The inspection took place on 11 April 2018 and was unannounced. At our last inspection we rated the service 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 ongoing 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.

Withins (Breightmet) Limited 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.

Withins (Breightmet) Limited accommodates up to 65 people in one purpose built building over three floors The home is located in a residential area in Breightmet, about two miles from the centre of Bolton.

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 felt safe at the home. Staff had received training in safeguarding and were confident the registered manager would take concerns seriously.

There were individual and general risk assessments in place and health and safety records were complete and up to date. Staffing levels were good and recruitment was robust.

There was a suitable medicines policy and procedure in place and systems were safe. Infection prevention and control measures were in place, the building was clean and clutter free and there were no malodours in any area.

There was a thorough induction programme and further training was on-going. Care plans were person-centred and included relevant personal, health and support information. The files included care plans around death and dying. These outlined people’s wishes for when they were nearing the end of their lives.

People were involved in their care planning and regular reviews of care. Care records were held securely to help ensure the confidentiality of people’s personal information.

People’s nutritional and hydration needs were addressed appropriately. Attention had been paid to making the environment suitable for people living with dementia.

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

Staff interacted respectfully with people who used the service, showing compassion and empathy. People’s dignity and privacy was respected. There was a service user guide which included details of the service and facilities.

People we spoke with felt the service was very responsive. There were a range of activities on offer and people were also taken out into the community to other activities.

The complaints procedure was appropriate and up to date and complaints were responded to appropriately and in a timely manner. We saw a number of compliments received by the service.

The registered manager and deputy manager had an ‘open door’ policy. Staff turnover was low and staff said that were very happy with their jobs.

Formal supervision sessions were not up to date. Following the inspection the registered manager implemented a programme of supervision sessions and commenced these immediately.

All the policies and procedures were appropriate, reviewed regularly and up to date. There were a number of audits in place at the home, followed by appropriate actions.

Care plans evidenced good partnership working with other professionals and agencies. The management attended the regular local care home meetings to share good practice and access current guidance. The service had enrolled with Bolton Council's ‘Care H

The unannounced inspection took place on 19 August 2015. At the last inspection the home was found to be meeting all regulatory requirements inspected. Withins (Breightmet) Limited is a purpose built home providing accommodation and care for up to 65 adults. The home is located in a residential area in Breightmet, about two miles from the centre of Bolton.

There was a registered manager 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.

We asked people who used the service if they felt safe and they told us they did. The service had an up to date and relevant safeguarding policy and procedure and staff demonstrated a good working knowledge of the procedures. The service had a robust recruitment procedure and staffing levels were sufficient to meet the needs of the people who used the service.

Emergency procedures were in place and checks were carried out regularly to ensure these were appropriate. Security at the home included well regulated CCTV in communal areas to help ensure the safety of those who used the service.

We observed a senior member of staff on a medicines round. We saw that safe systems were in place for the ordering, administering, storage and disposal of medicines.

People who used the service said the food was good and we saw that there was plenty choice. Staff induction was robust and included mandatory training, shadowing and access to appropriate policies and procedures. Further training was on-going and staff were encouraged to access training throughout their careers.

Care plans were thorough and easy to follow. They included relevant documentation, including monitoring charts. People told us they were involved with their care plans, but the documentation around this was minimal.

The service worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff demonstrated a good working knowledge of capacity issues and DoLS.

People who used the service and their relatives felt staff were kind and caring. We observed care delivery during the day and saw that there was a friendly and comfortable atmosphere and interactions between staff and people who used the service were pleasant. Consent was sought for all interventions offered. Information about the service was available via the home’s website and there was a brochure produced by the service.

Some people were being cared for were nearing the end of their lives and families told us they were impressed by the kindness and compassion of the staff and the home’s commitment to ensuring people’s end of life wishes were respected.

The service employed two members of staff who were dedicated to providing activities at the home. There was evidence that events and activities took place on a regular basis and we saw that people who used the service and their families were actively encouraged to participate.

Care plans were person centred and individualised and people were encouraged to personalise their rooms and to follow their own interests and hobbies.

There was an appropriate, up to date complaints policy. People told us they had no complaints, but were confident any concerns would be dealt with promptly.

The registered manager was present in the home for much of the time both during the week and at weekends. People who used the service, visitors and staff told us the management were always approachable.

There were regular residents’ meetings and surveys to provide forums for people to offer suggestions and raise concerns.

A number of audits and checks were completed but the quality of these varied and some were merely tick lists with no documentation of follow up to issues raised.

Staff were able to approach the management any time for support and assistance.

We visited Withins on 23 July 2013 and found the home spotlessly clean and the atmosphere friendly and relaxed. There were adequate numbers of staff whom we observed delivering care efficiently and treating people with respect.

We looked at five care plans, which included information about health, care needs, background, likes and dislikes. There were appropriate risk assessments and monitoring charts which were reviewed and updated on a monthly basis.

We spoke with four people who used the service. One person said “They look after us here. The food is lovely.” Another said “They do their best for you”, whilst another told us “The girls are all nice, I’m happy here.”

We spoke with six visitors who were all very positive about their relatives’ care. One visitor said “I feel very involved." Another visitor told us that when their relative had been admitted to the home the staff had been exceptionally supportive “It was like somebody putting an arm around me, like being wrapped in a warm blanket.”

The home had safeguarding procedures which were followed appropriately. Staff were aware of safeguarding issues and were confident that they could recognise, report and record concerns.

We spoke with three staff members who felt they were well supported in their employment, learning and development.

There was evidence of quality assurance and consultation with people who used the service and their relatives to ensure the continued quality of the service delivery.

We did not ask people who use the service any specific questions relating to this outcome.

The three people we spoke with said they were happy with the care they received at Withins (Breightmet) Limited. One person said "We don't want for anything" and another said "I wouldn't change anything". People were very complimentary about the care workers. Everyone said that care workers asked permission before carrying out any care, and one person said care workers always gave them choices.

The people we spoke with told us they had no concerns about the cleanliness of the home. We were told that their rooms were cleaned daily. They all said they knew about how to make a complaint.

We did not ask people who used the service about their views in connection with this outcome.

People told us that there was plenty of choice regarding the daily activities provided by the home but they did not have to join in unless they wanted to. We heard that people were kept up to date about medical interventions. One person who used the service told us that “The care is wonderful. The girls will do anything for you.”