Abbotsford Care Home - Manchester

Abbotsford Care Home - Manchester is a residential care home. At the time of this inspection the home was registered to provide personal and nursing care nursing care. In May 2021 the provider had made the decision to provide residential care only and nurses were no longer employed by the service.

People receiving care and support at the time of this inspection did not require nursing care and all personal care needs were met by the service and other external health professionals. The service was providing personal care to 30 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

People’s experience of using this service and what we found

Medicines were now being managed safely. Systems were in place to protect people from abuse. Practices and processes had improved. Risks to people's health, safety and well-being associated with their care needs were assessed and management plans were in place to ensure risks were reduced wherever possible. Premises checks and all maintenance records were up to date. Required test and safety certificates were in place.

People had their care and support needs met by sufficient numbers of suitably trained staff. The care environment was clean, and a programme of redecoration was in progress. Infection control procedures were in place and staff used PPE effectively. Cleaning regimes were in place to help manage the COVID-19 pandemic.

People were complimentary about the food on offer. Communal areas were comfortable, although we judged that the dining room décor could be improved to maximise a positive dining experience for people. There was signage and equipment to help support and orientate people living at Abbotsford, including signage for people whose first language was Cantonese.

Electronic care plans guided staff as to people’s care needs and preferences. The service was progressing with making care plans more person-centred. Electronic care plans and risk assessments provided staff with relevant information so that appropriate care could be provided for people. The service had good working relationships with local GP practices and healthcare professionals. The service worked in partnership with people, their families and staff. We received positive feedback from people and staff about the service.

People were complimentary of the care they received. People and their relatives had appreciated the efforts of the home during the COVID-19 pandemic. The service was keen to re-establish partnerships with professionals following the COVID-19 pandemic.

The service had good governance arrangements in place and completed regular internal quality checks at manager and provider level. Systems and processes for audit and quality assurance were in place. Findings from audits carried out by the nominated individual were reviewed by management and used to improve practice within the service.

We discussed the registration status of the home and the nominated individual addressed this during the inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 29 November 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 22, 23 and 29 October 2019. Five breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, fit and persons employed and good governance.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abbotsford Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Abbotsford Nursing Home – Manchester is a 'care home' that provides both residential and nursing care. The home can accommodate up to 44 people in one adapted building. Accommodation is spread across four floors, with communal areas including a dining room, two lounges and activity room situated on the ground floor. At the time of this inspection there were 37 people living at the service.

People’s experience of using this service and what we found

The systems in place to monitor the quality of the service and auditing systems were not always effective and had not identified the issues we found during this inspection.

We found management of medicines at the home continued to be inconsistent and unsafe. Auditing systems in respect of medicines continued to be ineffective and had failed to address key concerns regarding the safe management of medicines.

We found shortfalls in the homes approach to safety. We found boxes were being stored in a bathroom on the second floor, this posed as a potential trip hazard. We were also able to access an unlocked laundry room on the basement floor. This placed people at a risk of harm through unintentional touching of electrical equipment.

We found the mealtime experience differed on both days of our inspection. We observed people were left waiting in the dining room for a long time before the meals were served. Improvements were made on the second day.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, we found there was variable information to show if the person had given consent. We found consent forms had not always been completed.

People living in the home had a comprehensive risk assessments and care plans in place, however we identified one person’s care plan had not been reviewed in a timely manner when we identified potential concerns.

End of life care plans were not always in place for people. We recommend the provider develops end of life care planning for people.

We observed many caring and positive interactions between staff and people throughout the inspection. However, on the first day we observed one person shouting out on a number of occasions and staff were not always responsive to their needs.

Staff received training and had the skills and knowledge needed to perform their roles effectively.

People were enabled to have choice and control of their lives and staff supported people in the least restrictive way possible.

Complaints were dealt with in accordance with the organisation's complaints procedure, people said they knew how to complain. People were supported to engage in activities in the home and in the community.

Incident and accidents were analysed for patterns and trends. Risks to people were assessed and referrals were made to other professionals in a timely way when people living in the home were in need.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (26 October 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Enforcement

At this inspection we identified breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe management of medicines, safe recruitment, safeguarding processes, failure to maintain the premises and ineffective auditing systems. The last rating for this service was requires improvement. The service remains rated requires improvement.

Why we inspected

This was a scheduled inspection based on the rating at the last inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this inspection, we found that substantial improvements had been made and the provider was meeting the requirements of the majority of the regulations. However, we found an ongoing breach of regulations in relation to the safe management of medicines. We have made one recommendation, which is in relation to management of complaints.

Abbotsford Nursing Home – Manchester is a ‘care home’ that provides both residential and nursing care. 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.

Abbotsford Nursing Home is located in a residential area in South Manchester. Local facilities and bus routes are within easy walking distance of the home and there are car parking facilities at the front of the property. The home accommodates up to 44 people in one adapted building. Accommodation is spread across four floors, with communal areas including a dining room, two lounges and activity room situated on the ground floor. At the time of our inspection there was a local authority suspension on placements at the home. This meant the home had reduced occupancy, and there were 26 people living there at the time of our inspection. The top-floor of the building was not being used for accommodation at the time of our site visit.

At the time of our site visit the manager was not registered with the CQC, and the service had been without a registered manager for over six months. However, the manager had recently re-submitted an application to register and their registration was completed during the course of this 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.

Medicines were administered safely, and accurate records were kept. However, the treatment room was located on the top-floor of the home, away from where most people were administered their medicines. This meant that the medicines trollies were stored in the dining area during the day where the temperature the medicines were stored at was not monitored. It is important that medicines are kept at the temperature recommended by the manufacturer to ensure they remain effective.

We found that sharps containers, which are used for used needles for example, were kept on the medicines trollies in the dining areas when not being used. They were not kept securely, which would increase the risk of them being handled inappropriately and potentially causing injury. There was also an ongoing issue from our last inspection in relation to medicines administration records not being kept securely.

There were sufficient staff on duty to meet the needs of people living at the home. We saw people received the support they needed in a timely way throughout the inspection. The manager assessed staffing requirements using a dependency tool. Since our last inspection, the way staff were deployed had been changed to help ensure there was adequate staff support available during handovers and at night.

Staff assessed risks to people’s health, safety and wellbeing. We saw risk assessments had in all but one instance been completed accurately. Staff took reasonable steps to help reduce the risk of people being harmed.

The provider was undertaking a continued programme of refurbishment. We found the home was clean, and the provider had received an overall green RAG (red, amber, green) rating during a recent external infection control audit. The provider had made some further adaptions to make the home more ‘dementia friendly’, although there was scope for further improvements in this area.

The chef was aware of, and met people’s dietary needs and preferences. This included providing a choice of Chinese, Caribbean and Western dishes at meal-times. People told us they enjoyed the food on offer, and we observed that people received the assistance they needed to eat and drink.

Staff understood the basic principles of the Mental Capacity Act. We saw that decision specific capacity assessments and best-interest decisions had been undertaken as required. Staff had consulted with others involved in people’s care, such as families when making best-interest decisions.

Since our last inspection, the provider had appointed a clinical supervisor. Their role was to carry out clinical supervision with the nursing staff and to assess their competence. We saw the manager also carried out competency spot-checks. We saw evidence that they had identified and challenged poor practice.

The home supported people from a range of cultural and religious background, including a proportion of people who were of Chinese origin. Reasonable steps had been taken to help ensure the service was meeting people’s cultural and religious needs. One of the lounges at the home was decorated in a Chinese style, and the TV showed a Chinese language channel. There were visits from a range of religious groups.

Since our last inspection, the service had appointed a member of Cantonese speaking staff to act as an interpreter. The service was also actively looking to recruit further members of staff who could speak Cantonese. Other options to improve communication between staff and people living at the home who did not speak shared languages included the use of flash cards and translation apps.

People and relatives told us they found staff to be kind, caring and attentive. During the inspection, our observations supported these reports. We found staff interacted positively with people and communicated effectively and respectfully.

People had been involved in assessments and reviews of their care plans. Where it was of benefit to the individual, information in people’s care plans had also been translated into Cantonese. Care plans provided details about people’s preferences in relation to how they received care and support.

The activity co-ordinator had assessed people’s likes, dislikes and interests to help provide them with personally meaningful and culturally appropriate activities. We saw a range of activities were provided, including one to one’s where people accessed the local community, music afternoons, bingo and pamper sessions.

There had been one recorded formal complaint in the last year, which had been managed appropriately. We saw that key documents, including the complaints policy had been translated into Cantonese. Whilst most people felt able to raise any concerns they had, one person told us they had not reported their concern to the manager due to the language barrier. We have made a recommendation that the provider explores way to encourage and support people to make complaints.

There was an open an honest culture at the home. Staff told us the manager had discussed concerns raised during our last inspection with them, and what needed to be done to improve. Staff told us they would feel supported to report any incidents or mistakes and that they would be treated fairly. We also saw evidence from team meeting minutes that showed the manager encouraged open and honest discussions amongst the staff team.

The manager carried out a range of checks and audits to help them monitor and improve the safety and quality of the service. We found evidence that the checks had been effective in driving improvements in the service. For example, the manager had recognised a patter in accident/incident reports, which led to them changing the way staff were deployed, to help increase the available support in a certain area of the home.

The opinions of people using the service and relatives had been sought through the use of questionnaires, and direct conversations with the manager. The manager had sought to involve the input of people using the service and relatives to help drive improvements at the home.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

This inspection was brought forward due to some information we received, alleging people were being abused. Whilst we found no evidence to substantiate evidence of intentional physical or psychological abuse, we found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care and good governance. Additionally we found breaches of the regulations in relation to dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, nutrition and hydration needs, staffing and fit and proper persons being employed.

Abbotsford Nursing Home 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.

Abbotsford Nursing Home is a four-storey detached building, set in its own grounds, with ramped access to the building. The home provides accommodation and care to a cultural mix of people including, Caribbean, Chinese and Pakistani or British descent. The home is registered to provide accommodation for up to 44 people who require nursing or personal care. On the first day of our inspection, there were 36 people living at the home, 16 of whom required nursing care. On the last day of our inspection, one person had sadly died and two people had been admitted to hospital.

The home had a manager in post. They had not yet registered with the Care Quality Commission, although they had begun the process of their application during 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 safeguarding and whistleblowing policy in place and the manager and staff were able to outline the actions they would take if they had any concerns anyone was at risk of abuse or harm. However, people’s care needs were not always met and this placed people at risk of harm.

Risks to people had not always been identified and, where they were identified, we found measures to reduce risks were not always followed. Systems were in place for safe management of medicines. However, staff did not always follow appropriate procedures and some recording of medicines required improvement.

Good analysis of accidents and incidents took place, to enable trends or themes to be identified.

People were not always provided with safe care and treatment, in line with their plans of care and appropriate actions were not taken in an emergency situation. This placed people at risk of harm.

Although some regular checks were made to ensure the safety of the building and equipment, we identified some areas which posed a risk, such as those in relation to hazardous substances or combustible materials.

Despite a dependency tool being used to help determine staff numbers, it was not evident sufficient numbers of staff were deployed to meet people’s needs because the dependency tool was not effective nor updated when needs changed. Safe recruitment practices were not followed.

People were not always protected by the prevention and control of infection procedures. We found some areas of the home were not kept clean or hygienic to ensure people were protected from acquired infections.

Staff received induction into their roles and regular training. However we identified moving and handling training had been ineffective. We found clinical supervision was lacking.

People were not supported to have maximum choice and control of their lives and records did not demonstrate people were supported in the least restrictive ways possible. The principles of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were not followed.

Nutritional and hydration needs were not effectively met, with some people losing weight and appropriate action not being taken. A tool used to determine the risk of malnutrition was not being used correctly and therefore some risks were not identified.

People received additional support from health care professionals, in order to have their care and treatment needs met where this was appropriate. However, actions following this were not always effective.

Although some staff treated people with kindness and compassion, other staff did not. Some staff spoke over people to each other. Some staff failed to recognise when people’s dignity was being compromised. The language used in some care plans was not indicative of a caring environment.

Care plans were updated regularly but people or their relatives were not always involved in this. Person centred care was not embedded practice and care provision was seen to be task orientated. Some people’s care records did not give consideration to their diverse needs in terms of culture, religion or sexuality for example.

There was a lack of meaningful occupation. The registered provider employed an activities coordinator. However, they had not performed this role for the three weeks prior to this inspection because they were undertaking a carers’ role.

Regular staff meetings took place and staff felt informed. Staff felt the manager was supportive and effective.

Some care records were inaccurate and incomplete. Some audits were not robust and did not identify many areas for improvement, which were highlighted throughout the inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Abbotsford Nursing home is a large four storey detached building set in its own grounds with plenty of parking space. There is ramped access to the front of the home to enable people with restricted mobility or wheelchair users to access the building. The home supports a cultural mix of people including, Caribbean, Chinese, and Indian, Pakistani or British descent. Local facilities and bus routes are within easy walking distance. The home is registered to provide residential and nursing care for up to 44 people. At the time of this inspection there were 38 people using the service; 20 who required nursing care and 18 required residential care. Two people were in hospital during our inspection.

The home was managed by a registered manager who had been in post since May 2015. 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. The registered manager was supported in their role by a deputy manager; both were registered nurses and were present during the inspection.

Care files we viewed lacked service user input. We were made aware by the registered manager that they were in the process of updating the information to reflect people’s involvement. We saw the care files provided details about the person’s individual needs and identified risks to the person’s health and well-being.

People were referred to healthcare professionals as and when required and people were supported to attend routine appointments with the GP, optician and dentist as required. Medicines were stored, administered and disposed of safely. People who required the medicines to be administered covertly had appropriate protocols in place including best interest decisions.

Staff were able to demonstrate their understanding in relation to obtaining consent prior to carrying out any care or support. However, the service had not considered people’s communication needs in relation to their understanding. They understood the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). We saw the service had taken appropriate action and applied for DoLS when necessary.

We found people were cared for by sufficient numbers of staff who had received appropriate training and been safely recruited. People felt safe and staff were aware of how and who to raise any concerns to. Staff we spoke with had a good understanding of the care and support people required.

Interactions between staff and people, who lived at the service, were warm and friendly. Staff were polite and patient in their approach. People’s religious and cultural needs were considered and daily activities were offered to add variety to people’s days. We saw the service welcomed the local community into the home to develop links and offer people chance to become part of the wider community.

People’s nutrition and hydration needs were met with a varied menu choice which incorporated a variety of needs including both nutritional needs for example diabetes but also cultural needs. However, people had not been consulted with regards to the menu choice. Staff knew who required support to meet their nutritional and hydration needs and what support they needed.

The service completed quality assurance checks to ensure people received safe and effective care. However these had not identified that care plans and other documentation was not available in other formats to support people whose first language wasn’t English. We saw systems were in place to provide information in the event of an emergency and that this information was reviewed and kept up to date. There was a formal complaints procedure in place which provided a record of the response and action taken. This was not available in all formats to support people to make a complaint.

Staff felt supported by the registered manager and received regular supervisions. The service had policies and procedures in place to support staff and staff were following these. Statutory notifications were sent to CQC as required.

During this inspection we found three breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 details of this can be found at the back of this report.

We visited the service on 15 September 2014 to carry out an unannounced follow up inspection to see if the necessary improvements had been made. During our inspection we spoke with the registered manager, the deputy director of the service and the maintenance man.

We saw documentary evidence to show the equipment used by people who lived at the home was being serviced and maintained to make sure it remained safe to use.

We found systems and services such as; emergency lighting, fire alarms and gas and electrical appliances were being tested and maintained on a regular basis.

There were systems in place to assess and monitor how well the service was operating. Information was available to demonstrate that regular audits of care plans were carried out. This meant that the management team could make changes to people's support needs quickly and effectively.

In this report the name of two registered managers appears who were not in post and were not managing the regulatory activities at this location at the time of the inspection. At the time of the inspection there was a registered manager who had been in post since July 2014. We spoke with staff who told us they felt well supported by the registered manager.

There was evidence to demonstrate the provider had taken action to address the concerns raised at the last inspection carried out in June 2014.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive to people's needs?

Is the service well?

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 family members, the staff supporting them and looking at records.

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

Is the service safe?

Training was in place to protect the people who lived at Abbotsford Nursing Home such as moving and handling, safeguarding adults and first aid. The staff team also had National Vocation Qualifications (NVQ) and Registered General Nurse (RGN) qualifications to meet people's need.

We found during our inspection that we had concerns about the overall maintenance of the building and equipment. We were concerned that regular maintenance including furnishings was not carried out in a timely manner such as; the floor covering in the dining room presented a health and safety hazard which we understood had been in a poor state of repair for some time. Also work required included in the electricity certificate of 2012 had not been carried out.

We found that carpets and floor coverings in the entrance hall and lounges were badly stained and that the home in general did not present as being very clean. Two people we spoke with said that they did not find the home particularly clean. One person said, "The home is shabby and doesn't feel very fresh". However two other people we spoke with told us that they were satisfied with the cleanliness of the home. One person said 'I am happy with my relatives room; it is always clean and I am satisfied with that'.

We were also concerned about the fire safety of the home such as holes in fire doors and the use of digital locks on fire exits. As a result of our concerns we contacted Greater Manchester Fire and Rescue Service who undertook their own inspection of the home and will be taking their own action.

We also contacted other agencies to inform them of our concerns regarding the lack of cold water and how this affected the people who lived and worked at the home. In addition we also shared our concerns about the apparent lack of legionella testing and how this may affect people's health and safety. The Contracts Manager from Manchester Local Authority Contracts was pursuing these concerns with the relevant agency; the Health and Safety Executive.

Is the service effective?

The family members we spoke with said that they were kept informed about their relative's care. They also told us that if they had any concerns they were comfortable with talking to the staff team.

One family member told us, 'I feel the staff are coping very well with my relatives care needs'. They also said that they looked at a number of homes but that they liked the atmosphere of Abbotsford Nursing Home.

A passenger lift and equipment was available such as hoists and assisted baths to help the care workers meet people's care needs.

Assessments had taken place prior to someone being admitted into the home. The assessments formed the basis of the care plan. We were told by the family members we spoke with that they had been involved in the recent reviews that had been conducted by the Nursing Funded Commissioning team and/or Manchester Contracts team.

There were a number of people living at the home whose first language was Chinese. We saw that one of the lounges had satellite television so that people could watch programmes that were transmitted in Chinese. There was always a member of staff on duty throughout the day and night who was able to speak Chinese and could interpret for others. There was also a Chinese cook employed to ensure that people had the type of food they wanted.

Other people who lived at the home were of Caribbean descent and as such enjoyed Caribbean food. The cook told us that she tried to meet their requirements but that it was not always easy to obtain the ingredients necessary from the food suppliers the organisation used. The manager had made enquiries with the owner to obtain petty cash in order to purchase the ingredients necessary.

Is the service caring?

We were able to speak with four of the people who lived at the home during our inspection and four family members by telephone. Everyone told us that overall they were happy with the service being provided. One person told us; 'The staff are attentive and caring'. Another said that they were looked after 'ok', had no complaints and that the staff were 'ok'.

We observed during our visit that people were treated with respect by the staff team whilst they carried out people's daily care. People told us that the staff respected their privacy and dignity.

Is the service responsive?

We saw that risk assessments and care plans were in place that reflected the person's care needs to ensure that they received appropriate care. The care plans contained information from GP, district nurse and other health care professional's visits such as dietician.

We were able to speak with the dietician who told us that people were appropriately referred by the Clinical Lead for Abbotsford whenever there were concerns about nutrition or weight loss.

There had been two audits from the Community Infection Control team and the NHS Commissioning and Quality team in May 2014. The manager was currently working through the recommendations on of which was the cleanliness of the home, that had been made by the teams.

Is the service well-led?

Abbotsford Nursing Home is a limited company. There is an owner/provider who has overall responsibility for the home. There is an assistant director who visits the home from time to time and had in May 2014 conducted an audit of the home and produced an action plan for the manager to follow. The actions when implemented would improve the service in such areas as cleanliness and quality assurance surveys with people who use the service.

The registered manager who was in post at the beginning of 2014 had left in February 2014. Since this time there had been no registered manager. A manager commenced employment at the end of February 2014 but left after a few weeks at the end of March 2014. The current manager commenced employment at the end of April 2014 but informed us that they were leaving in July 2014 and will therefore not be registering with CQC. We discussed with the provider their plans for a replacement and were told that an agency was in the process of looking for a new manager on their behalf. This meant that the provider was in breach of the conditions of their registration which requires there to be a registered.

We were told by people and families who used the service and the staff team if they had any concerns about the care being provided they would inform the manager. No one we spoke with had ever made a complaint. There was a complaints policy and procedure available.

We were told by the staff team that even though they informed the manager who passed on the information to the provider that 'things' did not get done such as; there being no cold water in the kitchen for some time.

We saw that the current manager had started to conduct audits and improve systems for record keeping. One person told us that they had noticed an improvement in the storage of records since the manager had been in post which meant that the staff could find records quickly and easily.

We found that there had been no surveys conducted to obtain people's views and opinions since December 2013. Because of this the provider had no means in which to assess and monitor the views of people in order to improve the service provided.

We saw that since our last inspection in February 2013 a new record management system had been implemented and notes and care plans were well organised. This meant that staff were able to quickly identify individual needs and preferences in records.

We saw that people who use the service were well cared for and the concepts of privacy and dignity were understood by all staff. The service carried out appropriate recruitment and employment checks and staff received training in safeguarding and infection control.

We saw that the home was clean and well maintained. A number of rooms had been recently redecorated and refurbished and toilet and bathroom areas were clean and well maintained