This inspection took place on 24 and 25 April 2018 and was unannounced. We last inspected Eachstep Blackley in April 2017 and rated the service as Good overall with an outstanding rating for the well led domain. This is the first inspection the service has been rated as requires improvement.

Eachstep Blackley is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Eachstep Blackley accommodates up to 60 people. There are five households across three floors. Two households provide nursing care and three provide residential care for people living with dementia. At the time of our inspection there were 54 people living at the home.

There was a registered manager who had managed the service since it opened in 2012. 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 this inspection we found breaches in the regulations for person-centred care, safe care and treatment and good governance.

Care plans and risk assessments for people living in the residential households did not contain sufficient information and guidance for the staff to follow to meet people’s identified needs. Where risks had been identified there were no associated care plans on how these risks would be managed. Care plans and risk assessments for people living in the two nursing units did contain the required information and guidance.

A care plan champion had been appointed whose role was to support the senior carers on the residential units to review and update the care plans.

A quality assurance system was in place which reviewed a range of areas in the home. Accidents and incidents were reviewed by the registered manager to identify any patterns. Audits were completed for health and safety, care plans and medication. The provider’s area manager visited the home regularly and completed their own observations and checks. However this had not identified the issues we found with the care plans on the residential units.

You can see what action we told the provider to take at the back of the full version of the report.

Call bells and requests for support were answered promptly; however we noted the lounge / kitchen areas were left unattended at times and we saw people enter other people’s rooms uninvited. We have made a recommendation for current staffing deployments to be reviewed, including the use of domestic staff, to ensure communal areas are not left unattended for long periods during the busy morning period.

People received their medicines as prescribed; however the recording of any medicines carried over from one month to the next was not always clear. We have made a recommendation that national guidelines are followed to record how people will communicate, verbally or non-verbally, that they require an ‘as required’ medicine to be administered.

People’s confidential care files were stored in lockable cupboards in a quiet area of each household. We have made a recommendation that these cupboards are kept locked when not being accessed by the care staff.

People and their relatives said they felt safe living at Eachstep Blackley and that staff were kind, caring and treated them with dignity and respect. People said they were supported to maintain their independence by completing the tasks they were able to do themselves.

A robust recruitment system was in place. Staff received the training and support to undertake their roles through supervision meetings and staff meetings. New staff completed their initial training and shadowed experienced staff so they were able to get to know

Eachstep Blackley is a purpose built care home in Manchester. It provides 24 hour residential and nursing care for 60 people principally with dementia related conditions. It is also registered to provide home care across Greater Manchester, supporting people with dementia to continue to live independently in their own homes, although this part of the service is not currently operational. The home opened in July 2012 and is run by Community Integrated Care, which is a charity. On the day of the inspection 59 people were accommodated at the home. The home is divided into five households of 12 people, each having their own facilities. Each household has access to an outside balcony and there are gardens suitable for people who have a dementia.

The service had a registered manager in place as required under the conditions of their registration with CQC. 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 registered manager had been in post since June 2012.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

The home was clean and tidy. The environment was maintained at a good level and homely in character. We saw there was a maintenance person to repair any faulty items of equipment.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

We saw that where people had behaviours that may challenge others staff had the skills to safely diver their attention.

We saw staff were kind and patient with the people they cared for and sat and talked to them.

There were many opportunities for people and their families to attend activities. The activities included sessions provided by experts to help care for people with dementia.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

People were given information on how to complain with the details of other organisations if they wished to go outside of the service.

Staff and people who

We carried out this inspection as we received information of concern relating to the numbers of staff available to meet people’s needs and the care and support people received while living at Eachstep Blackley.

During the inspection we spent time in all areas of the home. We observed people being supported in a timely manner and with dignity and respect.

We viewed documentation which showed us the staffing provision was planned in advance and when gaps were identified, extra staff were provided. We spoke with staff and relatives of people who lived at Eachstep Blackley and we were told they had no concerns regarding the numbers of staff available to meet people’s needs.

We looked at a sample of three care records and saw people’s needs were assessed and care planned to meet those needs. We saw staff were attentive and patient when interacting with people who lived at the home and we spoke with four relatives who expressed no concerns regarding the care and welfare provided at Eachstep Blackley.

People living in the home suffered with varying degrees of dementia, which made it difficult to speak with people in order to obtain their views about the service. However, we spoke with the relatives of five people who used the service. They told us that they were happy with the care their relative received. Comments included: “From the ground upwards I’m just bowled over by the level of care”, “They go above and beyond. They’ve always acted in my [relative’s] best interests” and “I cannot fault one member of staff, even down to the laundry and cleaners…They’re all dedicated.”

Before our inspection we received information of concern that people living at Eachstep Blackley were not receiving safe and appropriate care. During our inspection on 13 March 2014 we found that care plans and risk assessments were in place for each person. Records showed that people had regular access to a range of other health care services such as their GP, district nurses and community psychiatric nurses.

Before our inspection we received information of concern that safeguarding incidents were not being reported to the relevant authorities and were not being fully investigated. During our inspection we found that safeguarding incidents were reported to the local authority safeguarding team and the provider engaged with a range of health care professionals to ensure incidents were investigated fully.

We had also received information of concern that general incidents were not being responded to and investigated appropriately and that the management team were not open and approachable. During our inspection we found that incidents and near miss events were being reported and responded to appropriately. Relatives told us that they would feel comfortable approaching the manager if they wanted to raise a concern. We saw that where complaints had been received there was a process in place to investigate and respond to them. Staff told us that they enjoyed their job and felt supported to fulfil their role.

We spoke with people who lived in the home and their relatives. Those people who were able to express their views told us that they were satisfied with the care and support they received from staff working in the home.

One relative told us “It is awesome here” and that “They (the staff) have put the light back in her eyes.” Another told us “It is the best place I have been in.” And another told us “It is brilliant here, the staff are very very caring.”

Staff working at Eachstep said they enjoyed their work. Comments included “It feels good coming to work here” and “I love working here.”

We found that consent for care and treatment was sought from the person who used the service or their relative and that choices were offered. Staff told us “I read the care plans so that I know what each person requires.”

We found the home to be very clean and well maintained with a variety of environments for use by service users and their families.

We found that complaints were taken seriously and thoroughly investigated and responded to.

We did not seek any feedback from people using the service during this inspection.

We checked whether the provider had improved their processes to ensure that all necessary information was held within staff files. We found that the provider had taken appropriate action and was now meeting the standard on the recruitment and suitability of staff.

We used a number of different methods to help us understand the experiences of people using the service, including observing care and speaking to those people who could give their views on the home. We spoke with seven people who lived in the home about their care and treatment. We also spoke with two relatives of people who lived at the home. All the people we spoke with were very positive about the care they received. One person who used the service told us: "I'll give them a glowing report". Another said of staff that work in the home: "They're all alright; they all help us". A third person said: "They're very kind".

We found that the home was meeting the essential standards and people were very well cared for. The only exception was that there was a minor issue in that it was not clear that appropriate information was available for all staff who worked for the home.

We carried out this unannounced inspection over two days, on 04 and 07 November 2014.

Eachstep Blackley provides personal care and accommodation for to up to 60 people who live with dementia. The home also provides nursing care for people that require this level of support. The home is divided into five households and there is also a day centre and café on the ground floor of the home, which may be used by people who live at Eachstep Blackley. There is a courtyard with raised flower beds on the ground floor of the home and each household on the upper floor has an enclosed balcony which people can access from the lounges. 55 people were living at the home at the time of our inspection.

Eachstep Blackley also provides personal care to people who live in the community and there is a respite service for people. During this inspection we spent time in all the households. We did not inspect the personal care provision for people who live in the community, however this will be inspected in the future.

The home had a registered manager who has been in post since July 2012. 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.

Care records contained risk assessments, which identified risks and described the measures in place to ensure people were protected from the risk of harm. Staff we spoke with told us, and we saw that there were procedures in place to instruct staff in the action to take if they were concerned that someone was at risk of harm and abuse. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health professionals as appropriate.

Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes and we viewed documentation that showed us staff were enabled to maintain and develop their skills through training and development activities. The staff we spoke with confirmed they attended training and development activities to maintain their skills. We also viewed documentation that showed us there were recruitment processes in place and staff confirmed these had been carried out when they had been employed.

We spoke with people who lived at the home and their relatives. We were told they were happy with the service the home provided. Comments we received included; “ They are so caring, lovely. They have time for everyone.” and “I am very happy – we are looked after really well.”

We observed people were encouraged to participate in activities that were meaningful to them. For example we saw staff spent time with one person discussing their hairdressers appointment and what they wished to have done. We also saw people were asked if they wanted to visit the day centre and if they declined, their wishes were respected.

We spoke with two visiting health professional who told us they found the home to be responsive to people’s needs and they had no concerns.

During the inspection we saw staff were attentive and patient when supporting people, in addition we saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered choice and if people required assistance to eat their meal, this was done in a dignified manner.

We saw a complaints procedure was displayed in the main reception of the home. This provided information on the action to take if someone wished to make a complaint and included contact details of the quality assurance manager if the complainant did not wish to discuss their concerns with the management at the home.

We discussed the quality assurance systems in place with the regional manager. We were told audits of accidents, incidents and falls were carried out and these were investigated by the manager to ensure risks were identified and improvements made. We saw documentation that showed us this took place. The regional manager also told us they had access to all the audits and checked to ensure that these and any subsequent actions were completed.