We inspected Homeleigh on 11 and 16 July 2018. The first day of the inspection was unannounced. This meant the home did not know we were coming.

Homeleigh is a 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 32 people with mental health needs. At the time of our inspection there were 28 people living at the home, but just seven people were in receipt of the regulated activity personal care.

At our last inspection on the 16 and 17 May 2017 the overall rating of the service was 'requires improvement'. We issued two warning notices in relation to breaches of regulations concerning the provision of safe care and treatment and good governance. This meant we sent a formal notice to the provider that they must become compliant with the regulations by 30 August 2017. The provider sent us an action plan to tell us the improvements they would make in order to become compliant with the regulations. At this inspection we found the provider had made significant improvements and they were meeting the requirements of the regulations.

The service had a registered manager in place. 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.

We found arrangements in place for the safe management of people's medicines and regular checks were undertaken. However, we found the medicines clinic room temperature was exceeding the recommended temperature of 25 degrees. The provider attempted to resolve this problem with fans, but this had not been successful.

We found improvements in how the provider risk assessed people’s needs. Staff assessed and understood risks associated with people's care and lifestyle. Risks were managed effectively to keep people safe whilst maintaining people's rights and independence.

Recruitment included pre-employment checks to ensure people were of a suitable character to work in a care home environment. Staffing levels were consistently maintained to provide safe care and support to people.

People were protected from avoidable harm and abuse. Staff had good knowledge of the types of abuse and how to report them. Systems supported staff to record and take appropriate actions in line with their safeguarding policies and procedures.

People received effective care from staff who knew them well, and had the skills and knowledge to meet their needs. Staff monitored people's health and well-being and made sure they had access to social and healthcare services according to their needs.

People received personalised care and support, which was responsive to their current and changing needs. Care plans were developed with the input of people who were involved in decisions about their care and support. Care plans now captured people's goals and aspirations.

People were supported to enjoy an active lifestyle doing things that interested them and that they wanted to do.

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). We saw that staff sought people's consent before providing care and support. Where people had been identified as lacking capacity to make certain decisions the service acted in accordance with legal requirements. Necessary DoLS applications had been made and subsequent conditions were complied with.

People living at Homeleigh were diverse and multi-cultural. Through talking to staff, we were satisfied the ethos and culture at the home was non-discriminatory and the rights of people from certain groups would be respect

We inspected Homeleigh on 16 and 17 May 2017. The first day of the inspection was unannounced. This meant the home did not know we were coming. The service was previously inspected in September 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Homeleigh is a twenty-seven bedded residential care home located in the Manchester area. There were 27 people living at the service when we inspected. It is a large Victorian, detached house set in its own private gardens. The bedrooms offer single and double accommodation, with some rooms converted into flats. There is a kitchen/diner/lounge on each of the three floors. There are a number of communal bathrooms/shower rooms located near to the bedrooms that are fully accessible.

The service provides accommodation for people who require nursing or personal care and have enduring mental health needs. The fundamental purpose of Homeleigh is to support people to recover, rehabilitate and become independent.

The home had a registered manager who was previously the deputy manager. At the time of our inspection the registered manager was not available, due leave of absence. A registered manager is a person who has registered with the Care Quality Commission (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.

We found that medicines were not managed safely. When comparing the Medication Administration Records (MARs) with the medicines in stock we found one had not received their prescribed medicines for 16 days. Another person’s strong pain relief tablet had been out of stock for two days. This meant the person would have been without their prescribed treatment if they had been in pain.

Each person receiving a service had a care plan in place. The risks identified through the provision of care had been assessed. However, we found one person’s care plan and risk assessments had not be reassessed when we noted an incident in February 2017 of this person choking and requiring staff assistance to dislodge the blockage. This action had not been addressed in a timely manner and potentially put this person at further risk of choking.

Care plans did not include people's goals and aspirations. We found no evidence documented of people’s setting goals and being supported to achieve them.

The fire safety management within the home required reviewing. We found people continually disregarded the homes rules of no smoking within the building. This meant the safety and wellbeing of other people living at the home and staff who worked there was compromised. We have asked the Greater Manchester Fire and Rescue Service to advise the provider on fire safety arrangements in the home.

The managers and staff understood their obligations under the Mental Capacity Act 2005 and Mental Health Act (MHA)1983 and worked within these legislative frameworks. Staff had received training in both subjects and were fully informed of any changes at team meetings to ensure they continued to provide care within the law. However, two people subject to Community Treatment Orders (CTOs) had not been informed about the reason for their CTO and their rights under the MHA.

Staff knew what action to take to ensure people were protected if they suspected they were at risk of harm. They were encouraged to raise and report any concerns they had about people through safeguarding and whistleblowing procedures.

People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals.

Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need).

The service had quality assurance systems in place, however these were not always entirely effective a