and respect with people who used the service. Staff demonstrated a commitment to preserving people’s dignity.

People who used the service and their relatives, where appropriate, were involved in the planning of their care and support. This involvement was documented in their care files.

There was a welcome leaflet which included an invitation to look around the home prior to the person’s stay. There was a confidentiality policy which was appropriate and up to date. People’s records were stored securely.

Care plans were person centred and preferences and choices were documented within the files. A range of activities occurred during the day and arrangements were in place to ensure people’s religious and cultural needs could be met.

There was an appropriate complaints system, where any concerns or complaints were logged and follow up actions documented. Questionnaires were given to all users of the service and their families to complete on discharge. The service had received a number of thank you cards and compliments.

There was an end of life champion and a number of staff had undertaken training in end of life care.

Staff told us they felt supported by management at the home.

Accide

The unannounced inspection took place on 21 January 2016. The last inspection was undertaken on 23 April 2014 and the service was found to be meeting all requirements reviewed.

Wilfred Geere House provides dementia care and is registered to provide accommodation for up to 27 people. The home is run by Bolton Council.

There was a registered manager in place at the home. 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 were sufficient staff in evidence on the day of the inspection. We saw from rotas that the service responded to people’s dependency levels to ensure the correct number of staff were deployed on each shift.

The service had a robust recruitment process and the induction programme was comprehensive. Training for staff was on-going.

Safeguarding policies and procedures were followed appropriately and staff were aware of these. There were two staff members who were safeguarding champions. Infection control procedures were in place and there was an infection control lead within the staff.

Health and safety measures were in place and equipment was maintained and tested regularly.

The service had an appropriate medicines policy and medication procedures were followed by staff.

The service catered for a large number of people who were living with dementia as well as some who did not have this diagnosis. We saw that people were free to walk around the building as they wished, whilst being discreetly supervised by staff. There was a dementia champion amongst the staff membership.

Care plans included a range of health and personal information and were person centred. Appropriate risk assessments were held within the care plans. Staff were aware of how to deal with incidents and accidents.

Nutritional needs were catered for and mealtimes were relaxed and well managed by the service.

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

We observed interactions between staff and people who used the service and saw that these were friendly, kind and courteous. People we spoke with who used the service, their relatives and visiting health professionals, told us they were happy with the care provided.

The service endeavoured to work in an inclusive way, ensuring equality and diversity for everyone.

There was a range of activities on offer and people were given choices in the course of their daily lives.

Complaints were dealt with appropriately and learning taken from them to help improve the service. The service had received a number of compliments from people who had used the service and their relatives.

Staff and people who used the service described the management as approachable.

A number of quality audits were undertaken, issues identified and measures put in place to help ensure continual improvement to the service.

During this inspection the Inspector gathered evidence to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

At the time of the inspection the service had gone through some significant changes, due to the restructure of a number of local authority services. They had been required to accommodate some people who had lived within another local authority home and further changes were expected in the near future as the facility was to be primarily a service for people who required respite breaks.

During the inspection we looked at care, partnership working, use of equipment, staff requirements and quality assurance.

This is a summary of what we found, using evidence obtained via observations, speaking with staff, speaking with people who used the service and their families, and looking at records:

Is the service caring?

We observed good interaction between staff and people who used the service. Staff were friendly and respectful and cared for people in a timely and efficient manner.

We looked at care records and saw they included a range of health and personal information which was factual and up to date. Information included personal choices, preferences and risk evaluation which helped ensure care was delivered in an individual way for each person.

We saw evidence that people who used the service and their relatives were involved in reviews. One relative told us, “We are invited to reviews. We have a say and they take our point of view into consideration. They always listen to us”.

People at the home all lived with dementia, so it was difficult to obtain their views. However, we spoke with one person, who showed us their bedroom and said, “This is my room, I like it. These are all my things”.

Is the service responsive?

People’s individual care needs were assessed and care delivered in as personal and individual way as possible. We saw evidence of the consideration of mental capacity and decisions being made in people’s best interests, with the input of relevant professionals, family and friends.

The service had been required to adapt to a significant number of changes due to the restructure of a number of local authority services. They had efficiently accommodated people coming from another home, and had helped them to settle in to a new home in a short space of time. They had also been required provide reassurance to families who were understandably upset and unsettled by the change, which they had achieved well.

Is the service safe?

Risk assessments, such as moving and handling and safe use of equipment were in place in the care records, along with clear guidance for staff to follow. These risk assessments were reviewed and updated regularly to ensure people’s needs were met safely.

Staff had undertaken all required training and their knowledge and skills were appropriate for their roles. Staff guidance was in place to help support them in their roles.

Appropriate equipment was in place to help ensure the safety of the people who used the service, for example crash mats, sensor alarms to alert staff to potential danger, hoists, wheelchairs and slings. The equipment was well maintained, clean, fit for purpose and in working order.

Building and security checks were carried out on a regular basis to ensure the safety of the premises.

Is the service effective?

Staff with whom we spoke demonstrated a good understanding of their roles and responsibilities.

Feedback from the recent relatives’ survey indicated a good level of satisfaction. Relatives were confident to offer suggestions for improvements and there was evidence that these were considered and responded to appropriately.

Is the service well-led?

Although there had been a number of recent changes to management, due to the restructuring of many of the local authority services, the staff felt they were now more settled. Managers from the other services involved were contactable in the absence of their own manager and were seen to offer support and assistance when required.

There were a significant number of quality assurance measures in place ensuring monitoring and improvement was ongoing within the service.

The manager who attended on the day of the visit told us they were well supported by higher management and they felt they could ask for assistance whenever they needed to.

Wilfred Geere were undergoing a refurbishment when we visited, which was part way through. There were only seven people residing there as no new admissions had been taken for a while.

We looked at two care files and saw that they included information about people’s health, care needs, background, likes and dislikes. Appropriate risk assessments and monitoring charts were held within the files and were reviewed and updated on a monthly basis.

We spoke one person who used the service and one visitor. We were told “If you ring the bell for assistance they come straight away.” The visitor said “There were problems when a lot of staff left suddenly, in one instance, and new staff were engaged. The local council did not inform us of this until two days later. They are quite content now, and the new staff are good.”

We saw that the home had appropriate safeguarding procedures and that they followed these when relevant. Staff had an awareness of safeguarding issues and knew how to recognise, report and record concerns.

There were adequate numbers of staff to meet the needs of the people who used the service. Staff said they felt supported and that morale had improved recently. Training was regularly undertaken and skills development encouraged.

We saw that the home carried out audits to assess the quality of their service and had effected changes to try to continually improve the service. There was a complaints policy and complaints were followed up appropriately.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC (Care Quality Commission) inspector joined by an

Expert by Experience – a person who has experience of using this type of service and who

can provide that perspective and a practising professional.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

All the people who responded to the recent survey at Wilfred Geere House rated the care given by staff as 'excellent'. We heard that staff were gentle and efficient and the service was thought of as good quality with excellent staff. One person told us that they usually watched television or read books during the day, rather than join in activities, but this was their choice.