This unannounced inspection was carried out on the 18 September 2017.

Amadeus is a private residential care home providing accommodation for up to 39 people, requiring personal care only. The home is a detached property located in Eccles, Salford, Greater Manchester. At this inspection, there were 34 people were living there.

At the last inspection on 17 February 2015, the service was rated overall as ‘Good,’ with safe rated as requires improvement. At this inspection we found the service retained its overall rating of ‘good.’ The service continued to meet all relevant fundamental standards including ‘safe, which was now rated as ‘good.’

People consistently told us they felt safe living at the home. There were systems in place to protect people who lived at the home from abuse by ensuring appropriate referrals were made and action taken to keep people safe. Risks to people were managed in a way that protected them and kept them safe from harm. People were supported safely and their needs were met by sufficient numbers of staff. People told us there was always enough staff to support their needs and respond to them in a timely manner. People continued to receive their medicines safely.

People were confident in the abilities of staff to meet their individual needs. Staff received training and support that was specific to the people they supported. They were encouraged to undertake any training that was relevant to their role. People were supported by staff to make their own decisions. When people lacked mental capacity to take particular decisions, staff took the required action to protect people's rights and ensure people received the care and support they needed. People’s dietary requirements were assessed and people were provided with sufficient food and drink.

People continued to receive support from staff who were kind, caring and compassionate. Staff were respectful of people’s privacy and dignity. People were listened to and felt able to voice their opinions. People were actively involved in determining the care and support they received.

People received care and support that was individual to them. Their support needs were kept under review and staff responded when changes in these needs were required. People were able to give feedback and make complaints about the care and support they received.

People told us they were cared for by a team of staff that were well-led. Staff told us that there was an open culture within the home and they would be confident to raise concerns directly with the registered manager. There were systems in place, which continued to monitor and assess the quality of the care provided.

This unannounced inspection was carried out on the 17 February 2015.

Amadeus is a private residential care home providing accommodation for up to 39 people, requiring personal care only. The home is a detached property located in Eccles, Greater Manchester.

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 carried out in July 2013, we did not identify any concerns with the care provided to people who lived at the home.

People who used the service and their relatives consistently told us they believed they or their loved ones were safe at Amadeus.

During our inspection, we checked to see how the home protected people against abuse. We found suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse.

We found there was a range of risk assessments in place designed to keep people safe from harm. Where risks were identified, clear instructions were provided for staff to reduce the risks and keep people safe.

We looked at how the service managed people’s medicines and found the arrangements were safe. We found all staff administering medication had received training, which we verified by looking at training records. Staff were also subject of annual competency checks to ensure they were safe to administer medicines.

On arrival and during the entire inspection, we judged there were sufficient numbers of staff on duty to meet people’s needs and ensure they were safe. On the whole, both people who used the service and staff told us there were sufficient numbers of staff on during the day to provide support to people. However, some staff felt the current numbers of three staff at night time was not enough and needed to be increased by a further member. Though, they did not believe people were subject of any increased risk with the current numbers of staff. The registered manager told us the service used a dependency tool supported by a staffing guide to determine staffing levels, which was continually reviewed.

Some areas of the home including the main corridor and stairway appeared cluttered with furniture and wheelchairs. This was apparent outside the laundry room in the main corridor, which was used to store clean clothes on hanging rails. This affected the space that was required to move freely around, especially when care staff were moving people in wheelchairs.

On the whole, we found the environment to be clean and saw posters in bathrooms advising about hand hygiene together with supplies of hand gel and paper towels available for staff. Staff we spoke with could describe measures they took to prevent cross infection including the use of personal protective equipment (PPE) and spillage kits. However, we saw that PPE was not used by staff entering the kitchen even though it was available in the kitchen lobby.

We looked at the training staff received to ensure they were fully supported and qualified to undertake their roles. One member of staff told us; “I have done a level II National Vocational Qualification (NVQ) and have done plenty of training here. I’m currently doing meds at the moment which will allow me to give medication. When I started here I received training in infection control, first aid and safeguarding as part of the induction.”

We spoke with four health and social care professionals who were visiting the home during our inspection. One professional told us they used the service often for placements as they believed the home was very much geared up to re-enablement and providing person centred care. We were also told that the home was very prompt at raising any concerns and responded positively to any guidance provided.

The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLS). The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We saw there were procedures in place to guide staff on when a DoLS application should be made.

We found regard had been given to the design and signage features within the home that would help to orientate people living with dementia and included toilet doors painted in the same colour to other doors in order to be easily identifiable. Corridors were given street names such as ‘Market Street’, which was clearly signed and intended to help orientate people.

Throughout the day we observed staff seeking consent from people before undertaking any tasks. This included routinely asking people whether they wanted to wear an apron during meal times, or whether they wanted a drink or to use the bathroom.

Lunch was provided in the dining area within the home, though some people chose to have their meals in their rooms or in the lounge area. We saw staff speaking individually to people to discuss their choices for lunch that day. If people did not like the two cooked choices an alternative of sandwiches was offered. We looked at care files and found that individual nutritional needs were assessed and planned for by the home. We saw evidence that for people who were assessed as being at nutritional or hydration risk, professional advice had been obtained from other health care services such as dieticians.

People told us that they found staff were always kind, caring and friendly. One person who used the service told us; “No complaints about staff, I’m quite happy and everybody is friendly and nice.”

Throughout our inspection, we observed instances where staff demonstrated a thorough understanding of respecting people’s privacy, dignity and choices. We observed staff knocking on doors before entering bedrooms and asking whether they could enter.

Family members told us they could visit at any time during the day, which we confirmed from our own observations. Visitors and people who used the service could choose to sit in the main lounge or seek the privacy of their bedrooms. One relative told us they often used the rear lounge which was always quiet, where they would bring fish and chips for their relative and as a family have tea together in the room.

The home was responsive to people’s individual and changing needs. One relative told us; “She has had her hair washed for the first time in years. They have given her the confidence to have it washed. Here she has the confidence to sit on a chair in the shower.” Another relative said “They would listen to any concerns we had and respond.”

We looked at a sample of eight care files. We saw that each care file had a one page summary on the front of the file, which highlighted people’s preferences and main support needs. New care plans were added as they were needed, for example when a person began to refuse medication. The structure of the care plan was clear and easy to access information.

The service employed an activities coordinator and maintained an individual record detailing people’s involvement in any activity or event that had been arranged.

We found the service did listen to people’s concerns and experiences about the service. The registered manager adopted an open door policy which relatives confirmed. We found questionnaires had been completed during July 2014. We found that the last minuted resident’s meeting undertaken by the service had been in March 2013, which discussed issues such as staffing, care planning and end of life care.

People who used the service and staff told us they believed the home was well run. They were able speak freely to staff and the registered manager about any concerns and were confident these matters would be addressed by the home

We observed that the home’s mangement were visible throughout our inspection and demonstrated a good knowledge of the people who lived at the home. Throughout the day we saw the registered manager engaging with people who lived at the home and staff. The atmosphere was relaxed and comfortable.

The home undertook a range of audits of the service to ensure different aspects of the service were meeting the required standards. These included care file audits, medication audits and annual medication competency checks on staff. Regular checks were undertaken of fire safety equipment including the emergency alarm and emergency lighting. Other audits included weekly inspecton of escape routes and fire drill training. Accidents and incidents were also monitored closely.

We visited Amadeus on 30 July 2013 and found the home clean and tidy. People who used the service were well presented and staff carried out care tasks competently.

We looked at a sample of files and saw that care plans and risk assessments were up to date. Turning charts, weight monitoring charts and food and fluid intake and output monitoring charts were all completed appropriately.

We saw that appropriate policies were in place around food, hydration and nutrition, moving and handling, pressure area care and transfer to hospital.

Drinks were offered regularly throughout the day and we saw the lunchtime routine. A range of choices were offered and assistance was given where needed. We spoke with three people who used the service, two told us the food was OK and one said they had enjoyed their meal.

We spoke with seven members of staff. All care staff had undertaken basic training in moving and handling and food hygiene. Some had done further courses relating to nutrition.

Care staff were able to explain moving and handling techniques, the referral process, use of equipment and how to record. They were aware of how to recognise the signs of pressure sore development and knew how to refer to district nurses. Staff could follow instructions from district nurses with regard to the management and prevention of pressure sores.

There was a policy in place around transfers to hospital and staff were able to explain the process they would follow.

On our visit to Amadeus we found that the home was clean and warm and there was no evidence of malodour. We saw staff were friendly, polite and competent.

We looked at three care files and found that they included relevant 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 with six people who used the service. One person told us “It’s a lovely place to be. Staff help a lot and the food is lovely.” Another said “They are all nice, it’s lovely and clean. You couldn’t fault this place.”

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.

We saw that there were adequate numbers of staff to meet the needs of the people who used the service. Residents and relatives meetings were held regularly to ascertain views on care delivery.

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.

Records were factual and accurate and stored appropriately within the home. The records were kept up to date and the home followed data protection and confidentiality guidance when dealing with records.

We spoke with four people who use the service. They told us the staff were polite, helpful and always asked before they carried out any care activities.

The people we spoke with told us they were very happy at the home and that they were kept involved in the review of their care plans.

People told us they always received their medication on time. They also told us that the staff were always around when they needed them.

When we asked people who use the service about whether they felt they were treated with dignity and respect we were told by one person: "When you meet staff for the first time they introduce themselves and shake your hand, I like that, it shows respect. The staff always say things like, 'may I....’ rather than just do it and not ask, I am impressed."

One person living in the home told us: "I really like living here and the staff are lovely."

Another person living at Amadeus said: "You could not hope for a more pleasant place to live, the staff are kind and funny and keep you going."

One person when we asked about the activities offered by the home told us: "I enjoy the healthy hips and hearts exercises as it gets you going a bit instead of watching the television." Another person told us: "I don't like to join in but I like to watch."

Another person living in Amadeus told us: "Staff come around often with drinks and I don’t want for anything. My room is comfortable and warm. They listen to what you want. I am happy here."

One person using the service said: "The staff are gentle and kind."