About the service: Altham Care Home is a residential care home that was providing personal and nursing care to 34 people aged 65 and over at the time of the inspection. This included people with a diagnosis of dementia.

People’s experience of using this service:

The service met the characteristics of good in all five key questions. Therefore, our overall rating for this service is good.

Assessments and care plans were in place. Although we found some had not always been updated in accordance with policy, staff felt the needs identified were current and they knew the people they cared for well. Following on from inspection the provider ensured specific risk assessments and strategies were in place.

Medicines were being managed safely but creams needed to be signed when opened and topical charts needed to be in place for all people.

People liked living in the service and the home had a warm, friendly atmosphere. People told us they felt safe. They were protected from abuse and discrimination. People told us that staffing levels were appropriate and staff responded in a timely way to people’s needs. We saw that accidents and incidents were managed appropriately.

Staff told us they received a comprehensive induction and had the right skills and experience. People were complimentary about the meals at the service and the dining room experience was pleasant.

Staff had appropriate knowledge of the Mental Capacity Act (MCA)and appropriate Deprivation of Liberty Safeguards (DoLs) applications had been made. People felt the staff were lovely. We observed staff to be kind, caring and empathetic. We saw that they treated people with dignity and respect.

People were consulted about their care and families were involved in reviews.

The management had a visible presence within the home and positive feedback was given about them, in particular the new registered manager. Staff told us they felt well supported by the management.

Rating at last inspection: The service was inspected 8 June 2018 when we undertook a focused inspection and looked at two keys areas, safe and well led. The service was rated good. The report was published 12 September 2018.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We undertook an unannounced focused inspection of Altham care home on the 8 and 21 June 2018. We inspected the service against two of the five key questions we ask about services: is the service well led and is the service safe?

We carried out an unannounced comprehensive inspection of this service on 24 and 25 February 2016. After that inspection we received concerns in relation to a specific incident which led to the death of someone living in the home. As a result, we undertook this focused inspection to consider those concerns and ensure the home had acted accordingly and people were safe. This report only covers our findings in relation to the key questions associated with this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Altham Care Home) on our website at www.cqc.org.uk

No risks, concerns or significant improvements were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Altham Care Home 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 care home accommodates 36 people in one adapted building. At the time of the inspection there were 32 people living in the home.

The home is over two floors and has a large dining room and lounge area to its centre. There is also a large quieter lounge. Kitchen and laundry facilities are on the ground floor.

The home had two registered managers in post at the time of the inspection. One of them was a company director. 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 the last inspection there were no identified breaches to the regulations of the Health and Social Care Act. At this inspection we found there were no breaches to the regulations but have made two recommendations. We recommend the provider undertakes an assessment of people’s dependency levels and ensures there are enough available staff to always meet people’s needs. We have recommended that when the provider undertakes audits to ensure they have a more focused review of the accuracy of the information audited and not just the completeness of the documentation. This is specifically around care plans and the use of body maps after accidents.

We looked at how the provider had managed the specific incident and found they took immediate steps to reduce associated risks. We also found that once the details of the incident were investigated further, more permanent steps were taken to ensure the circumstances of the incident could not be replicated.

We found staff were recruited fairly and equitably ensuring they were suitable to be employed supporting vulnerable people.

Medicines were managed safely including safe storage, administration and recording of people’s prescribed medicines and when they were given.

The home had safeguarding procedures in place and staff at the home understood what constituted abuse and when they should raise concerns, both internally and externally, with the Local Authority.

On the days of the inspection there were enough suitably trained staff to meet the needs of people living in the home.

We saw the provider took steps to ensure equipment was tested and the building was both secure and safe for the people living there.

The provider had improved the home’s management of clinical waste by the second day of the insp

We carried out an inspection of Altham Care Home on 24 and 25 February 2016. The first day was unannounced. This is the first inspection of Altham Care Home since there had been a change in the company name in November 2014.

Altham Care Home is registered to provide accommodation and personal care for up to 36 older people including people living with dementia. At the time of our visit there were 35 people living in the home.

The home is purpose built and located in Clayton-Le-Moors. It is close to local amenities and public transport. Accommodation is provided on two levels in thirty two single and two shared bedrooms. There is an enclosed garden area that is easily accessible for people. Communal rooms include three lounges, two of these have a dining area. There is a small car park for visitors and staff.

The service was managed by two registered managers. 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.

During this inspection we found the service was meeting the current regulations.

People living in the home told us they felt safe and well cared for. They considered there was enough staff to support them when they needed any help. The registered managers followed a good recruitment procedure to ensure new staff were suitable to work with vulnerable people. We found there were enough staff deployed to support people effectively.

The staff we spoke with were knowledgeable about the individual needs of the people. They knew how to recognise signs of abuse and had undertaken safeguarding training. Staff were clear about their responsibilities for reporting incidents in line with local guidance and they knew how to report any poor practice.

Risks to people’s health, welfare and safety were managed very well. Risk assessments were in place in relation to pressure ulcers, behaviours, nutrition, falls and moving and handling. Where risk assessments identified potential hazards, plans were in place to promote people's safety.

Medicines were managed safely and people had their medicines as prescribed and when they needed them. Staff administering medicines had been trained to do this safely.

We found the premises to be clean and hygienic and appropriately maintained. Regular health and safety checks were carried out and equipment used was appropriately maintained. The service held a maximum five star rating award for food hygiene from Environmental Health.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.

People were provided with a nutritionally balanced diet. All of the people we spoke with said that the food served in the home was very good. They were offered a varied diet and were provided with sufficient drinks and snacks. Menu sampling days were held for people to help them choose favourite foods, and their relatives/visitors were also invited to join in the sampling.

There was an open and friendly atmosphere in the home, which showed good relationships existed with the staff and people they cared for. Staff were respectful to people, attentive to their needs and treated people with kindness and respect in their day to day care. People told us they had their privacy respected by all staff. Staff had been trained in End of Life care. This meant staff could? //approach people’s end of life care with confidence and ensure their dignity, comfort and respect was considered.