Spennymoor Care Home is a large detached property in the Smithills area of Bolton. The home is registered to provide personal care and support for up to 19 older. This was an unannounced inspection that took place on the 5 January 2017. There were 19 people using the service at the time of the inspection.

We last inspected the service on17 July 2015 and there were three of our key questions that required improvement. At the time of this inspection the home had two breaches of the Health and Social Care Act (Regulated Activities) Regulation 2014 in relation to governance and staffing. At this inspection we found that that improvements had been made and the breaches had been addressed.

The home had a manager registered with the Care Quality Commission (CQC). The registered manager is also the provider. 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 and associated Regulations about how the service is run. On the day of the inspection the registered manager was on annual leave. The deputy manager assisted with the inspection.

Staff were able to demonstrate their understanding of the whistle-blowing procedures and they knew what to do if an allegation of abuse had occurred.

We found people were cared for by sufficient numbers of staff who were safely recruited. We saw that staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

People who used the service and their relatives told us they felt the staff had the skills and experience to meet their needs. People were happy with the care and support they received and spoke positively of the kindness, compassion and caring attitude of the staff.

We found the systems for managing medicines were safe and we saw how the staff worked in cooperation with other health and social care professionals to ensure people received appropriate care and treatment.

Risk assessments were in place for the safety of the premises. All areas of the home were clean and well maintained. Procedures were in place to prevent the risk of cross infection. The service had scored 100% in the last infection control audit completed by Bolton Council in November 2016.

People’s care records contained sufficient information to guide staff on the care and support required. The care records showed that risks to people’s health and well-being had been identified and plans were in place to reduce or eliminate risks. We saw that people and their relatives, where appropriate were involved and consulted about their care. This help to ensure the wishes of people who used the service were considered.

We saw that arrangements were in place to assess whether people were able to consent to their care and treatment. We found that some care records would benefit from more detailed information when relatives were acting in people’s best interest.

The service was working within the legal requirements of the Mental Capacity Act (MCA) (2005). Deprivation of Liberty Safeguards (DoLS) authorisations were in place where required and staff were aware of the implications of these.

People’s nutritional and hydration needs were assessed and recorded appropriately. We saw a selection of hot and cold drinks and snacks served throughout the day.

We saw that staff were kind and caring and there were good interactions between staff and people who used the service. People who used the service and their families were involved in discussions about the delivery of their care. Staff respected people’s dignity and privacy.

People who were nearing the end of their lives were cared for, as far as possible, in accordance with their wishes.

There was a programme of activities at the home and people were encouraged to participate if they

We carried out this inspection on 17 July 2015. The inspection was unannounced. The last inspection was carried out on 17 June 2013 and the service was found to be meeting all regulatory requirements inspected.

Spennymoor provides residential care for up to 19 older people and is situated about three miles away from Bolton town centre. At the time of the inspection 18 people were living at the home.

There was a registered manager at the home. 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 building was secure and the communal areas clutter free. This enabled people with restricted mobility to move around safely with the use of walking aids as required.

People who used the service did not have personal emergency evacuation plans (PEEPs) in place to ensure staff were aware of their level of need in case of an emergency evacuation. Following our inspection we have been provided with a copy of a PEEPs plan.

We saw that staff had been recruited appropriately, ensuring they had application forms, references and Disclosure and Barring Service (DBS) checks in place. This helped ensure people were suitable to work with vulnerable people. We saw that there were sufficient numbers of staff to attend to the needs of the people who used the service.

Safeguarding procedures were in place and staff we spoke with demonstrated when prompted an awareness of safeguarding issues. They knew how to follow the procedures and who to report to should the need arise.

Systems were in place for the safe ordering, administering, storing and disposal of medicines. This was done by a designated member of staff.

We observed the lunch time meal and we saw people were given choices; these were displayed on the board in the dining room.

Initial training was given to staff on induction and further training was on-going.

We saw that care plans included a range of personal and health information. There were risk assessments and monitoring charts for issues such as turning, nutrition and weight if required.

Consent was not always recorded within care plans where required and verbal consent was gained by staff for all interventions and assistance offered.

The service worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA sets out the legal requirements and guidance around how to ascertain people’s capacity to make particular decisions at certain times. There is also direction on how to assist someone in the decision making process. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom.

There was no one at the home who was subject to a Deprivation of Liberty Safeguards (DoLS) authorisation, but the registered manager was aware of how to refer for authorisation should the need arise.

People told us they were looked after with kindness and compassion. We observed staff throughout the day offering care in a friendly and caring way.

We saw that people and their relatives were involved in the initial stages in the planning and delivery of their care and support. However people spoken with told us they were not routinely consulted with the reviews of their care records.

Staff spoken with were able to give examples of how they respected people’s privacy and dignity. We observed this throughout the day.

We saw that the service sought informal feedback regularly through chatting with people who used the service and their families.

People told us they were given choices about their daily lives, such as what time they wanted to rise and retire what they wanted to wear.

We looked at three care plans and saw they reflected people’s individual preferences and wishes.

A range of activities were on offer at the home. These included armchair exercises, art and crafts, dominos, a movie night and visits from outside entertainers. However there was a lack of activities and trips outside the home.

There was an up to date complaints procedure which was displayed in the hallway. We saw that no recent complaints had been received by the service. We saw some compliment cards received by the service.

We found that the provider had failed to send some statutory notifications as required by the Care Quality Commission (CQC). Following this being discussed with the registered manager the notifications were forwarded and systems were put in place to ensure that notifications would be forwarded appropriately in future.

People who used the service and their relatives told us the registered manager was very pleasant and approachable.

Staff felt the registered manager was supportive and they were able to call the registered manager or deputy manager at any time, for support and advice.

The service had a stable staff group, most of who had been employed at the home for a significant length of time.

There was no evidence documented of any quality monitoring audits and checks to monitor the effectiveness of the service. Following this being discussed the registered manager agreed to action this immediately. Following our inspection the registered manager confirmed that audit forms were being sourced and formal recorded audits would commence.

We visited Spennymoor Care Home on 17 June 2013 and found the home to be warm, clean and comfortable. We were made aware the registered manager was on annual leave and we carried out this inspection with the deputy manager.

On arrival at the home most people were up and were finishing their breakfast. We were told some people were not well and remained in bed. We observed staff interacted well with people in a polite and friendly manner.

We looked a three care files and saw they contained detailed information about the care and support each person required. Care files included personal preferences, medical and social background, likes and dislikes, nutrition and hydrations and monitoring and input from health care professional such as the district nurse, dietician and GPs.

We spoke with people who used the service. One person told us, “I am fine here, we are well looked after. I have no complaints”. One relative told us, “Everything is fine, the staff are very good”.

We saw staff training was ongoing and we were told staff had completed mandatory training as required including infection control, safeguarding, food hygiene, moving and handling and mental capacity awareness.

Due to the time of our visit we did not ask people who used the service any questions relating to these outcomes.

Due to the time of our visit we did not ask people who used the service any questions relating to this outcome.

Another person told us, “This is a nice place to live. I have no complaints”.