This inspection was carried out on 21 and 22 December 2016 and the first day of inspection was unannounced.

Bourne House is situated in the Ashton-under-Lyne area of Tameside. The home provides care, support and accommodation for up to 33 older people who require personal care without nursing.

All rooms provide single accommodation and 19 of the rooms are en-suite. Bedrooms are located over two floors and the first floor is accessed using a passenger lift or staircase. There are three communal bathrooms, communal toilets, one lounge to the front of the home, one dining room to the front of the home and one combined lounge / dining room to the rear of the home.

At the time of our inspection 32 people were living at Bourne House, with one new admission planned. The registered manager told us that the service had a waiting list of 13 people who would like to be accommodated at the home.

There was a registered manager in post at the time of this inspection. 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 overall rating for the service following the last inspection was found to be ‘Requires Improvement’. This inspection was carried out to see if the required improvements had been made.

The service was last inspected in May 2016, at which time we found there were multiple breaches of the Health and Social Care Act (Regulated Activities) 2014. We found that significant improvements had been made since the last inspection and the breaches of Regulations identified in May 2016 had since been satisfactorily addressed.

People and their relatives told us they felt the care and support they received kept them safe and was of a good standard.

Staff we spoke with were aware and understood their roles and responsibilities in keeping people safe and protecting them from harm.

We found that medicines were managed safely and people were receiving their medicines in line with the prescriber’s instructions.

Care plans, risk assessments and all supporting documentation had been had been updated to a new format. This documentation identified assessed risk and the measures in place to minimise the risk. Personal emergency evacuation plans were in place detailing the assistance each person would need to safely exit the premises should there be an emergency situation.

The new care plans were detailed and person centred. The care plans we reviewed were all up to date, contained information and guidance from other health care professionals and had been reviewed on a regular basis.

The registered manager told us that since the last inspection of the service, each person had been assessed in line with the Mental Capacity Act 2005, and where a person had been deemed not to have capacity there had been a Deprivation of Liberty Safeguard (DoLS) applied for.

Staffing levels had been increased and sufficient staff were on duty at the time of this inspection to keep people safe and their support needs were being met in a timely manner.

Staff had undertaken appropriate training to make sure they had the skills and knowledge needed to carry out their job safely. The management team supported staff and provided them with individual supervision and appraisal meetings giving them the opportunity to discuss their personal development and performance.

Staff were supportive of people, patient and caring. People were treated with dignity and respect and staff supported people to maintain their independence where possible and were mindful to protect people’s privacy.

People and staff were complimentary about the qualities of the registered manager and senior staff team and told us they felt supported and able to approach the management team.

We inspected Bourne House on 8, 9 and 10 March 2016 and our visit was unannounced on day one.

The service was previously inspected on 2 April 2014 when no breaches of legal requirements were found.

Bourne House is situated in the Ashton-under-Lyne area of Tameside. The home provides care, support and accommodation for up to 33 people who require personal care without nursing.

All rooms provide single accommodation and 19 of the rooms are en-suite. Bedrooms are located over two floors and the first floor is accessed using a passenger lift or staircase. There are three communal bathrooms, communal toilets, one front lounge, one front dining room and one rear combined lounge/dining room. The rear lounge/dining room overlooks the patio and large well kept, secure gardens with areas for people to sit outside. The building is a two storey detached house with a large, single storey extension to the rear.

At the time of our inspection 33 people were living at Bourne House Care Home and the registered manager told us that they were currently operating a waiting list.

There was a registered manager in place. A registered manager is a person who has registered with the 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.

This inspection was carried out in response to a regulation 28 report from the Coroner’s office. This is a report that is written after an inquest into someone’s death and the Coroner believes there is a risk of other deaths occurring in similar circumstances. The home is required to produce an action plan to ensure the prevention of a reoccurrence. We found that actions identified in the report had been completed by the home.

We identified 13 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full report.

During this inspection we found that there were not always enough staff available to meet people’s needs. The registered manager told us they used an online tool to calculate how many staff should be on duty but this did not accurately reflect the level of the needs and dependency of the people we observed who lived at Bourne House.

The provider did not have effective systems in place to identify the risks to people’s health, welfare and safety. Care plans did not include comprehensive risk assessments to identify specific risks to people.

Accidents and incidents were not comprehensively reported, analysed or acted upon.

A full building/ environmental audit would have highlighted potential environmental risks, as identified during this inspection.

People, relatives, and staff spoke of the service; one person’s relative told us “Staff are caring and I am informed of any changes”.

Visiting professionals were complimentary of the service and were confident that staff follow their guidance when providing care. One visiting professional told us “It’s one of the better homes”.

Staff we spoke with were aware how to safeguard people and were able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm. However, staff did not demonstrate an understanding of the legal safeguards around mental capacity.

Safe and appropriate recruitment and selection practices had been used to ensure that suitable staff had been employed to care for vulnerable people and staff received regular supervision and support from management.

Documentation at the home showed us that people received appropriate input from health care professionals, such as district nursing and their general practitioner, to ensure they received the care and support they needed. However, we found that people were not always appropriately

A compliance inspector visited this service on 2nd April 2014 to carry out an unannounced inspection. Prior to our visit we looked at all the information we hold on this service to help us to plan and focus on our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

People were treated with respect and dignity by the staff. People we spoke with and some of their relatives told us they felt confident in raising concerns with the staff team and manager and were confident that these would be addressed. The people we spoke with told us they felt that staff listened to them and respected their rights to receive care and supported them in a way that suited their individual needs and preferences.

There was a comprehensive training programme in place to ensure that staff had the relevant qualifications, knowledge and skills and experience to meet the assessed needs of people living in the home. Training included safeguarding adults, health and safety and moving and handling. This meant that people living in the home could be confident that their needs were being met by fully trained staff.

Systems were in place to make sure that managers and staff learned from events such as incidents, complaints, and safeguarding events. The manager told us that good practice was reinforced in one to one staff supervision, staff meetings and training sessions. Staff told us that when they identified a training need they only had to ask the manager who would arrange appropriate training so that staff had the skills they required for their role.

During our visit we looked at the premises which were fit for purpose. The home was clean and tidy and there were protocols in place to manage the ongoing maintenance of the home and ensure that staff followed health and safety procedures. management systems were in place to monitor and audit all aspects of practice such as checks on care plans and medication audits.

Is the service effective?

Prior to people being admitted into the home a member of staff visited people in their home needs to carry out an assessment of needs. This meant that people could feel confident that the service could meet their care needs when they moved into the home.

The manager of the home was pro active in ensuring that staff were kept up to date with current developments in adult social care and used a variety of means to do so. The service was involved with programmes which focused on 'living well with dementia', and auditing systems which included input from the Stockport NHS. These audits had resulted in the service being awarded a number of certificates including one for 'going the extra mile when working with people with dementia'.

The service had recently been awarded a grant following a detailed application tender submitted by the manager. The money received had been used to create a garden which had been designed with special features to compliment the work the staff carry out with the people living in the home.

Is the service caring?

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

When we spoke with people living in the home and some of their relatives we were told that the staff were skilled and competent and carried out their care duties in a caring way. During our visit we saw staff interact well with people and they used good communication methods when working with people. We saw that staff listened to people and support people in a way that suited their individual needs and preferences.

Is the service responsive?

When we spoke with families who were visiting they told us that they could approach the staff or manager with any concerns. They told us that they were confident that any concerns would be addressed immediately.

The service had systems in place to ensure that people were regularly consulted about their views and ideas on how the home should be run. This was done by means of resident and family meeting and feedback surveys. We saw evidence of these surveys being carried out on a regular basis and the analysis of the findings. Where action was required we saw documentation on how these were addressed, and all of this was reported to people in a monthly newsletter demonstrating that the service was open and transparent on the way the service operated. Good systems were in place to support people in using the complaints procedure. As a result of listening to people who use the service the quality of the service was continually improving.

Is the service well led?

The service worked well with other services to make sure people living in the home received appropriate care and assessment from the right professionals in a timely way. When we spoke with visiting professionals they told us that the staff worked well with them and made appropriate and timely referrals to them which resulted in home care instead of unnecessary hospital admissions.

When we looked at documentation we saw that there were good systems in place to audit and monitor all aspects of care practice in the home.

When we spoke with staff they spoke highly of the support they received from the manager and the senior staff. They told us that if a training need was identified this was arranged for them. There was evidence to demonstrate that all staff received regular supervision and support.

The manager worked well with other agencies and used every opportunity to develop and progress the service. Examples of this are using external agencies to add to the monitoring process and accessing grant opportunities to improve the environment for the people living in the home. The manager, senior staff and care staff had developed a good team approach where they worked well together. Staff made many comments about how they felt they worked well as a team. During this visit there was evidence of an enthusiastic approach and a willingness to continually develop the service. The manager was continually updating her own skills and knowledge.

These actions and innovations helped to ensure that people received a good quality of service at all times.

During our visit we spoke with ten people living in the home, and we spoke to some relatives over the telephone after our visit. Relatives told us that they were highly satisfied with the service and that the care staff were very caring and well trained.

When we spoke with people living in the home, they told us they were happy and satisfied with the care and support they received from care staff. Comments included:

"It's a lovely refuge for me."

"The staff treat me with respect but they don't pry. They really respect my privacy but I know they are there if I need them."

"I get the feeling the staff are well trained, they seem good at managing difficult situations."

"The staff seem to know people well."

We looked at the care records of three people. These contained the relevant documentation and provided staff with the information they needed to provide safe care and support to people living in the home.

When we looked around the building we saw that polices and procedures were in place and staff adhered to them so that people living in the home benefited from a safe and clean environment.

Training records showed that the service prioritised training for staff. Training was relevant to the service and included dementia training.

Systems were in place to monitor and quality audit all aspects of care practice in the home.

People who used the service described staff as 'patient and kind'. They told us that staff were responsive to their needs and always listened to them about how they wanted their care and support to be provided.

Comments from people using the service included:

"The staff are lovely and kind. They are understanding and if there is anything wrong they help as much as they can."

"It's lovely here. I am really happy. I like the atmosphere and the staff are so caring."

Through discussion with people living in the home and observing how the staff provided care and support to them, we saw that people were encouraged to express their views and to lead a life that suited their individual needs and preferences.

We were told that when people were unable to make decisions independently, they received support from their relatives or advocacy services. Information on independent advocacy services were available to people and informed people about their choices.

Medication systems were robust and ensured that people received their medication in a safe way. Arrangements were in place for obtaining, recording, storing, administering and disposing of medication.

Staff had access to ongoing training and were supported by the manager and senior staff. People we spoke with expressed confidence in raising any concerns or complaints to the staff and management team. Systems were in place to record any concerns and to ensure that staff learned from any of the issues raised.

People told us they had been given information about out the service to assist them in making a decision about their future care and support arrangements.

People told us that they had been asked about their lifestyle preferences and were treated with dignity and respect.

One person said, "I like the way we have resident and relative meetings, I feel we are involved and listened to."

People we spoke with were very positive about the care and support they received.

One person told us, "It was hard to settle in. No one wants to be in a home, but the staff here are wonderful and have made it so much easier to settle. They are there to help me if I need it.

I have some vision problems and am under the hospital. The staff help me with my appointments. They do anything you ask and I keep up with my usual occupations such as going to church."