We inspected Chamberlaine Court on 18 July 2018. The inspection visit was unannounced. The home is divided over two floors and provides personal care for up to 38 older people, including people living with dementia. There were 37 people living at the home when we inspected the service. Chamberlaine Court is a ‘care home’. People in care homes receive accommodation and 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.

There was an experienced registered manager in post at the time of our inspection visit. A requirement of the service’s registration is that they have a registered manager. 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 the associated Regulations about how the service is run.

We last inspected in May 2017, when we rated the service as ‘Requires Improvement’ overall. At that inspection the key areas of Responsive and Well-led were rated as ‘Requires Improvement’ because improvements were needed in how people were supported to maintain hobbies and interests, and audit procedures did not always identify where improvements were required at the home. At this inspection we found improvements had been made and have rated the service as ‘Good’ in all areas.

People received their medicines as prescribed to maintain their health and wellbeing. People were supported to access healthcare from a range of professionals, and received support with their nutritional needs. This assisted them to maintain their health.

People told us there were enough staff to keep them safe and we saw there were enough staff during our inspection visit to ensure people were cared for safely. All necessary checks had been completed before new staff started work at the home to make sure, as far as possible, they were safe to work with people who lived there. People were supported by a staff team that knew them well.

Staff received training and had their practice observed to ensure they had the necessary skills to support people. Staff treated people with respect and dignity, and supported people to maintain their privacy and independence. People were consulted about their wishes at the end of their life.

The provider, registered manager and staff understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The registered manager had made applications to the local authority where people’s freedom was restricted, in accordance with DoLS and the MCA requirements.

People were supported to take part in social activities and pursue their interests and hobbies. People made choices about who visited them at the home, which helped people maintain personal relationships with people who were important to them.

People knew how to make a complaint if they needed to. Complaints received were investigated and analysed so the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views about how the service was run; action was taken in response.

Quality monitoring procedures identified areas where the service needed to make improvements. Where issues had been identified in checks and audits, the registered manager and provider acted to address them to continuously improve the quality of care people received. The provider and registered manager worked with other organisations and external professionals to improve and develop the quality of care.

The inspection took place on 30 May 2017. The inspection visit was unannounced on 30 May 2017 and we agreed to return on 2 June 2017 so we could speak with more staff and to see how people were supported.

Chamberlaine Court is a residential home which provides care to older people including some people who are living with dementia. Chamberlaine Court is registered to provide care for up to 38 people. At the time of our inspection there were 37 people living at the home.

Chamberlaine Court was last inspected in April 2015 and was rated as ‘Good’.

There was a registered manager at the home. 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.

Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships.

Staff encouraged people to make daily choices in how they lived their lives. For people who lacked capacity to make decisions, staff continued to prompt and offer people visual choices so people continued to have input in how their support was provided.

People were supported to pursue various hobbies and leisure activities and although there were a variety of interests for people, improvements were needed. A number of people told us other than planned activities, there was not much else to keep them stimulated.

People had meals and drinks that met their individual requirements and people said they enjoyed the food choices provided. However, we saw examples where a person’s drinks were out of reach and staff were not always attentive to notice when a person’s drinks were untouched.

People were encouraged and supported by a caring staff team and people were encouraged to maintain relationships and keep in touch with those people who were important to them.

People told us they felt safe living at Chamberlaine Court and staff knew how to keep people safe from the risk of abuse. Staff understood what actions to take if they had any concerns for people's wellbeing or safety. The registered manager knew what action to take if concerns regarding people’s safety were brought to their attention.

People had their medicines administered by trained and competent staff but the management of medicines required improving to ensure people received their medicines as prescribed, in line with pharmacist guidance.

Infection control measures when identified were not effectively managed within the home which had potential to place people and staff at unnecessary risk.

Some senior staff were not always clear of their roles and responsibilities which meant the shift and staff were not effectively managed to ensure people received their care and support needs in a timely and responsive manner.

The registered manager had quality monitoring processes which included audits and checks on medicines management, care records and accidents and incidents. Improvements were needed because we found the provider’s systems did not always identify and rectify improvements and some records did not demonstrate what actions had been taken.

We inspected Chamberlaine Court on 16 April 2015 as an unannounced inspection. At our last inspection in July 2014 we identified concerns in the care and welfare of people, staffing and the support given to staff. We asked the provider to take action to improve the service. The provider returned an action plan to demonstrate how they would improve the service in our allocated timeframe. On this inspection we found improvements had been made.

Chamberlaine Court is divided into two separate floors and provides personal care and accommodation for up to 38 older people, including people living with dementia. There were 31 people living at Chamberlaine Court when we inspected the service.

A requirement of the service’s registration is that they have a registered manager. 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. There was a registered manager in post at the time of our inspection.

There were enough staff available to safeguard the health, safety and welfare of people. Staff were given induction and training so they had the skills they needed to meet the needs of people living at the home.

People were protected against the risk of abuse, as the provider took appropriate steps to recruit suitable staff, and staff knew how to protect people from harm. The provider had appropriate policies and procedures so staff understood how to report abuse, or allegations of abuse.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People’s rights were protected where they could not make decisions for themselves; as decisions were made in people’s ‘best interests.’

People were provided with food and drink that met their health needs and their preference. People were supported to access healthcare professionals to maintain their health and wellbeing.

Care staff treated people with respect and dignity and supported people to maintain their privacy and independence.

People chose who visited them at the home, which helped them to maintain personal relationships with people in their community. However, people weren’t always supported to take part in interests and hobbies that interested them.

People knew how to make a complaint if they needed to. Complaints were fully investigated and analysed so that the provider could learn from them. Action was taken to improve the service following complaints.

People who used the service, and their relatives, were given the opportunity to share their views on the quality of the service. Quality assurance procedures were in place to identify where the service needed to make improvements. Where issues had been identified the manager took action to improve the service.

This inspection was completed by two inspectors. During our visit we spoke with the manager, four care staff, two people who lived in the home and five visiting relatives. We also carried out observations of care throughout the home. The evidence we collected helped us to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and carers told us.

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

Is the service safe?

People were cared for in an environment that was well maintained and fit for purpose. We found it was clean and tidy with no unpleasant odours.

Relatives and visitors told us they felt their relatives were well looked after. We were told, "We couldn't ask for any more from a care home."

There were arrangements in place to deal with foreseeable emergencies. This included 24 hours staffing and a call bell system that people could use to call for assistance.

We identified concerns during our visit with regards to the number of staff available on the first floor of the home. Staff on this floor also raised concerns with us about the numbers of staff available and the impact it was having on people's care and welfare.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The manager understood their responsibilities in relation to this legislation.

Is the service effective?

People and relatives we spoke with told us they were happy with the care provided. They told us, "They are looking after me very good", "They have catered for all Nan's needs" and "I think it's really nice."

We found that some of the care plans we looked at were not reflective of people's needs. We saw care plans were evaluated monthly, but were not always updated with any changes to care needs.

Is the service caring?

People were supported by staff who were kind and attentive. Relatives we spoke with said, "It seems very nice and friendly" and "The staff are lovely, very caring."

Interactions we observed between staff and people who lived in the home were positive and friendly.

Staff we spoke with on the first floor told us they felt they were not able to always provide the care they wanted to because of the numbers of staff available. They said, "People go without the care. We used to sit and talk to them, chat with family. It’s impossible to do this."

Is the service responsive?

Systems and processes were in place to monitor and manage complaints, accidents and incidents.

People and relatives we spoke with told us they were able to approach the manager and staff freely to discuss any concerns or worries they had.

Is the service well led?

There were processes and systems in place to monitor the service provided. The manager used the information gathered through these processes to assess and improve the quality of service for people.

Staff had mixed views regarding the management of the home. Some staff we spoke with on the ground floor told us they felt well supported and able to approach the manager. They said, "X's (the manager's) door is always open and she is available for support." Other staff, working on the first floor told us they rarely saw the manager. We were told, " I get no support from the manager" and "Very rare seniors come up. They don’t support us."

Staff did not received regular one to one supervision to enable them to discuss issues, concerns or ideas or personal development.

When we visited Chamberlaine Court we did so unannounced which meant that no one who lived at or worked at the service knew we were coming. During our visit we met some of the people that lived in the home and visiting relatives. We also met and spoke with the manager, three members of care staff, the domestic staff and the laundry assistant.

The majority of relatives we spoke with told us that they were satisfied with the care and support their family members received. Comments such as, "X is well looked after, well fed and well kept, what more could we ask for?” and "Mum has been here a while now and we are very happy with the care she gets." Two relatives raised concerns with us, some of which we were aware of. The concerns we were not aware of were directed to the manager to follow up.

People who lived in the home were complimentary about their care and the staff, commenting, " it's lovely here and very clean” and “The staff are lovely, I can get up and go to bed when I like.”

Some people living in the home had complex needs which meant that they were not always able to tell us their experiences. We spent time during our visit observing care to help us understand their experiences. We saw that staff treated people with kindness and compassion and when people approached the staff they stopped, listened and spoke with them even if they were busy doing something else.

The reason for this inspection was to look at the safe handling of medicines following our previous inspection on 13 November 2013 where concerns were identified with medicine management. This was assessed by a pharmacist inspector.

We looked at the storage of medicines, medicine administration records and some care plans.

We spoke with the new manager who it was acknowledged had been in post for two weeks. We also spoke with two members of staff and two people living in the service. The two people we spoke with were not able to discuss their medicines with us but one person told us ‘’everybody is lovely’’.

We found that improvements had been made to ensure that medicines were managed safely.

In this report the name of a registered manager, Carol Jones, appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still the registered manager on our register for this service at the time.

We carried out this review to check compliance against the concerns we identified during our previous inspection in July 2012. We also looked at how the home managed medicines for people.

During our visit we spoke with four people who used the service, two relatives, the manager and five staff on duty. Some people we met were not able to speak with us because of their complex needs. We saw that people appeared comfortable and relaxed in their surroundings and with the staff.

People we spoke with, which included visitors to the home, told us that they were satisfied with the care provided. "I'm satisfied with how they look after me, I like it here" and "Mum's been here since it opened, I've no complaints about how she's cared for" were comments made.

Care records were clear and provided staff with enough information to care for people. Daily records were being completed in line with people's care plans. People's healthcare needs were being addressed, with relevant healthcare professionals being called out in a timely manner as necessary.

The safe handling of medicines was assessed by a CQC pharmacist inspector. We found that improvements in medicine management would be necessary in order to ensure the safe handling of people’s medicines.

We found that records were well ordered and easy to follow. All records were located and produced promptly when requested.

On the day of the visit on 7 July 2011, we spoke with people living in the home, visitors, staff and health care professionals.

Due to the needs of some people living at the home who were unable to verbally share their experiences, we spent time observing the support given to people and how they spent their day.

People living in the home, who were able to do so, told us that they were happy with the care they received. They said ‘’I think it’s quite good’ and ‘we are looked after very well’. ‘Everyone has been beautiful’. Another said, ‘they are alright’ ‘they look after us well’. We asked people about their experience of living in the home, if they felt safe and if they were treated respectfully. People told us about staff ‘they are excellent ‘very very good’ and ‘they speak to you well’.

We observed staff speaking with people at the correct pace and in a way that was not undermining of their age and ability.

We observed that staff were very busy and this reflected in the amount of time they were able to spend with people, how quickly they were able to offer their personal care and the delivering of activities. Recordings on monitoring charts, particularly fluid monitoring, were not always accurate and identified long periods in time where people were not offered a drink. Staff also said that they were very rushed and that at times this had an impact on the quality of care they could provide.

A health care professional told us they had concerns that care was not always carried out as directed in the care plan, with particular areas of concern around people’s hydration, care of pressure areas and staff not using the equipment made available to them. We were told that individual staff were good, but there was at times a lack of communication between the two teams and that numbers on duty were not always sufficient.

The home shared with us that concerns had been raised about the home’s ability to provide adequate catheter care and people not receiving adequate nutrition and hydration. The regional director had undertaken an internal investigation and we were shown a copy of this and the action plan produced.

Staff spoken with told us that they were aware of the systems in place and the actions that they had to take should they become aware of anything, or witnessed anything, that may constitute abuse. They said that they would feel comfortable reporting issues to the managers.

When we visited Chamberlaine Court we met with most of the people using the service. We met and spoke with six members of staff, the registered manager and an operations manager for Prime Life Ltd.

Most people using the service were not able to talk to us about their care because of their complex needs, however when we asked them if they were comfortable they smiled and nodded. We spoke briefly however with four people using the service. One person told us, “The staff are very good, in fact they are excellent. They treat me respectfully.” Another person told us, “I go to the lounge a lot. People come in, we have flower arranging today. The staff arrange things like quizzes and I go out occasionally.’’

We saw people's bedrooms were clean, warm and well furnished. People had brought some personal items with them into the care home and this made their rooms "homely".

We found that staff knew people's personal needs and ways of communicating those needs. We saw that people were relaxed and at ease with staff and within the home environment.

We looked at the care planning documentation for four of the people using the service to see how their care was provided and managed. We found care planning in place to meet people’s identified needs however, although reviews of care were carried out this did not always happen promptly when a person’s needs changed.

People told us that the food was “good” and we saw that any special dietary needs had been detailed in people’s care plans. Improvement was needed however in recording the amount of food and drink people took each day to be sure their health and well being was being maintained.

We spoke with three relatives who were visiting at the time. They told us that their family members were cared for well and that staff were “good” and “kind.” One relative told us, “We are very happy with the home. Mum is always nicely dressed, happy and cheerful.” Another relative told us, “Mom has her medication on time and her GP has been to visit her. The home is nice and clean.”