This inspection took place on 16 May 2017 and was unannounced.

Bedford Charter House is a substantial, purpose built care home providing a service for up to 72 people who have a range of care needs including dementia and physical disabilities. Short term (respite) care is also provided. During this inspection 64 people were using the service, and no one was receiving respite care.

A registered manager was 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.

We found some areas that required improvement:

There were sufficient numbers of suitable staff to keep people safe and meet their needs. However, some people told us they were left waiting when they called for assistance, particularly before and after the lunch time meal. The registered manager had made changes to the way staff were deployed in the home to ensure additional support in the evenings and new staff had been employed. It was therefore hoped that this would improve as the new staff gained confidence and experience. The registered manager also told us about changes he planned to make to enhance people’s dining experience in the future.

The provider carried out checks on new staff to make sure they were suitable and safe to work at the service. The majority of the required checks were in place however, we found some checks had not been carried out for all staff, such as obtaining a full employment history. The registered manager confirmed after the inspection that changes would be made to the existing recruitment process, to ensure all required checks were obtained in future.

We also identified many areas during the inspection where the service was doing well:

Staff had been trained to recognise signs of potential abuse and keep people safe. People felt safe living at the service and staff were confident about reporting any concerns they might have. Processes were in place to manage identifiable risks within the service to ensure people were supported safely and did not have their freedom unnecessarily restricted.

Systems were in place to ensure people’s daily medicines were managed in a safe way. Improvements reported on at the last inspection had been sustained and as a result medication errors had decreased significantly.

Staff received the right training to ensure they had the necessary skills and knowledge to meet people’s needs.

Systems were in place to ensure the service worked to the Mental Capacity Act 2005 key principles, which state that a person's capacity should always be assumed, and assessments of capacity must be undertaken where it is believed that a person cannot make decisions about their own care and support.

People had a choice of food, and had enough to eat and drink. Assistance was provided to those who needed help with eating and drinking, in a discreet and helpful manner.

The service worked with external healthcare professionals, to ensure effective arrangements were in place to meet people’s healthcare needs.

Staff provided care and support in a caring and meaningful way. They treated people with kindness and compassion and respected their privacy and dignity at all times. Personalised care plans had been developed to record how people wanted to receive their care and support, and they were supported to have choice and control of their lives as far as possible.

People were given opportunities to participate in meaningful activities and further improvements were planned in this area.

Arrangements were in place for people to raise any concerns or complaints they might have about the service. These were used by the service as an opportunity for learning and improvement. We saw that people were given regular opportunities to expres

Bedford Charter House is a substantial, purpose built care home, which opened in February 2015. Prior to this, the service had operated from a smaller building on the same site. The new building provides a service for up to 72 people who have a range of care needs including dementia and physical disabilities. Short term (respite) care is also provided. During this inspection, 68 people were using the service.

During our inspection in February 2016, we identified concerns in terms of how people’s PRN (as required) and topical medication was managed. We identified that medication protocols for the administration of PRN medication were not always sufficiently detailed. In addition, medication administration records (MAR) charts did not always record the reasons for PRN medication being given, making it difficult to assess whether a person's healthcare condition had changed.

This was a breach of Regulation 12 (1) (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection the provider sent us an action plan detailing the improvements they were going to make, and stating that improvements would be achieved by 30 June 2016.

We undertook this unannounced focused inspection on 7 October 2016, to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bedford Charter House on our website at www.cqc.org.uk

A registered manager was 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.

We reviewed the medication systems in place, and found that these had been strengthened. The processes in place were more robust and more regular audit checks were taking place of all aspects of the medication systems, including recording and disposal. Because of this issues were now identified and addressed in a timelier manner.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for safe at the next comprehensive inspection.

This inspection took place on 16 February 2016. It was unannounced.

Bedford Charter House is a substantial, purpose built care home, which opened in February 2015. Prior to this, the service had operated from a smaller building on the same site. The new building provides a service for up to 72 people who have a range of care needs including dementia and physical disabilities. Short term (respite) care is also provided. During this inspection, 68 people were using the service.

A registered manager was 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.

Systems were in place to ensure people’s daily medicines were managed in a safe way and they got their medication when they needed it. However, concerns were identified in terms of how people’s PRN (as required) and topical medication was managed.

Processes were in place to manage identifiable risks within the service, and ensure people did not have their freedom unnecessarily restricted. We did find some anomalies in terms of how often risk assessments had been reviewed or completed however.

We saw that although people were given opportunities to be involved in making decisions about their care and support, their care plans were not always adequately robust, or reflective of their current needs.

We also found that the service worked to the Mental Capacity Act 2005 key principles, which meant that people’s consent was sought in line with legislation and guidance. However, this information was not always transferred into people’s care plans.

Despite this, we did see evidence of work that had begun to review everyone’s risk assessments and care plans, as a part of an improved care plan system that was due to be implemented.

The registered manager also had a plan to address gaps in staff training and supervision; to ensure all staff working in the home received the right support and training to carry out their roles and meet people’s assessed needs.

People felt safe living at the service. Staff had been trained to recognise signs of potential abuse and keep people safe.

There were sufficient numbers of suitable staff to ensure people’s safety and meet their individual needs.

The provider carried out proper recruitment checks on new staff to make sure they were suitable to work at the service.

People had enough to eat and drink. Assistance was provided to those who needed help with eating and drinking, in a discreet and helpful manner.

People’s healthcare needs were met. The service had developed positive working relationships with external healthcare professionals to ensure effective arrangements were in place to meet people’s healthcare needs.

Staff were motivated and provided care and support in a caring and meaningful way. They treated people with kindness and compassion and respected their privacy and dignity at all times.

People’s social needs were provided for and they were given opportunities to participate in meaningful activities. It was clear that the provider recognised this as an important part of people’s lives.

A complaints procedure had been developed to let people know how to raise concerns about the service if they needed to.

There were effective management and leadership arrangements in place.

Systems were also in place to monitor the quality of the service provided.