About the service:

Walkden Manor is a residential care home situated in Worsley, Greater Manchester and is registered with the Care Quality Commission to provide care for up to 29 people. At the time of the inspection there were 28 people living at the home.

People’s experience of using this service:

• The atmosphere in the home was calm and relaxed and we observed staff and people engaged in conversation and laughter throughout our inspection.

• Staff had been recruited safely and there were sufficient numbers of staff on duty to meet people's needs.

• Care files were organised and easy to navigate. Risks were appropriately managed and the equipment in place to manage people’s risks was maintained and in good working order.

• The registered manager in collaboration with the activities coordinator and care staff had made positive improvements to the environment and outdoor areas of the home. The themed corridors promoted people’s independence and enabled people to navigate themselves around the home freely.

• People spoke positively of the staff and the care they received. The staff knew people’s needs well and demonstrated they were committed to ensuring people’s individual needs were met.

• Staff received an induction, relevant training and supervision to support them in their role.

• The home was well -led. There was strong leadership in the home and an open and honest culture. When things had gone wrong lessons were learnt and training and support provided to prevent re-occurrence.

• Governance and oversight of the service had continued to improve since our previous inspection. There was an operational structure in place and audits had evolved to ensure compliance with the regulations.

Rating at last inspection: Good but well-led was rated as Requires Improvement; last report published on 11 May 2016. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remains Good but well-led had also improved to Good.

Follow up: Going forward we will continue to monitor intelligence about this service and plan to inspect in line with our re-inspection schedule for those services rated Good. If we receive any information of concern, we may inspect sooner.

This unannounced inspection took place on Wednesday 16 March 2016.

Walden Manor is a residential care home situated in Worsley, Greater Manchester and is registered with the Care Quality Commission to provide care for up to 29 people. The home is located on a busy main road in the town and is close to local shops and transport routes.

At our previous inspection on 29 June and 09 July 2015, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care, dignity and respect, safe care and treatment, good governance and staffing. As a result, we issued requirement notices and four warning notices due to the concerns we had identified. The home was also placed into special measures meaning significant improvements were required, or further enforcement action could be taken. Following this inspection, the home sent us an action plan, detailing the improvements they intended to make.

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 the time of our inspection, the current home manager had recently returned to the home in January 2016 after previously spending a period of time as manager at the sister home close by. As such, they were not registered with the CQC (Care Quality Commission) as the home manager.

At the previous inspection, we had concerns in relation to risk management, medication, staffing levels, infection control, the safety of the environment and moving and handling techniques used by staff. During this inspection, we saw improvements across all areas. We found there were enough staff available meet people’s needs in a timely manner and we saw lounge areas were not left unattended when in use.

We undertook a tour of the building and found it to be clean and tidy, with domestic staff carrying out their duties during the day. Although many of the people who lived at the home were different than from at our last inspection, we saw people were transferred safely into their chairs by staff, with appropriate moving and handling assessments having been undertaken.

People who lived at the home told us they felt safe. The relatives we spoke with also said they felt their family members were safe living at the home as a result of the care provided. Staff had a good understanding of safeguarding procedures and how to report concerns.

We found appropriate recruitment checks were undertaken before staff started working at the home. This included ensuring references from previous employers were sought and either a DBS/CRB (Disclosure Barring Service/Criminal Records Bureau) check was undertaken.

Medication was given to people by staff who completed relevant training. Regular audits of medication were also undertaken to ensure this was being done safely.

At our previous inspection, we had concerns in relation to staff training, meal times and dementia friendly environments. During this inspection we saw staff had now received appropriate training to support them in their roles and told us they felt well supported. We saw people received appropriate support at meal times and saw that although independence with eating was encouraged, staff prompted people as much as possible to ensure good nutritional intake.

We saw improvements had also been made to make the environment more ‘Dementia Friendly’. This included adequate signage around the building and the use of sensory objects people could touch and use as they walked around the building. There was also a picture of a large, makeshift window, which looked out onto a lake located on the corridor of the ground floor. We saw people looking at this during the inspection on several occasions.

We found appropriate DoLS (Depr

As part of our inspection we spoke with people who used the service, staff, relatives as well as reviewing care plan documentation and policies and procedures.

We asked people who used the service and their relatives what they thought of the service provided at Walkden Manor. Comments from people included;

“There has been a change in the home since the beginning of the year for the better”. The staff are very attentive to our needs”.

“I like to try and walk every day. I bring the newspapers in each morning”.

“The staff are smashing. I couldn’t ask for better people”.

“Care is better than fine. It’s definitely the friendliest of all the homes in the area although it is not as posh as some homes in the area”.

“The staff check if I am ok. They make sure I have everything I need”.

We found that people’s nutrition and hydration needs had been met and that where required, people were assisted and prompted to eat their meals throughout the day.

We reviewed the staffing rotas and found that there were sufficient staffing levels on the day of our inspection. We also noted through observations that staff were able to meet people’s needs in a timely manner.

We looked at audits, surveys and meetings minutes and found that there were appropriate systems in place to monitor the quality of service provision.

Our inspection was carried out in order to follow up on several areas of non-compliance that were highlighted at our last inspection.

During our inspection we found that people had been treated with dignity and respect and had now been involved in their care whilst living at Walkden Manor. One person told us “The staff are lovely. They treat me very well”.

We looked at whether there were enough suitably, qualified staff in order to meet people’s needs at the home. The manager told us that she has increased staffing since our last inspection and was currently still recruiting. From the rota provided we saw that the manager had planned sufficient staffing for the home however on the day of inspection one member of staff had failed to attend their shift. Although the manager worked “on the floor” to cover this shortfall the effect of being one carer short did impact on the delivery of care within the home.

On the day of our inspection we found that generally, people's nutrition and hydration needs had been met. However, we did observe that some people who required assistance to eat, did not receive support from staff on several occasions.

We checked records and found that they were clear, concise and had been signed by carers and also by people who used the service where possible.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service and a practising professional

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with six people living at the home their comments included: "The home is lovely I enjoy living here." "The staff go and get you anything you ask for inside or outside the home." "It's ok and that the staff are nice."

A visitor expressed concerns that people were "expected to fit into the routines of the home." “They don’t have enough time to spend talking to people.” “They could do with more staff.”

We asked people if they were able to make choices and one person told us: "I was asked about likes and dislikes." “The staff give help when it is needed.”

This unannounced inspection took place on 30 June and 9 July 2015.

Walkden Manor is located in Salford, Greater Manchester and is owned by Walkden Manor Care Homes Ltd. The home is registered with the Care Quality Commission (CQC) to provide care for up to 29 people. The home provides care to those with residential care needs, many of whom live with dementia. People’s bedrooms are located on both the ground and first floors of the building. In addition, there are two lounges and a dining room, with doors opening onto a patio area at the rear of the building. Car parking is available at the home, as well as in side streets close by.

We last visited the home in November 2014 where the service was rated as ‘Inadequate’ overall. Since that inspection, the provider sent us action plans in relation to each breach of regulation, telling us about what improvements they planned to make. We also met with the provider on 5 June 2015, where were told that things were progressing well at the home. This inspection focussed on what improvements had been made since our last visit.

During this inspection, we identified five breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to Person Centred Care, Dignity and Respect, Safe Care and Treatment, Good Governance and Staffing. We raised these concerns with the home owners and manager who following the inspection, sent us an action plan detailing how these concerns would be addressed, along with any necessary timescales they would be completed in.

At our previous inspection we had concerns with how medication was handled and issued a warning notice in relation to this regulation. At this visit, we still identified problems which meant people did not always receive their medication safely. This is a breach of regulation 12 (2) (g) with regards to the proper and safe management of medicines; of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we had concerns over the safety of the environment which placed people at risk. We observed a lock on the door to the basement to be broken, which meant that people could easily access the staircase unaccompanied and fall. When we returned to the home on the second day of our inspection, a key pad lock had been added to the door to ensure it was secure

We also saw that window in the lounge was also left wide open, with a gap big enough for somebody to climb through, leading to a busy main road. The window was open when we arrived at the home at 5.40am and anybody from outside could also have gained unauthorised access. These concerns demonstrated a breach of regulation 12 (2) (d) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Safe Care and Treatment.

During the inspection, we observed one gentleman who smoked, had managed to gain access to a lighter and as a result, set a handkerchief on fire. This person also had cigarette burns in their coat which placed them at further risk of starting a fire within the home. We found there was no risk assessment in place for the use of a lighter within this persons care plan. On the second day of the inspection, the new home manager had implemented a risk assessment for this person so that staff were aware of the risks this presented and what they needed to monitor.

We saw that moving and handling transfers were not always completed safely. On the first day of our inspection, we observed three transfers which were not completed in a safe manner. This still proved a problem when we visited the home during the second day. In this instance, a new care plan had been implemented for one person who required assistance from two members of staff with all transfers. However, this had not been fully communicated to all staff on shift as we observed one member of staff assisting a person to stand on two occasions. These incidents demonstrated a breach of regulation 12 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Safe Care and Treatment.

We also had concerns in relation to infection control and the general cleanliness of the building at our previous inspection. At this visit, we still observed areas of poor practice around the home. These related to a large stain on the floor outside the downstairs bath room, paper towel dispensers being empty, two foot operated pedal bins being broken and hand hygiene guidance not always being located near the sink for people to refer to in the upstairs bathroom. We also observed a mattress with faeces on it at approximately 10am. These issues demonstrated a breach of regulation 12 (2) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Safe Care and Treatment.

We also had concerns over night time staffing levels and the fact that there were no staff trained to administer medication through the night. We saw improvements in this area during the inspection, with the staff present being appropriately trained to administer medicines such as pain relief as required on both days of the inspection. Prior to our inspection, we received whistleblowing information, stating that night staff were working at the home without receiving appropriate training first. We looked at old staff rotas and saw that one member of staff in particular had worked 19 night shifts at the home without receiving any training. We asked the home owner and manager to show us evidence of any training records for this person, however they were unable to provide these to us. This is a breach of regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Staffing. This was because we were unable to see that suitably skilled, qualified and competent staff were working at the home on a consistent basis.

We checked to see what improvements had been made to make the home environment more ‘Dementia friendly’. We saw that signage had been introduced around the home directing people to areas such as bedrooms, toilets and the dining room. Although this had been introduced, wall colourings were still very bland in appearance and things such as people’s bedrooms doors did not clearly stand out, making them easier to locate. There was also a lack of consistency as to who had their name or picture on their bedroom door which meant they may be unable to correctly locate it.

We checked to see what training staff had available to them and if they felt suitably supported to undertake their role. We looked at the training matrix which identified any training undertaken by staff. This showed that staff had received training in areas such as moving and handling, health and safety, infection control and medication. Despite this, the matrix demonstrated that only five members of staff had done Safeguarding Adults training, six had done Dementia training, two had done MCA/DoLS training and that nobody had received any training relating to Challenging Behaviour. This was out of 16 members of staff listed on the matrix. Following our inspection, we asked the home owner to provide us with evidence that staff were appropriately training in these areas, however this was not sent to us. We were told a refresher course in relation to Moving and Handling had been scheduled for Friday 3rd of July.

We observed the lunch time period at the home on the first day of the inspection. The lunch time period lacked oversight and there was nobody ensuring that people’s nutritional needs were being met. For instance at our last inspection, we raised concerns that staff were assisting more than one person at the same time and we saw that this still took place during this inspection. This was not a personalised or dignified way for people to received assistance whilst eating their meal. This improved on the second day of our inspection, with more staff presence in the dining room, where people received individualised support.

There was a lack of stimulation for people during the day with people being left unaccompanied in the lounge areas for long periods. We saw a skittles activity taking place in the afternoon but people told us this did not meet their personal preferences. One person said; “The only activities are skittles, which I‘m well past. We need entertainers to come in to entertain us in the lounge as it can get very boring”. Whilst looking at people’s care plans we saw that ‘bucket lists’ had been created for people containing activities they wanted to undertake. However, there was no evidence these had been explored by staff at the home. Some contained basic activities such as getting out of the home more often, gardening and playing the guitar. These were missed opportunities to provide activities that were personal to people. This is a breach of regulation 9 (1) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Person Centred.

We observed several instances where people who lived at the home were not treated with dignity and respect. For example we saw that one person who lived at the home was seated in a chair which had faeces on it. We alerted staff to this and this person was then moved to another chair, however they were not offered a change of clothing. Another person who lived at the home said that they wet themselves because staff had not assisted them to the toilet in a timely manner. These concerns meant there had been a breach of regulation 10 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Dignity and Respect.

We saw several examples where people’s personal preferences were not adhered to and we saw no evidence that people were involved in the creation and ongoing review of their care plans. Where people’s care plans specifically stated they would like to do certain things, these were not always provided for them by staff. For instance, about whom they sat with at lunch or the types of clothing they wore. This is a breach of regulation 9 (1) (e) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Person Centred Care.

At the time of our inspection, there was no registered manager in post, who was appropriately registered with the Care Quality Commission. A new manager had commenced in post on the day prior to our inspection. 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.

There was a lack of leadership on the day of our inspection, with nobody overseeing what was going on within the home. For instance, there was nobody overseeing the lunchtime period where we identified concerns at our last inspection and nobody overseeing that staff were deployed in the correct areas within the home, which we had observed to be unsupervised. The new manager had only commenced employment at the home the day before we visited and was still getting used to how the home needed to be run. The home owners were present, but again, were not overseeing that things were running smoothly at the home throughout the day and were office based.

At our previous inspection we had concerns in relation to records not being maintained at the home such as charts to people being re-positioned and monitoring food and fluid intake. During this inspection we saw that other records were still not being maintained such as checks on people during the night and continence sheets. We saw these had not been completed since 25 June 2015. We raised this concern where we were told they had been transferred to the back of people’s doors but when we checked, they were still not being completed consistently by staff. This is a breach of regulation 17 (2) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Good Governance.

We found that records held at the home were not held securely, with confidential information easily accessible to anybody in the building. For example, on the third floor or the home records waiting to be archived were left in boxes on the floor and could be accessed by anybody. On the second day of the inspection, this area was much tidier with the records being stored beyond a locked door. We also found that the drawer containing staff personnel files was not locked and neither was the office door. Additionally, people’s care plans were either in a drawer that was not locked or left on the side in the office for anybody to read. This is a breach of regulation 17 (2) (d) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Good Governance.

There were a range of audits in place which had been completed by the previous manager and also the home owners. They covered care plans, meal time experience, cleanliness, medication, water temperatures, monthly fire equipment checks, weekly H&S and maintenance checks including door guard closure, monthly audits of fire alarm, automatic door closure and exit route checks. A head office audit had also been completed on 2 June 2015 and looked at areas including staff files, training and cleanliness. Despite these audits, they did not identify some of our findings during the inspection for instance that people did not have moving and handling assessments in place, or our environmental concerns. This is a breach of regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Good Governance.

Following an examination of safeguarding records maintained by the service, we found that the service had failed to notify the Care Quality Commission of abuse or allegation of abuse in relation to people who used the service. This is an offence under Regulation 18 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014, with regards to notification of other incidents.

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.

We are considering our enforcement actions in relation to the regulatory breaches identified. We will report further when any enforcement action is concluded.