The Chase

The Chase is a residential care home providing personal care to up to 31 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 30 people using the service.

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

People told us they were happy living at The Chase, they told us they felt safe and staff were kind and caring. Everyone we spoke with told us they would recommend the service to others. People were supported to remain independent.

The service had continued to improve. Medicines records were complete and checks and audits had been effective in identifying and addressing shortfalls.

Risks to people had been identified and action had been taken to keep them as safe as possible. Medicines were managed safely and people received their medicines as prescribed. Lessons had been learnt when things went wrong and action had been taken to reduce the risk of them happening again. Staff knew how to identify and report any safeguarding concerns. Staff had been recruited safely. The service was clean, and staff followed safe infection control processes.

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.

People, their relatives and staff were asked for their views of the service and the provider acted on feedback received. The provider had a continuous improvement plan in operation and areas of the service had been developed since our last inspection. Staff felt supported by the leadership team.

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 April 2022). 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

This inspection was prompted by a review of the information we held about this service. 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.

We carried out an unannounced inspection of this service on 6 April 2022. 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 medicines management and checks and audits.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Chase on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Chase is a residential care home providing personal care to up to 31 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 20 people using the service.

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

The quality of the service had improved since our last inspection, but further improvements were required to ensure people always received a good service.

People’s medicines were not always managed safely. Medicines management processes had improved however, effective systems were not in place to manage all medicines which were no longer needed. Some medicines records were not complete. The provider had introduced new checks and audits since our last inspection. Medicines audits had not identified the shortfalls we found. Other audits had been effective, and action had been taken to continually improve the service.

People told us they felt safe living at The Chase. Their care had been planned to mitigate risks to them and maintain their independence. People were protected from the risk of the spread of infection. Effective systems were in operation to support people to see their visitors safely. Any safeguarding risks had been identified and shared with the local authority safeguarding team. New staff had been recruited safely. Any accidents or incidents had been analysed and action had been taken to reduce the risk of them happening again. When things had gone wrong the provider had apologised.

The culture at the service had significantly improved and everyone we spoke with told us the registered manager was approachable and listened to them. People, relatives and staff had been asked for their views and these had been used to improve the service. Systems were in operation to make sure staff were always up to date and knew about people’s needs. The registered manager and staff worked closely with health and social care professionals to make sure people received the care they needed in a timely way.

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 inadequate (published 10 December 2021). 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 some regulations. However, they remained in breach of two regulations.

This service has been in Special Measures since 31 August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 27 July 2021. 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, good governance and fit and proper persons employed.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. 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 The Chase on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management and checks and audits at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Chase is a residential care home providing accommodation and personal care. The service can support up to 31 people. At the time of the inspection there were 29 people living with dementia at the service.

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

There had been a lack of oversight and leadership by the provider and registered manager. Robust action had not been taken by the provider to address this. Checks and audits had not been completed on all areas of the service. High-risk shortfalls we found had not been identified and addressed. The registered manager had not always worked in partnership with other professionals to improve the service. Staff did not feel supported by the registered manager and told us communication between them was poor.

People were not always protected from the risks of harm and abuse. One incident had not been reported to the local authority safeguarding team so it could be investigated. Unsafe guidance had been provided by the registered manager to staff about restricting a person and this placed them at risk of harm. National guidance around managing the risk of the spread of infection had not always been followed. However, the service was clean, and people were being supported to see their relatives safely.

Medicines were not managed safely. Staff did not know about one emergency medicine that a person may need and stock levels could not be reconciled. Unsafe guidance had been provided by the registered manager to staff about the administration of pain relief medicines. Staff had not followed this guidance and asked people if they required pain relief before it was given. Risks to people had not always been assessed and mitigated. Guidance around how to mitigate some risks did not reflect information from health care professionals. Accidents and incidents were not analysed to look for patterns and trends and there was a risk they would occur again.

Robust recruitment checks had not been completed on new staff to ensure they were able to fulfil their roles. The provider’s dependency assessments process had not been followed to ensure there were always enough staff on duty.

People and their relatives had been asked for their views of the service, but these had not been reviewed and acted on. Staff told us they shared their views with the registered manager but again these had not been listened to or acted on to improve the service. However, they told us the provider did listen to their views and had used this to make improvements.

People were relaxed in each other’s company and the company of staff and there was a calm atmosphere at the service. We observed staff offered people support when they needed it and knew how to meet people’s needs. Relative’s told us the staff were kind and went out of their way to make sure people were happy. The provider and staff worked as a team and shared the same philosophy of care. This included supporting people to be independent and treating them with respect.

Following our inspection, the provider acted to reduce the risks to people and improve the quality of the service they received. We will check to make sure this action is effective at our next inspection.

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 (published 28 April 2020).

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This enabled us to look at the concerns raised and review the previous ratings.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Chase on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding people from abuse, keeping people safe, infection control, medicines management, staff recruitment, acting on people’s feedback and completing checks to improve the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

The Chase is registered as a care home without nursing for 31 older people and people living with dementia. There were 23 people living in the service at the time of our inspection visit. Most people lived with dementia and some had special communication needs.

People's experience of using the service and what we found

People and their relatives were positive about the service. A person said, “I get on well with the staff.” A relative said, "The staff are very kind and they care for the residents.”

The local authority was investigating an historic allegation of neglect. Recruitment checks had not always been completed in the right way. We have made a recommendation about the recruitment of staff.

Infection had not been fully prevented and controlled. People received safe care and treatment and medicines were managed safely. There were enough care staff on duty. Accidents and near misses had been analysed so lessons could be learned to avoid preventable accidents.

Parts of the accommodation were not furnished and decorated to meet people’s needs and expectations. People were not fully supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

Personal care was delivered in line with national guidelines by care staff who had received training and guidance. People were supported to safely eat and drink enough. People were assisted to obtain medical attention and received coordinated care.

Care was provided in a compassionate way respecting people’s right to privacy, promoting their dignity and encouraging their independence.

People had not been fully supported to avoid the risk of social isolation. We have made a recommendation about promoting social inclusion.

People had been involved in reviewing their care and given information in a user-friendly way. Complaints had been quickly resolved and people were supported to have a dignified death.

Quality checks had not always resulted in improvements quickly being made. A suggested improvement by people living in the service had not been implemented. We have made a recommendation about quality checks and improving the service.

Insufficient attention had been given to obtaining feedback from relatives and external professionals. We have made a recommendation about receiving and acting on feedback.

Regulatory requirements had been met, good team work was encouraged and joint working was promoted.

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

Rating at last inspection

The service has been in Special Measures since 19 August 2019. During this inspection the registered provider demonstrated improvements have been made. The service is no longer rated as Inadequate overall or in any of the key questions. Therefore, the service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

The Chase is a residential care home providing personal care for 31 older people and people living with dementia. At the time of the inspection 28 people were living in the service. Most of the people lived with dementia and had special communication needs.

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

People and their loved ones told us they felt safe and well cared for at the service. However, we found people were not safe and well cared for. People lived in an environment which was unsafe and unhygienic. Areas of the service had unpleasant odours and flooring was a trip hazard. Systems to manage infection control were not effective.

Risks to people were not always assessed and managed in a way which ensured people’s safety. Actions had not been taken to minimise risks and staff were not always aware of plans to keep people safe. This put people at risk of injury or their health deteriorating. There had been some improvements in medicines management, but some medicines continued to be administered in an unsafe way putting people’s health at risk.

People’s health care needs were not well managed. Communication systems were ineffective in ensuring staff understood people’s health needs. There was a risk that people would not receive the care they needed. People were not always supported to have their food and drink in ways they preferred or met their needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not fully supported to maintain their dignity. They were left in dirty or torn clothing and were not assisted to wash after meals. People went for long periods of time without meaningful interaction with staff. People’s preferences were not always known or followed and care plans did not contain up to date information. People had not been fully supported to plan their care they preferred at the end of their life.

Although there were arrangements to resolve complaints a recent enquiry had not been thoroughly investigated and quickly resolved. Audits were ineffective and did not identify the shortfalls found at this inspection. The provider had failed to take action when concerns were raised to them. Staff were recruited safely but did not have the training and support they required to carry out their role. Staff told us there was low morale and they did not feel able to raise concerns or make suggestions. There were shortfalls in the systems and processes to learn from incidents or accidents to minimise the risk of recurrence.

Information was not available to people in accessible formats. Staff worked with other professionals to meet people’s needs. However, a lack of knowledge about people’s needs impacted on staff knowing when to seek support. People attended residents’ meetings and had been invited to complete quality surveys.

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 22 November 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of choking. This inspection examined those risks.

We have found evidence that the provider needs to make improvements.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified new and continued breaches in relation to safe care and treatment, need to consent, dignity and respect, staff training, the environment and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.

The Chase is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Chase can accommodate 31 people, and there were 31 people living there at the time of our inspection.

The Chase is a large detached house situated in a residential area of Canterbury, with access to the city centre. There were 29 bedrooms, two being able to offer double occupancy. People's bedrooms were provided over two floors, with a passenger lift in-between. Six of the bedrooms had ensuite facilities whilst the others had shared bathroom facilities over both floors. There were sitting and dining rooms on the ground floor and an enclosed garden to the front and rear.

The service had 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Chase was last inspected in June 2017. At that inspection we rated it as ‘Requires Improvement’ overall.

At this inspection, although people and relatives gave mostly positive feedback about the service, we found significant concerns about the safety of people. Emerging risks were seen in areas where we did not have previous concerns and breaches of regulation were found.

Risks including those associated with medicines, the environment, the spread of infection, and fire had not been assessed and minimised placing people at risk of potential harm. Medicines were not always stored or documented safely.

Recruitment processes were not robust enough to ensure suitable staff were employed to work with vulnerable people. Staffing levels were not always sufficient to meet people’s needs.

Staff understood how to identify abuse and how to escalate concerns. Accidents and incidents had been logged and analysed by the registered manager to try to minimise the risk.

Staff had not received the training or supervision needed to complete their roles effectively. Although some changes had been made to the environment, further planned work had yet to be completed including the replacing of carpets.

The registered manager had assessed people’s needs prior to them receiving a service. People told us they enjoyed the food at the service, and were supported to eat and drink sufficient amounts to maintain a balanced diet. Staff teams worked well with each other and external agencies to provide people with access to healthcare professionals. The principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards were understood and applied in the service.

We observed staff to be busy which impacted on their ability to have meaningful interactions with people. People’s dignity was not always respected, one person asked twice to have a shave and despite us informing staff, the person was not supported to shave.

Although people told us they enjoyed the activities on offer, improvements could be made to the quality of activities on offer for people. With the exception of one care file we reviewed, people’s care plans provided an up to date picture of their support and needs. There had been no complaints since our last inspection. End of life planning had been a focus for staff and the registered manager, and was person centred.

The service was not consistently well-led. Audits were in place but had in some cases had failed to identify issues raised in this inspection, and in other cases the provider had not completed the actions necessary.

The manager had formed good relationships with healthcare professionals who supported improvements at the service. People’s views were sought, and used to improve the service.

We have made a recommendation for improved activity provision for people with dementia.

We have made a recommendation about the management of staffing.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are considering our regulatory response to our findings and will publish our action when this has been completed.

This inspection took place on 29 and 30 June 2017 and was unannounced. The previous inspection was carried out in January 2016 and concerns relating to the management of medicines, the management of risk, the maintenance of the premises, infection control, staff training, people not being treated with dignity and respect and quality monitoring were identified. At that time we asked the provider to send us an action plan about the changes they would make to improve the service. At this inspection we found that actions had been taken to implement these improvements. However, some areas required further improvements.

The Chase is registered to provide personal care and accommodation for up to 31 people. There were 29 people using the service during our inspection; who were living with a range of health and support needs. Many people were living with different types and stages of dementia. The Chase is a detached house situated in a residential area of Canterbury, with access to the city centre. There were 29 bedrooms, two being able to offer double occupancy. People’s bedrooms were provided over two floors, with a passenger lift in-between. Six of the bedrooms had ensuite facilities whilst the others had shared bathroom facilities over both floors. There were sitting and dining rooms on the ground floor and an enclosed garden to the front and rear.

The service had a registered manager, who was present throughout the 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 and associated Regulations about how the service is run.

A number of audits and checks were carried out each month by the registered manager, deputy manager or area manager, but they had not been wholly effective in identifying the shortfalls in food and fluid intake or in driving forward improvements in the environment.

People were offered a choice of nutritious meals and snacks. A picture board was displayed to prompt and remind people about the day’s menu and their meal choices; however during the inspection this was not kept up to date and therefore could confuse rather than assist people.

Staff followed correct and appropriate procedures in the storage and dispensing of medicines. People were supported in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

A robust system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit and appropriate to be working with people. There were sufficient numbers of staff on duty to make sure people were safe and received the care and support that they needed.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to support people in a way that met their needs. Staff continued to receive training and support. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about whistle blowing and were confident they could raise any concerns with the provider or outside agencies if needed.

The care and support needs of each person were different, and each person’s care plan was individual to them. Care plans, risk assessments and guidance were in place to help staff to support people in an individual way. People's legal rights were protected as staff provided care in line with the Mental Capacity Act (2005). Correct procedures were followed when depriving people of their liberty. Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve outcomes for people.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff knew people and their support needs well, they treated people with kindness, compassion and respect. Staff took time to speak with the people they were supporting. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. People's privacy and dignity was respected.

Complaints had been properly documented, and recorded whether complainants were satisfied with the responses given. People and relatives said they knew how to complain if necessary and that the registered manager was approachable.

Staff felt there was good communication and were clear about their roles. They felt well supported by the registered and deputy managers. Feedback was sought from people, relatives and professionals.

The Chase provides accommodation with personal care for up to 31 older people living with dementia. There are 27 single and two double rooms at the home. There were 27 people living at the service at the time of inspection. The accommodation is over two floors and bedrooms can be accessed by a passenger lift. There is a communal lounge/dining room and an additional lounge. There was an accessible and secure garden to the front of the home.

The service has a registered manager who was available and supported us during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was not proactive in making improvements to the environment for the benefit of people who lived and worked at the service. An improvement plan was in place but did not contain any timescales for works to be completed. There were a number of areas where there was an increased risk of an infection spreading, should it occur in the home.

The service specialised in supporting people living with dementia but care staff had only received basic training in this area and had received no training in how to effectively support people with behaviours that may challenge themselves or others. Some staff who were responsible for moving and handling people had not received recent training in this area to ensure they were able to do so safely.

There was a detailed medicines policy in place to guide staff how to administer, record and store medicines safely and appropriately. However, staff did not always follow this guidance. For example, an assessment of a person’s capacity had not been undertaken when a person was being given their medicines without their knowledge and some medicines were stored on occasions at temperatures exceeding the manufacturer’s recommendation.

The home was clean but action had not always been taken to minimise the spread of any infection.

The provider did not take an active role in assessing if the quality assurance processes in place were effective. A number of shortfalls in the service were identified at this inspection.

Accidents and incidents were recorded but an event had highlighted that not all senior staff knew how to act in a timely and appropriate way when such an event occurred.

People had their health needs assessed and monitored and professional advice was sought as appropriate. People were offered a choice at mealtimes, and where appropriate support was provided and people were not rushed.

People, visitors and professionals gave positive feedback about the compassionate and caring nature of the staff team. Staff communicated with people in a kind manner, but there were a number of exceptions to this, where people were not treated with dignity and respect. This included one incident when staff talked about a person as though they were not there and storing equipment in people’s bedrooms.

New staff received an induction which included shadowing new staff. All staff had received training in the Mental Capacity Act 2005. Although staff understanding of the principles varied, staff gained people’s consent before supporting them with any care and treatment. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. DoLS applications had been made for people who lived in the home to ensure that people were not deprived of their liberty unnecessarily.

Staff said there was good communication in the staff team, that they felt well supported and received regular formal supervision with the registered manager.

Checks were carried out on all staff to ensure that they were fit and suitable for their role. Staffing levels ensured that staff were available to meet people’s needs.

Assessments of individual risks to people’s safety and welfare had been carried out and action taken to minimise their occurrence, to help keep people safe. Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order. Staff knew how to follow the home’s safeguarding policy in order to help people keep safe.

People’s care, treatment and support needs were assessed before they moved to the service and a plan of care developed to guide staff on how to support people’s individual needs. Information had been gained about people’s likes, and past history and staff demonstrated they understood people’s choices and preferences.

The views of people and their relatives about the quality of care provided at the service were regularly sought and the results had been shared with them. Information was available to people about how to raise a concern or complaint and people and visitors/relatives, felt confident to do so. The service had received a number of compliments.

The registered manager was a visible presence in the service and led a staff team who felt well supported.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

The environment although difficult to clean in some areas, was clean on the day of our inspection. Checks were in place to ensure that the home was cleaned to an appropriate standard. Actions had been taken to minimise the spread of any infection, with the exception that not all bins in bathrooms had been provided with lids.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

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 relatives and speaking with staff.

Is the service safe?

People were treated with dignity and respect by the staff. They knew how to communicate with individual people who lived in the home.

Safeguarding procedures were in place and staff understood how to safeguard the people they supported. One relative told us, 'My Mum is safe and happy living here. I do not worry when I leave'.

Checks had been carried out for staff before they started work at the home, to ensure that they were suitable for their roles.

Systems were in place to learn from accidents, incidents, complaints, concerns, whistle blowing and investigations. This reduced the risks to people and helped the service to continually improve.

Equipment had been maintained and serviced regularly.

The Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Applications had been submitted, but none were current on the day that we visited the service. Relevant staff had been trained to understand when an application should be made, and how to submit one .

Is the service effective?

We saw from the home's annual survey for people living in the home and their relatives that most people were positive about the care that was delivered.

People's health and care needs were assessed with them, and they and/or their relatives were involved in writing their plans of care. This included a clear summary of information about peoples' likes, dislikes and past histories, so that staff could communicate with people more easily.

Staff had a good understanding of people's care and support needs and they knew them well.

Is the service caring?

People were supported by kind and attentive staff. For example, we saw staff sitting down beside people and talking with them when supporting them to eat and drink. Staff valued people's contributions when taking part in activities.

People were able to do things at their own pace and were not rushed. At lunchtime people were able to eat their meals as independently as possible, and in their own time.

People's preferences and interests were recorded and care and support was provided in accordance with their wishes.

People using the service and their relatives had been involved in the service and completed an annual satisfaction survey. Any shortfalls had been identified and action had been taken to address them. A relative told us, 'We filled in questionnaires and things have improved as a result. There have been more activities and music'.

Is the service responsive?

People's needs had been assessed in detail before they moved into the home.

People had access to activities that were important to them, in the home. An activities coordinator was employed during the week. Relatives said that people also went on trips out.

People had been supported to maintain relationships with their friends and relatives.

Relatives said that they knew how to make a complaint if they were unhappy, but said that they had not needed to. A complaints log was kept which detailed the nature of the complaint and the action that had been taken to resolve it.

Is the service well led?

The home manager had worked at the home for a three years, was registered with the Care Quality Commission and had achieved a national qualification to manage a social care service.

Staff were clear about their roles and responsibilities, felt well supported, and said that there was good communication in the home. All these things helped them to provide the appropriate support for people who lived in the home.

Staff had a good understanding of the whistleblowing policy.

The service had an effective quality assurance system in place which consisted of internal audits and external audits by the provider.

We found that the provider had made changes to improve the service following our last inspection in May 2013.

The provider employed sufficient staff with the necessary skills and experience to meet the needs of the people who use the service. We observed people being supported in the way they wished by staff who knew them well.

The provider had a process in place to assess and monitor the quality of the service people received. We found that people and their relatives were able to share their views of the service and the provider had acted upon these.

During the inspection we found that the service was using close circuit television (CCTV) in some communal areas. The manager was unable to demonstrate that the decision to use this had been made by people with capacity. The provider turned the CCTV off during the inspection.

We found that staff knew people well and supported people in the way that they preferred. Staff demonstrated that they were able to support people who became anxious or refused care.

We found that the service followed policies and processes when supporting people with their medicines. This ensured that people were protected.

We saw evidence to demonstrate that people's records were accurate and maintained in a way which protected their privacy.

The service did not have effective processes in place to gather and act upon information about the quality and safety of the service. This meant that potential risks to people using the service and others had not been managed.

We found that at times there were not enough staff available to meet people's needs in a timely way. People told us that they were bored at times during the day. Staff told us that on occasions people had to wait for their care.

Some of the people living in the home were living with dementia and were unable to tell us about their experiences so we spent time with people and observed interactions between the people and the staff.

The staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported. However, we found that people were not protected from the risks of unsafe or inappropriate care and treatment, because information provided to staff was not always detailed and accurate and there was a lack of care planning and risk management.

We saw that staff listened to people and answered their questions in a way that they could understand. People were reassured by this. We saw that the staff were friendly and people seemed relaxed in the home.

People told us that they were happy with the care they received at the home, one person said "They are very good here, they don't mind what they do for you".

We saw people receiving their medication and found ordering, storage and disposals processes were in place. However, we found that people were not protected against the risks associated with the unsafe use because medicine administration was not recorded accurately and there was no evidence that the results of testing was acted upon.