The inspection took place on 27 June 2018 and was unannounced. This meant the service did not know we would be visiting. We carried a further announced visit to the service on 04 July 2018 to complete the inspection.

Chataway Nursing Home is registered to provide care and accommodation for up to 26 people with enduring mental health problems. The building is a large detached property situated in the Crumpsall area of north Manchester. The home provides both shared (twin) and single room accommodation arranged over two floors, accessible by both stairs and a passenger lift. All bedrooms have a wash hand basin and there is a shower room and three bathrooms for people to use.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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. However, we have made one new recommendation regarding equality, diversity and human rights.

There was a registered manager in post. 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.

Staff demonstrated they adapted the support provided in response to people’s changing needs to mitigate risks. People had comprehensive and individualised risk assessments in place which had been updated timely. We saw control measures had been implemented and reviewed regularly to ensure risks were managed and restrictions imposed were removed promptly and appropriately when the risk had reduced.

People’s health needs were assessed and people were supported to access the required support to ensure their physical health needs were addressed.

Staff developed meaningful relationships with people and treated people with dignity and respect. Staff demonstrated they understood people’s individual needs and tailored the support provided to attain the best outcomes for people.

The service was responsive to people’s individual circumstances and supported people to increase their independence and to exercise choice and control over their lives.

People who used the service were diverse and multi-cultural. The service also benefited from an equally diverse workforce that was reflective of the local community.

The service strived to ensure people were not socially isolated and maintained links within the local community.

The service was well-led and the registered manager and support manager were held in high esteem by people using the service and staff.

The provider was visible within the service and played an active role. This included a good level of oversight through audit, quality assurance and questioning of practice.

The inspection took place on 15 September 2016 and was unannounced. This meant that the provider and staff did not know we would be visiting. We carried out a further announced visit to the home on 21 September 2016 to complete the inspection.

Chataway Nursing Home provides nursing and personal care for up to 26 people with enduring mental health needs. There were 23 people currently living at the home. Three people were in hospital at the time of our inspection.

The manager had commenced employment at the service in August 2016. At the time of our inspection she had applied to be registered with CQC as the registered manager. Following our inspection, she became registered with CQC as a registered manager. 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 told us that they felt safe at the service. Positive feedback was received from the health and social care professionals whom we contacted. There were no ongoing safeguarding concerns and staff were knowledgeable about what action they would take if abuse was suspected.

We found that the management of some people’s finances did not follow best practice guidelines since designated staff were appointees for certain people. The manager was aware of this issue and told us that there was a back log of appointeeship referrals at the local authority and she was liaising with people’s care coordinators to resolve this issue.

Checks and tests were carried out to ensure the safety of the premises. There was a no smoking policy inside the home. There was a designated outside smoking hut for people to use.

Medicines were managed safely. We checked medicines administration records and noted that these were completed accurately.

Risk assessments were in place which had been identified through the assessment and care planning process. This meant that risks were minimised to help keep people safe. Accidents and incidents were monitored and no trends or themes were identified.

Recruitment checks were carried out to ensure that applicants were suitable to work with vulnerable people. This included obtaining written references and a Disclosure and Barring Service check [DBS]. People told us and our own observations confirmed that there were sufficient staff deployed to meet people’s needs.

Improvements were required to ensure the design of the premises met the specific needs of people. We have made a recommendation that the design of the premises meets the specific needs of people who lived at the home.

Not all staff had completed training relating to the specific needs of people who lived at the service, however, plans were in place to source additional training. We have made a recommendation that training is carried out to ensure that staff can meet people’s needs. Staff told us that they felt supported. A supervision and appraisal system was in place.

Staff followed the principles of the Mental Capacity Act 2005. Further improvements were required however, to ensure there was documentary evidence to demonstrate how the requirements of the MCA were met with regards to people who had fluctuating capacity because of their mental health illness.

People’s nutritional needs were met. The chef and staff were knowledgeable about people’s dietary requirements. People had access to a range of healthcare services.

People told us that staff were caring. One relative said, “Chataway is a compassionate caring home.” We saw positive interactions between people and staff.

People told us and our own observations confirmed that staff promoted people's privacy and dignity. The manager had ordered dignity screens for all shared rooms to promote people’s privacy. We saw evidence that people were involved i

Is the service safe?

The home had a robust recruitment process in place which included a check with the Disclosure and Barring Service (DBS). This ensured support workers employed at the home were not barred from working with vulnerable people.

We spoke with a newly appointed member of staff who told us: “I had to fill in an application, have an interview, give references and wait for my DBS to come back before I could start work.”

CQC has a statutory duty to monitor the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We saw there were policies and procedures in place and training had been provided for staff in relation to the Mental Capacity Act and DoLS Codes of Practice.

We spoke with support staff who showed an awareness of the process and were able to identify when an application might be required. There had been no applications made to deprive people living in the home of their liberty.

We spent time observing how support staff interacted with people who lived at the home. We saw staff approached people with respect and worked to maintain people’s privacy and dignity.

We spoke with ten of the people who lived at the home who told us: "The staff ask me what I want to do and help me if I need help.” “They ask me if it is alright to help." "I can decide what I want to do." “I like it here.”

We saw risk assessments had been carried out in relation to the environment and this included a general emergency evacuation plan (GEEP).

There were policies and procedures in place to help minimise risks. The support staff we spoke with were aware of the safeguarding and whistleblowing policies and procedures and their responsibility to report poor practice.

Is the service effective?

We looked at a sample of people’s support plans and saw evidence to show people had been involved in planning their support. This meant people received support in the way they wanted. We saw support plans had a social history and a life map that gave detailed information about the person.

The people we spoke with told us there were forums in place for them to express their views and opinions about the service they received. People told us they had regular 'residents meetings' and an annual questionnaire. We saw minutes were taken during residents meetings and we saw topics such as; changes, activities, new staff and menus. We looked at the most recently completed quality assurance survey and saw comments were positive.

During our inspection we saw people were able to speak to the manager if they wanted to. People told us the manager spoke with them on a daily basis.

Support staff demonstrated a good understanding of people's care and support needs. We spoke with people who lived at the home and their comments included: “They explain what they are doing.” “They ask me what I want.” “They know what I like and I am happy here.” “We are like one big happy family here.” “The staff are nice.” “I get the help I need.” “It’s alright here, I am happy.”

Staff training records showed staff received relevant training to improve their skills and knowledge.

Is the service caring?

We spent time observing the interactions between people who lived at the home and staff. We saw support staff were patient and support was provided in a patient and sensitive manner.

We looked at a sample of people's support plans and found they contained information about preferences and interests. This meant care and support was provided in the way the person wanted.

We spoke with people who lived at the home. Comments included: "They know what I like." "The staff show respect.” “They ask me what I need.” “They know how I like things done."

Is the service responsive?

People’s needs had been assessed before they moved into the home. We saw support plans were reviewed on a regular basis. Where there had been changes to a person’s support needs; support plans were amended to ensure the person’s needs were met.

We saw there was a complaint policy and procedure in place and people were given a copy in their information pack.

The people we spoke with told us there were a variety of activities arranged. One person told us: "There’s always something going on." “We go out to the shops or to the pub.”

The lifestyle coordinator showed us the activities plan that included; bingo, gardening group, art therapy, cinema and trips out for coffee or lunch.

People told us: "We have meetings to talk about changes and activities."

Is the service well led?

The people we spoke with told us they liked the manager. Comments included: “The manager is nice she listens.” “I can talk to her (manager) anytime.”

There were systems in place to monitor the quality of the service they provided. These included surveys, audits and resident and staff meetings.

Comments made by people who lived at the home and their representatives were used to improve the service. This showed the provider took people's views into account.

We spoke with care staff who told us they were well supported by the management team. Comments included: "We have trained staff meetings as well as general staff meetings.” “This manager has been supportive.” “I have supervision about every three months but can raise any issues with the manager as they arise.”

We spoke to four people living in Chataway Nursing Home, a visitor to the home and to a visiting professional. For the purposes of the report we refer to the registered manager as the manager.

One person using the service said: "The staff are very kind here, they take good care of you and the food is lovely what more could you want?"

We had comments from another person living at the home who said: "They (the staff) do take good care of you and they are interested in you and that's a good thing really."

Another person said: “The only thing I don't like is waiting for my cigarette."

We undertook an inspection of Chataway Nursing Home on the 30 December 2013 and 3 January 2014 in response to information we received from an anonymous whistleblower via the Care Quality Commissions website. They alleged a number of concerns about the management of the home and the care provided to people who used the service. We looked into their allegations during our inspection.

One person told us: “We are treated like kings in this home. I have nothing to complain about we are well cared for.”

Another person said: “Staff here are nice they treat you nice.”

We found that people were supported to take part in activities of their choice in their local community and at times which best suited them.

We found that each person had a care plan which detailed their care needs and how these were to be met. We found that care plans were reviewed on a regular basis and that nursing staff and care staff had access to up to date information about people’s presenting care needs.

People told us they had no complaints but if they did they felt comfortable about raising issues with staff and they felt listened to.

We found measures were in place which ensured that people lived in a clean and hygienic environment.

We found that staff were not employed at the home until all pre-employment checks were in place.

We found that the home was sufficiently staffed to meet the needs of people who lived there.

We found that people were not fully protected against the risk of abuse because incidents were not always recorded and there wasn’t a full audit trail of events and actions taken by staff in response to events.