The inspection took place on 8 November 2016 and was unannounced. The service was previously inspected in April 2015 when breeches of legal requirements were identified. The provider sent us an action plan outlining how they would meet these breeches. You can read the report from our last inspection, by selecting the 'all reports' link for ‘Chapel Garth’ on our website at www.cqc.org.uk.

Chapel Garth provides residential care for up to 33 older people living with dementia. People are accommodated on the ground floor and there is an upper floor used exclusively as office space and by staff. The communal areas of the home are accessible to people who use wheelchairs. The home is located in Bentley on the outskirts of Doncaster.

The service had a registered manager in post at the time of 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.

We spoke with staff about safeguarding people from abuse and they were very knowledgeable about this. They told us they attended training and they had learned about the different types of abuse and how to recognise and report it. A safeguarding flowchart was available in the duty office to guide staff of what action to take if needed.

We looked at three recruitment files and found the provider had a safe and effective system in place for employing new staff.

We looked at systems in place to manage medicines and found that they were safe. Medicines were stored, administered and recorded correctly.

Care plans we looked at identified any risks associated with people’s care. For example, risk assessments were in place for falls, choking, pressure area care and nutritional needs.

Staff we spoke with told us they received appropriate training to do their job well. Training was provided via e-learning, however practical training courses were provided face to face.

We observed staff interacting with people and we spoke with staff and the registered manager and found the service to be meeting the requirements of the Mental Capacity Act. The registered manager told us that appropriate applications in relation to Deprivation of Liberty Safeguards were made to the supervisory body.

People received a healthy and nutritious diet based on their preferences and were given choices at meal times. We also saw a choice of drinks and snacks were offered at frequent intervals during the day.

People had support from health care professionals were required. This was sought in a timely and efficient way.

We observed staff interacting with people and saw they did this in very caring was. Staff had a calm and friendly manner and were focused on providing appropriate care and support to people who were using the service. Care plans we saw included information about people’s likes and dislikes.

The service had identified key staff to be dignity champions. Their role was to ensure dignity for people who used the service was upheld.

We looked at care records belonging to people and found they were informative and reflected the care and support being given. Care records included activities of daily living which explained how best to support the person.

The service employed an activity co-ordinator who was available 30 hours a week. We spoke with this person and they told us that they used this time to plan and support activities within the home.

The provider had a complaints procedure and people felt able to raise concerns if they needed to.

People told us the registered manager was supportive and there was a good leadership structure in place. People felt able to approach the manager and felt she listened to them and acted on what they told her.

We saw regular audits took place to check the quality of service

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

The inspection was unannounced. During the visit we spoke with seven people who used the service, five relatives, four care workers and the manager.

Chapel Garth provides residential care for up to 33 older people living with dementia. People are accommodated on the ground floor and there is an upper floor used exclusively as office space and by staff. The home is located in Bentley on the outskirts of Doncaster.

The service had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We saw there were systems in place to protect people from the risk of harm. We observed staff that responded well to people and understood their individual needs.

We found that people were supported by sufficient numbers of qualified, skilled and experienced staff. Staff had a programme of training which they found useful. Staff did not always feel supported by the manager and staff were not supervised on a regular basis. Procedures were in place for the recruitment and selection of staff and appropriate checks had been carried out prior to the staff starting work.

Suitable arrangements were in place to support people to maintain a healthy variety of food and drink. Snacks and drinks were offered throughout the day.

People’s needs were assessed but care and support was not always planned and delivered in line with their individual care needs. Care plans contained some information which explained how to meet the person’s needs. However some people had been assessed as being at risk from developing pressure ulcers and were also at risk of malnutrition and no care plans were put in place to address these needs.

We observed staff supporting people who had developed good relationships with people and knew what their preferences were. However, one person did not eat their lunch and the staff knew it was possibly because the person had been given potatoes with skins on them and this was not the person’s preference. Nothing was done to ensure an alternative was offered. 

The manager told us they were confident that all staff had a good understanding of the Mental Capacity Act 2005 and had completed training in this area.

People who used the service and their relatives said they felt comfortable to raise concerns with the manager or staff. The complaints procedure was on display in the main entrance area. The manager told us no complaints had been received over the past 12 months.

The provider had a system to monitor and assess the quality of service provision. This feedback gave the people chance to have their say and an opportunity for the provider to improve.

We were unable to ask the views of some people resident in the home because they were not able to express their views due to their condition . However, we did speak with 6 people who used the service. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed the dining room when people were having their lunch. We saw staff including people in their conversations even if they were not able to respond fully. We saw that people were given choices and that their choice was respected.

Before people received care and treatment they were asked for their consent and the provider acted in accordance with their wishes. The appropriate procedure was followed where people were not able to give consent.

People who used the service had a care plan which was relevant to their individual needs. We spoke with people who used the service, five relatives and two care workers, two senior care workers, the cook and a domestic assistant as well as the registered manager and deputy manager. One person who used the service said, "It's really nice here." A relative said, "It’s just like visiting my relative in their own home.”

People were supported to be able to eat and drink sufficient amounts to meet their needs. People we spoke with said that the food was homemade and good quality. One relative said, “There is always plenty of food and drink available.”

People were cared for in a clean and hygienic environment. People we spoke with said their relative’s room was always clean and tidy.

We found that the provider had an effective recruitment procedure in place. Appropriate checks were undertaken before staff began work.

The provider had an effective system in place to regularly assess and monitor the quality of service that people receive.

People we spoke with said they had no complaints but felt at ease to talk with staff.

We have not spoken with people who used the service during this inspection. However, the inspection report dated 22 June 2012 contains the views of people who used the service. At this inspection we reviewed the provider's compliance with a compliance action issued regarding the maintenance of some floor coverings in the home.

During our inspection we spoke with six people who used the service. They told us they felt safe and liked living in the home. They said they were happy with the care they received. They could make choices and decisions about their care. Comments included:

"We get two choices of meal at lunchtime and if we don’t like that, we can always have something else."

"The staff are good."

"We are well looked after."

We also spoke with two people’s relatives. They said they were happy with how the home was run. They were happy with the standard of care their relatives received. They told us that staff kept them up to date with their relative’s welfare and consulted them about their care. Comments they made included:

"There are plenty of activities."

"The staff are sensitive and respectful."

People told us the home was clean and well decorated and the gardens were nice. However, when we looked around the home we found that the floor coverings needed to be replaced in some areas.

The inspection took place on 14 and 16 April 2015 and was unannounced. Our last scheduled inspection at this service took place in July 2014 when we found two breaches of legal requirements.

The provider sent us an action plan stating that they would be compliant by March 2015.

Chapel Garth is a care home without nursing. It provides care for up to 33 older people who are living with dementia. The home is situated in Bentley on the outskirts of Doncaster.

The service had a registered manager in post at the time of 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.

We spoke with staff who had a clear understanding of safeguarding adults and what action they would take if they suspected abuse. One care worker said, “If I needed to report anything I would not hesitate, I know this would be dealt with appropriately.”

Care and support was planned and delivered in a way that ensured people were safe. The care plans we looked at included risk assessments which identified any risk associated with people’s care.

We spoke with staff and people who used the service and we found there were enough staff with the right skills, knowledge and experience to meet people’s needs.

People were supported to have their assessed needs, preferences and choices met, in the main, by staff who had the necessary skills and knowledge. We saw that although staff had attended training sessions the training was not always embedded into practice.

We found the service to be meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). However, some people who used the service were subject to a Deprivation of Liberty Safeguard (DoLS), and some staff we spoke with did not know which people had a DoLS in place, or how they would monitor this.

People were supported to eat and drink sufficient quantities to maintain a balanced diet. Meals were appropriately spaced throughout the day with snacks in-between.

People were supported to maintain good health, had access to healthcare services and received on-going healthcare support. We looked at people’s records and found they had received support from healthcare professionals when required.

We observed staff interacting with people and found the majority of staff were kind, friendly and respectful. They appeared to know the people they were supporting well. The activity co-ordinator was very active throughout the inspection and engaged well with people sharing jokes and friendly banter. However, we also observed a minority of staff appeared very task orientated and missed opportunities to engage with people.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plan.

The activity co-ordinator produced a quarterly newsletter which included staff profiles, introduced new staff, any changes in the service and any suggestions made.

The service had a complaints procedure and people knew how to raise concerns. The procedure was displayed in the reception area of the home. People we spoke with told us they would talk to staff if they had a worry. People were confident that issues would be resolved. We looked at the complaints log and found one complaint had been raised in the last 12 months. This was dealt with appropriately and in line with the company policy

We spoke with staff who confirmed they knew their role within the organisation. They felt supported by the registered manager. During the inspection we observed some times when leadership was lacking.