We carried out an unannounced inspection of Hope Manor Residential Home on 07 and 12 June 2017.

Hope Manor is a residential care home located in Salford, Greater Manchester and is owned and operated by Coveleaf Limited. Hope Manor is an older building with accommodation set over two floors. The home is situated off a busy main road and close to local amenities. Parking facilities are available at the front of the home which also facilitates wheel chair access. Hope Manor is registered with the Care Quality Commission (CQC) to provide personal care and accommodation for up to 26 people. At the time of our inspection there were 23 people living at the home.

The home was last inspected on 23 and 24 March 2016, when we rated the service as ‘requires improvement’ overall and identified two breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to person-centred care and staffing.

At this inspection we found the service had made improvements and was now meeting all regulatory requirements. We did not identify any current concerns with the care provided to people living at the home.

At the time of the inspection the home had 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.’

We found the home to be clean with appropriate infection control processes in place. Three housekeepers were employed and worked on a rota system to ensure daily input was provided. We saw detailed cleaning schedules in place to ensure bedroom, bathrooms and communal areas were cleaned regularly.

All the people we spoke with told us they felt safe and loved living at Hope Manor. Relatives were similarly positive about the safe care and treatment provided to their loved ones. The home had appropriate safeguarding policies and procedures in place, along with instructions on how to report safeguarding concerns to the local authority. All staff had been trained in safeguarding adults and knew how to identify and report any safeguarding or whistleblowing concerns.

Staffing was organised based on people’s dependency levels, with assessments of need being completed every month. We saw enough staff had been deployed to support people effectively and people living at the home told us they were happy with the number of staff on shift and any requests for assistance were met quickly.

Both the registered manager and staff we spoke with demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which are used when someone needs to be deprived of their liberty in their best interest. We saw the service was working within the principles of the MCA and had followed the correct procedures when making DoLS applications. The home had implemented DoLS care plans to ensure any recommendations or conditions listed on the DoLS authorisations had been addressed.

We saw medicines were stored, handled and administered safely and effectively. All necessary documentation was in place and was completed consistently. Staff responsible for administering medicines were trained and had their competency assessed annually. The home completed daily, weekly and monthly medicines audits, to ensure administration and recording had been completed accurately.

Staff spoke positively about the training available and we saw the home had links with the local college. All staff completed an induction upon commencing employment, which included a flexible period of shadowing experienced staff. We saw staff had been enrolled on the care certificate and on-going training was provided to ensure skills and knowledge remained to date.

Staff told us the

We carried out an unannounced inspection of this service on 23 March 2016. We returned to the service on 24 March 2016 and this visit was announced.

Hope Manor is a residential care home located in Salford, Greater Manchester and is owned and operated by Coveleaf Limited. Hope Manor is registered with the Care Quality Commission (CQC) to provide personal care and accommodation for up to 26 people. At the time of our inspection the service had full occupancy.

The home is situated off a busy main road and close to local amenities. Parking facilities are available at the front of the home which also facilitates wheel chair access. Hope Manor is an older building with accommodation that is set over two floors.

We last inspected Hope Manor on 25 and 27 August 2015. During this inspection we found six beaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in respect of person-centred care, safe care and treatment, meeting nutritional and hydration needs, premises and equipment, good governance and staffing. The service was rated ‘inadequate’ at that time and placed into special measures. We took enforcement action against the provider and four warning notices’ were issued in respect of safe care and treatment, meeting nutritional and hydration needs, good governance and staffing.

Since our last inspection of Hope Manor, CQC had worked with the local authority and NHS community services to monitor improvements at Hope Manor against an action plan submitted by the service. During this inspection, we found significant improvements had been made across all areas of the service. However, we found two continued breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in respect of person-centred care and staffing. You can see what action we have taken at the end of this report.

At the time of our inspection 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Since our last inspection, we found that improvements had been made to staffing. For example, a new deputy manager had been recruited, care staff were no longer required to complete laundry duties, and the service had a new activities co-ordinator. However, we found that between the hours of 7.00am and 11.00am there remained insufficient numbers of staff on duty to consistently keep people safe and to ensure people’s needs were met.

We found the service had appropriate systems in place to help protect people from abuse. The service had a safeguarding policy and associated local procedures which were up-to-date. We saw that there were safeguarding posters on display in the office and in the hallway on the notice board. Staff had completed dedicated safeguarding training.

Accidents and incidents were appropriately recorded and included details of preventive strategies used by the service to reduce the likelihood of such events occurring in the future.

Each care file included a Personal Emergency Evacuation Plan (PEEP), which contained information about the level of assistance the person would require in the event of an emergency evacuation.

The service had an appropriate medicines management policy and associated procedures. We found safe procedures for ordering, storage, administration, recording and disposal of medicines. People’s individual Medicine Administration Record (MAR) front sheet contained a photograph and information relating to allergy status.

We looked at recruitment procedures and found robust and safe recruitment practices were in place. This was evidenced through our examination of employment application forms, job descriptions, proof of identity, written references and training

Hope Manor Residential Home is a privately owned home for older people, providing personal care. The home is registered to provide accommodation for up to 26 people. At the time of our inspection there were 24 people who were resident at the home.

During our visit we spoke to seven people who used the service, six relatives and friends and six members of staff.

Our inspection team was made up of an inspector who addressed our five standard 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.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found people were treated with respect and dignity by the staff. People told us they felt safe. One person who used the service told us; “I really like all the staff here and feel very safe and protected.”

We saw safeguarding procedures were robust and staff demonstrated a good understanding of what action to take if they had any concerns.

Systems were in place to make sure that the service and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager was able to demonstrate a good understanding of the legislation and had been involved in the submission of applications. Staff had a limited understanding of the legislation and no recent training had been undertaken.

We found the service was clean and hygienic. Equipment was well maintained and serviced regularly therefore people were not put at any unnecessary risk.

The registered manager set the staff rotas and ensured suitable numbers of trained staff were available to meet the needs of people who used the service.

Recruitment practice was safe and thorough.

Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

We found people’s health and care needs were assessed with them, and that they or their representatives had been involved in determining what care and support was needed.

Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Visitors confirmed that they were always made to feel welcome and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We observed care staff supporting people in a kind and caring manner. People commented; “It’s lovely, we are very happy here.” “Staff are very kind and always ask if I’m alright.” “Staff very nice look after us well.” “They are very good.” “The care is good here.”

People who used the service, their relatives and friends completed a satisfaction survey.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and had been provided in accordance with people’s wishes.

Is the service responsive?

There was a limited range of activities available at the home. We were told that these were currently being reviewed by the new manager.

People knew how to make a complaint if they were unhappy. The service had procedures in place to deal with complaints.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service continuingly improved.

Staff told us they were clear about their roles and responsibilities within the home.

Since the last inspection the manager and provider had implemented an effective system to audit and monitor the quality of service provision, which was fit for purpose. We looked at the care files of eight people who used the service and saw evidence of regular reviews being undertaken of care plans and risk assessments.

A number of audits were routinely undertaken by the manager.

A questionnaire had been completed by people who used the service or their relatives. Comments were generally very positive and included; “My X seems happy at this home”, “Clean, helpful and care for my X’s needs” and “I don’t think it could be much better than it is.”

The provider and manager had reviewed the record keeping system. We found at this inspection that record keeping had improved.

We spoke with relatives who informed us they were always consulted about care and treatment provided. One relative who we spoke with said; "I have no concerns about the quality of care, the manager is very good, they seem to have plenty of ideas and are open to suggestions. There is a lot of interaction between staff and residents, they are always available for residents and are compassionate and caring".

A relative told us; "My X has put on weight since arriving here, she really loves the place. You can see how she is and that she loves it here. If we take her out she can't wait to get back".

All medicines were appropriately managed and records indicated people who used the service were having their medicines given to them correctly.

We were not provided with any evidence that audit tools had been developed to ensure that the quality of service provision was being effectively monitored. There was no effective system of assessing and monitoring the quality of care plans by the provider.

We spoke with one relative who said "I'm aware of the complaints policy, if I have any concerns I would approach the manager. I know matters will be resolved".

We found that care files were not accurate or updated to reflect changes in dependency and care needs.

As part of the inspection we spoke with people who used the service, members of staff and relatives. We looked at care records, policies and procedures, staff files carried also carried out a tour of the premises.

During the inspection we spoke with four people who used the service. One person who used the service told us “I enjoy spending time in my room and the staff respect that”. Another person who used the service told us “It’s like home from home, I’m well looked after here”.

We spoke with three staff members during the inspection who provided us with an overview of their job role. Comments included “I feel really well supported in my role” and “I received an induction when I first started here”, “We were supervised for several days before we got into the role properly".

People who used the service spoke highly about the activities and outings which were organised by the home and told us that they happened on a regular basis. One person who used the service told us “I’m off to the local school this afternoon for a Christmas lunch and I’m looking forward to it”.

We spoke to People who use the service and family and friends who were visiting service users. People who use the service told us that they were happy and felt safe living at Hope Manor. Comments included 'I like all of the staff, they are so kind','my room is lovely its always kept spotless', 'I can have my breakfast when I like', 'I wouldn't want to be anywhere else'.

People mainly told us that they received the care and support they needed. One person said,"The staff do lots for us." Another person said that 'staff understood their health care

needs and looked after them'.

Everyone we spoke to told us how much they liked the activities they did. People told us that they were supported to do things that were important to them, like visiting the war memorial on remembrance day.

People using the service told us they enjoyed the meals, but said that, if they had had a late breakfast, sometimes the lunch was served to early for them.

We carried out an unannounced inspection of this service on 25 and 27 August 2015.

During this inspection we found six beaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in respect of person-centred care, safe care and treatment, meeting nutritional and hydration needs, premises and equipment, good governance and staffing. You can see what action we told the provider to take at the back of the full version of the report.

We last inspected this service on 27th September 2014 and found it to be compliant.

Hope Manor is a residential care home located in Salford, Greater Manchester and is owned by Coveleaf Limited. Hope Manor is registered with the Care Quality Commission to provide personal care and accommodation for up to 26 people.

The home is situated off a busy main road and close to local amenities. Parking facilities are available at the front of the home which also facilitates wheel chair access. Hope Manor is an older building with accommodation that is set over two floors. Interior décor is worn and traditional in presentation. At the time of our inspection there were 24 people living at the home, one person was in hospital and the home had two vacancies.

There was no registered manager in place at the time of our inspection. However, a new manager had recently been appointed and they were currently applying to register as the registered manager for the service. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During our inspection we found there to be insufficient numbers of staff to meet the needs of people who used the service. The service did not have an effective means of assessing staffing levels against the needs of people who used the service. Through our observations in communal areas of the service, we observed several instances where the care and support needs of people who used the service were not being met. During our inspection, we also observed unsafe practice when a drinks trolley carrying a hot tea pot was left unsupervised in the lounge.

We found the safeguarding policy to be out of date and no information was displayed around the service to provide guidance on how to raise a safeguarding concern. We asked the acting manager to rectify this and immediate action was taken to update the safeguarding policy. Additionally, the acting manager sourced the latest local authority safeguarding guidance, and displayed this in several prominent locations around the service.

We looked at a sample of recruitment files to make sure safe recruitment practices were being followed. We found the identity of people applying to work at the service had been checked and verified and that checks had been completed with the Disclosure and Barring Service (DBS). A DBS check helps to ensure that potential employees are suitable to work with vulnerable people. However, we found recruitment procedures were not being operated effectively. The recruitment and selection procedures in place did not include taking interview notes to demonstrate candidate’s suitability for the role they had applied for.

During our inspection we identified several risks to the health and safety of people who used the service. We found that window restrictors on the first floor were unsafe and did not meet legal requirements. We asked the manager to rectify this and immediate action was taken. We also found a side door to the premises left open and unsupervised. This led out to an enclosed outside area with an uneven concrete surface and a significant step to negotiate. This meant that people who used the service were at risk of falling if they had attempted to go outside. We asked the manager to rectify this and immediate action was taken.

We found the service did not keep adequate records to demonstrate how risk was assessed in relation to buildings and premises. Risk assessments had not been completed in connection with the use of portable electrical devices, including those in people’s bedrooms. The service was also unable to demonstrate how it had effectively assessed the risks associated with waterborne microorganisms. Furthermore, the service did not have a business continuity plan in case of fire, flood or loss of power.

Policies and procedures for the safe administration of medicines had recently been updated. We found medicines were administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records. We found unsafe practice in the way keys to the controlled drugs cupboard were managed and we asked the service to take immediate action to rectify this. We also found the storage of stock medicines to be disorganised.

Accidents and incidents involving people who used the service were not monitored and recorded effectively. The service failed to identify risks and failed to implement preventative measures to reduce the likelihood of such accidents and incidents occurring again. We found that personal emergency evacuation plan (PEEP) documentation was contained within some care plans but methods for individual evacuation were not included. The service did not maintain a PEEP ‘grab file’ in case of emergencies.

We looked at the training staff received to ensure they were fully supported and qualified to undertake their roles. We found the service was working with an external training provider to train and develop staff to nationally recognised standards. However, we found the vast majority of mandatory training was delivered via short online e-learning modules covering topics such as basic first aid, infection control, fire awareness, dementia, health and safety, mental capacity act and deprivation of liberty safeguards.

Prior to the current acting manager being in post, we found recording of staff supervision was inconsistent. However, we saw that a new supervision matrix had been introduced and that progress was being made in completing one to one supervisions sessions with staff.

During our inspection we looked at the meal time experience for people who used the service at Hope Manor. Overall we found the atmosphere within the dining room to be calm with some people who used the service happily chatting at their tables. Main meals were pre-ordered from a frozen foods’ supplier and rotated over a four week period. No hot meals were freshly prepared on site. We found a choice of two main course options were offered on the day of our inspection, but these options did not correspond with the published menu.

We looked at the care and support records of 10 people who used the service at Hope Manor. We could see improvements had been made in developing new care planning documentation but a number of old style care plans were still in use which were not fit for purpose. Information relating to the care and support needs of people who used the service was disorganised and significant gaps in recording were identified. Person-centred care was not provided in line with people’s requirements. The service did not respond in an appropriate and timely manner to the changing care and support needs of people who used the service.

We also looked at the care and support records of people who used the service who had been assessed by a healthcare professional as a high risk of malnutrition. The service was unable to demonstrate how it was effectively meeting the nutritional and hydration needs of this group of people who used the service.

The service did not have a consistent approach to quality assurance and audit. However, we were able to see that improvements had been made in relation to medication audits and infection prevention and control.

The service had been working with Salford City Council Infection prevention and control team to improve standards of cleanliness and to raise awareness of infection prevention and control (IPC) amongst staff. On the day of inspection we found the home to be clean and tidy. However, we observed one instance of poor IPC practice going unchallenged.

We spoke with care staff to ascertain their understanding of the Mental Capacity Act (MCA) (2005) and the Deprivation of Liberty Safeguards (DoLS) legislation. We found care staff did not have sufficient working knowledge of this legislation or its practical application when providing care and support. However, we found the manager had an enhanced level of understanding of this legislation and fully recognised the knowledge gaps amongst some care staff.

Involvement of people who used the service and/or their representatives through the use of residents meetings was ineffective. At the time of inspection we found the last meeting had taken place in February 2015 and was poorly attended.

The service had a complaints policy and we found the manager had introduced a new complaints log. We saw evidence of one complaint had been made in the last year which appeared to have been dealt with and resolved appropriately.

Hope Manor had a policy of restricting visiting before 8am and after 8pm. This meant that family and friends of people who used the service were unable to visit during these restrictive hours.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.