Chacombe Park accommodates and provides care for up to 77 older people, some of whom are supported with dementia care needs. There were 55 people in residence when we inspected, with one other person hospital and expected to return to the home.

At the last inspection the service was rated ‘Good’ when we published our report on 25 November 2015. At this inspection we found the service remained overall ‘Good’, with ‘well-led’ requiring improvement.

A registered manager was in not in post when we inspected although we had received an application to register a manager and their application was being processed. The new manager was subsequently registered on 20 November 2017.

There had not been a registered manager in post since the last registered manager voluntarily cancelled their registration on the 18 April 2016. Their successor left without submitting an application to register as manager and this sequence of events resulted in the provider having to appoint another manager. Although the provider had made timely arrangements for Chacombe Park to be managed until a new manager was registered it remained a legal requirement that a registered manager was in post. 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.

People were safe. There were sufficient numbers of experienced and trained staff to safely meet people’s assessed needs. There were appropriate recruitment procedures in place to protect people from receiving care from staff that were unsuited to the job.

People’s needs had been assessed prior to admission and they each had an agreed care plan that was regularly reviewed to ensure they continued to receive the care and support they needed. People were safeguarded from abuse and poor practice by staff that knew what action they needed to take if they suspected this was happening. Risks to people’s safety were reviewed as their needs and dependencies changed.

People were treated equally and shown respect as individuals with a range of needs that came together from diverse backgrounds. They received care and support from staff that knew what was expected of them and they carried out their duties effectively and with compassion. Care plans were personalised and reflected each person’s individual needs and provided staff with the information and guidance they needed to manage risk and keep people safe.

People’s capacity to make informed choices had been assessed and the provider and staff were aware of the Mental Capacity Act 2005 and the importance of seeking people’s consent when receiving care and support. People were encouraged and enabled to do things for themselves by friendly staff that were responsive and attentive. Their individual preferences for the way they liked to receive their care and support were respected. Staff had insight into people’s capabilities and aspirations.

There were appropriate arrangements in place for people to have regular healthcare check-ups. People had access to community healthcare professionals and received timely medical attention when this was needed.

People who needed encouragement and support with eating a healthy diet received the help they required. They had enough to eat and drink, the menu choices were appetising and the people we spoke with said they enjoyed their meals.

Medicines were appropriately and safely managed and staff had received the training they needed in the safe administration of medicines. Medicines were securely stored and there were suitable arrangements in place for their timely administration.

People, and where appropriate, their family or other representatives were assured that if they were unhappy with the care provided they would be listened to and that app

People told us the staff respected their wishes and we found that people’s personal preferences and daily routines were recorded within their individual care plans. We saw that people’s individual care plans detailed the specific elements of people's care and the plans had been amended as and when people’s needs changed.

We found that staff received regular supervision and annual appraisals of their performance and they were provided with the necessary training to ensure they could do their work safely and effectively.

We saw that risk assessments were completed for identified risks to people’s health and wellbeing. For example, falls, nutrition, continence management, medicines administration and challenging behaviour. This meant that people’s care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

As part of our inspection we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI observation tool helps us to capture in a systematic way, the experiences of people who have difficulties in communicating their feelings and views.

We spent time observing how staff related to people who used the service and how people with dementia were supported to engage with other people around them and their environment. We saw that people were positively engaged in one to one and group activities.

We saw that the dementia care environment provided people with access to books, magazines, soft furnishings, rummage boxes, board games and other activity materials for people to engage with. We saw that people’s bedrooms had been personalised with their own photographs, ornaments and items of furniture that were meaningful to them.

We saw that staff worked at a relaxed pace and their interactions with people demonstrated that they valued and promoted the involvement of all people who used the service regardless of their mental or physical abilities.

People we spoke with said the staff were “happy, cheerful and friendly”. We spoke with one visitor who told us they were extremely pleased with the care their mother received, that the staff were very supportive to both them and their mother. They also express their satisfaction with the cleanliness of Chacombe Park.

People told us that they had comfortable bedrooms at the home which they could personalise. They told us the food was good and that staff were attentive and kind. Relatives told us they felt that the home "was doing a good job" and that "things had improved". People told us that staff involved them fully in their care and respected and treated them as individuals. They told us that their independence was promoted.

We spoke to four relatives and five of the people living in the home during our inspection. Relatives were broadly happy with the care provided and said the staff tried hard but had too much to do. One commented that “staff were very dedicated but were not a happy team”. One said that there were “not always enough staff to meet all the residents’ needs”. Relatives expressed concern about the impact of low staffing levels at times, on care and stimulation. Some gave examples of people being assisted to get up late in the morning and then being put to bed in the afternoon because of insufficient staffing. Others said that the quality of care had not been satisfactory and that this had been due to the staffing levels. Relatives were also concerned about the reduction in available activities. We were told by a relative that some cuts had been made on financial grounds, and that care staff were often too busy to support exercise sessions.

A relative said that there had previously been problems with the quality of the food but that this had improved recently. We were given an example of good practice around supporting one person’s dietary wishes and the home having involved the speech and language team to facilitate this.

The people we saw who lived in the home were able to give only limited feedback, but two did say they were “OK”. Three people made positive comments about the staff being caring and one told us they were very helpful. One said that it was boring in the home. The visiting hairdresser was said to be very good by one person, and a relative also said this. One person told us that the food was “OK”, and that the fish was especially good.

This unannounced inspection took place on 2 and 8 October 2015.

Chacombe Park accommodates and provides nursing and residential care for up to 77 older people including people living with dementia.

A registered manager was in post. 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.

People’s care needs had been assessed prior to admission to Chacombe Park and they each had an agreed care plan. Their care plans were regularly reviewed, were up-to-date and reflected their individual needs.

People were protected by robust recruitment procedures from receiving unsafe care from staff that were unsuited to the job. People were safeguarded from abuse and poor practice by staff that knew what action they needed to take if they suspected this was happening.

People’s needs were safely met. There were sufficient numbers of appropriately trained and experienced staff on duty. Some external agency staff had been regularly used to maintain staffing levels but only on a temporary basis until new staff were recruited. People were cared for by staff that knew what was expected of them when caring for older people, including those with nursing and dementia care needs, and they carried out their duties effectively.

People’s healthcare needs were met by nurses and care staff and when necessary by other external community based healthcare professionals. Medicines were secured stored, administered in a timely way, and appropriately managed.

People enjoyed a varied diet, with enough to eat and drink. Those that needed support with eating and drinking received the help they required. People’s diets and nutritional needs were assessed, monitored and acted upon.

People’s individual preferences for the way they liked to receive their care and support were respected. Staff were attentive to each person’s individual needs and acted upon required changes to their care and treatment.

People, and where appropriate, their representatives or significant others, were provided with the information and guidance they needed to make a complaint or express their views about the quality of their care. Timely action was taken to resolve complaints. The quality of the service provided was regularly audited by senior staff and improvements made when necessary.