We carried out an unannounced comprehensive inspection of this service on 02 and 03 February 2017. After that inspection, we received complaints and information of concern in relation to poor infection control measures; insufficient staffing levels and skill mixes; poor medicines management and lack of related training for staff. Additionally, we were told staff were not adequately trained; there was insufficient hydration for people who lived at the home; lack of external medical support when people deteriorated; inadequate personal care; and poor staff attitude. Furthermore, complainants told us there was lack of involvement of people and relatives in care planning; poor recordkeeping; unsatisfactory management of complaints; people’s preferences not met; lack of activities; and lack of confidence in the home’s management.

Consequently, we undertook a comprehensive inspection to review these concerns. We did this because there were multiple areas raised in relation to the five key questions we look at – is the service safe, effective, caring, responsive and well led?

Chaseside provides personal care and support for a maximum of 22 older people who may be living with dementia. The home is situated in a residential area of Lytham St Annes close to the local park and the promenade. There are two double rooms available for those who wish to share facilities, which include privacy screening. Communal areas consist of two lounges, a separate dining room and an area designated as the ‘sensory room.’

A registered manager was not in place. 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.

At the last inspection on 02 and 03 February 2017, we rated the service as Requires Improvement. This was because the home was in the process of making ongoing improvements, which required time to embed in service management, care delivery, staff understanding and Chaseside’s environment.

We additionally made recommendations for the provider to further improve people’s safety and welfare. These concerned systems to enhance recordkeeping associated with medication and infection control.

During this inspection, people we spoke with told us they felt comfortable living at Chaseside. One person said, “I feel safe.” Staff received medicines training and competency testing to demonstrate they were safe to administer medication. The provider developed with each person an individual medication care plan and risk assessment to guide staff to manage their medicines safely.

We received positive comments from people about the cleanliness of the environment. The provider had assigned a staff member the role of ‘infection control champion’ who was responsible for disseminating good practice at Chaseside.

The provider had systems to assess, monitor and alleviate potential risks to people who lived at the home. Staff demonstrated a good awareness of safeguarding and reporting procedures. They received training to underpin their skills and understanding.

We reviewed rotas and found staffing levels and skill mixes were sufficient to meet people’s support requirements. We checked staff records and noted employees received, or were in the process of completing, training. The provider had reviewed each applicant’s full employment history, qualifications and abilities to work at the home before they were recruited.

We observed staff were knowledgeable and effective in supporting people who lived with dementia or displayed behaviours that challenged the service. This helped to identify triggers and methods of supporting people that had a positive impact on them and everyone else at the home.

Records we looked at confirmed all staff who prepared food completed food safety a

The inspection visit at Chaseside was undertaken on 02 and 03 February 2017 and was unannounced.

Chaseside provides personal care and support for a maximum of 22 older people who may be living with dementia. At the time of our inspection there were 13 people living at the home. Chaseside is situated in a residential area of Lytham St Annes close to the local park and the promenade. There are two double rooms available for those who wish to share facilities, which include privacy screening. Communal areas consist of two lounges, a separate dining room and an area designated as the ‘sensory room.’

At the last inspection on 29 June 2016, we rated the service as Inadequate and placed it in ‘Special Measures.’ This was because breaches of legal requirements were found. The provider failed to ensure care was planned around people’s personal needs and wishes, in ways that promoted their dignity and privacy. We saw legal consent to care and treatment was not always obtained from each person or their representative. People were not always protected from the risk of being unlawfully deprived of their liberty. The provider failed to safeguard each person’s health and safety by not consistently assessing risks and planning support to mitigate them. They had not ensured staff had the skills to care for individuals in a safe manner. Additionally, staff were not properly recruited to protect them against unsuitable employees.

We additionally made a recommendation for the provider to care plan people's individual preferences in relation to activities. This included information about the support they required to engage in them.

During this inspection, we found the provider had made a number of improvements following our last inspection. Training records we looked at confirmed staff had completed training related to safeguarding principles. When we checked their understanding of protecting people from potential abuse or poor practice, we found they had a good level of awareness. The provider was implementing new risk assessments and related procedures to protect people from an unsafe environment and inappropriate care. In the meantime, we saw current records had been updated and reviewed. People told us they felt safe whilst living at the home. One person said, “Yes, I keep myself safe, but the staff are there to help.”

We looked at rotas from the previous four weeks and saw levels and skill mixes of staff were sufficient. Ancillary personnel enabled care staff to focus on their own roles and responsibilities. We reviewed staff files and found they consistently held the required information to protect people from the recruitment of unsuitable employees. Staff, including new personnel, had training and supervision, underpinned by competency checks, to support them in their responsibilities.

The home was clean and tidy throughout. However, we identified a strong, unpleasant odour within the ground floor hall and attached communal areas throughout our inspection. We saw further issues with the staff toilet, the lack of bin lids and kitchen cleaning recordkeeping. We discussed this with the provider, who assured us they would address the issues as a priority.

We have made a recommendation the provider seeks guidance about safe practice and recordkeeping in relation to infection control.

People we spoke with said they received their medicines on time and when required. We saw staff were trained to administer medication and had regular competency testing to check they were safe practitioners. However, we noted handwritten entries were not consistently countersigned to evidence accuracy and there were gaps in related monitoring charts. The provider told us they address these issues as a matter of urgency.

We have made a recommendation about the provider seeking guidance related to medicines recordkeeping.

The provider had improved how they obtained consent to care and worked within the Mental Capacity Act 2005 (MCA) and Deprivation o

This inspection took place on 29 June and 11July 2016 and was unannounced.

Chaseside Care Home is located in Lytham St. Annes, Lancashire. The home is registered to provide accommodation and care for up to 22 older people. The majority of people accommodated are living with dementia. At the time of our inspection there were 12 people who used the service.

At the time of this inspection there was no registered manager in place at the service. The previous registered manager left the service in November 2015. Since this date the provider had taken control of the day to day running of the home but had not applied to the Commission for registration. 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 last inspection of this service took place on 18 November 2015. At this time the service was found to be in breach of regulations relating to good governance and person centred care and was awarded a rating of ‘Requires Improvement.’

During this inspection we had ongoing concerns relating to the previous breaches. We also identified further breaches of regulations.

Risks to the health, safety and wellbeing of people who used the service were not always assessed or managed in an effective way. Some examples were found of risk assessments not being completed and other examples were found of risk assessments which did not contain current or accurate information. Where risks were identified, these were not always addressed through robust care planning.

We found that suitable arrangements were not in place to ensure that all staff had the necessary skills and knowledge to meet people’s needs safely.

There were significant shortfalls in the service’s recruitment procedures. We found several examples of staff being recruited and allowed to work shifts in the home without the appropriate background checks being carried out. This meant the safety and wellbeing of people who used the service was not protected.

The rights of people who were not able to consent to their care were not consistently protected as the service did not always work in accordance with the Mental Capacity Act and associated legislation.

People’s privacy and dignity was not consistently promoted due to inadequate arrangements to protect their personal information.

The arrangements for monitoring the safety and quality of the service were found to be in ineffective. Audits viewed had not identified some significant shortfalls and had failed to assist in identifying areas for improvement.

Evidence showed that potential learning from adverse incidents was not always identified or acted upon.

When viewing rotas it was not always clear who was in charge at the home on particular dates. Rotas were not always properly completed to reflect this information.

We requested the provider’s training records during and after the inspection to enable them to demonstrate their competence to carry out the role of registered manager. However, these were not provided.

Complaints were not always properly recorded. We did however, find evidence that the provider took action to resolve concerns raised.

Procedures for managing people’s medicines were found to be generally satisfactory. Although some minor shortfalls in records were identified.

People we talked with spoke highly of staff and felt they were treated in a kind and caring manner. People expressed satisfaction with the standard of accommodation and the quality and variety of meals provided.

The provider and staff worked in partnership with community professionals to help ensure people’s health care needs were met.

Meetings for people who used the service were held on a periodic basis. The provider attempted to gain people’s view

We carried out this inspection to answer our five questions; 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 four people who used the service, two relatives, the staff supporting them and from looking at records. We also spoke with two community professionals and the local authority commissioning team.

If you want to see the evidence supporting our summary please read the full report

Is the service safe?

The registered manager had improved processes for identifying risk to people who used the service in areas such as falling or developing pressure ulcers. Risk assessments were now an integral part of each person’s care plan and where risk was identified, there was a clear management plan in place to provide them with safe support.

Recruitment processes were significantly improved and there was evidence that all new staff members were required to undergo a variety of background checks prior to being offered employment. This meant that people were better protected from the risk of receiving their care from a person of unsuitable character.

There were improved processes for the monitoring and analysis of incidents and accidents. This meant the registered manager was able to identify any themes or patterns and take prompt action to address them.

Some improvements were found in the management of medicines, but we found evidence that medicines were still not always managed safely.

Safeguarding procedures had been reviewed and further training had been arranged to help ensure all staff were fully aware that any safeguarding concerns must be reported without delay. Further improvements to the risk assessment and care planning for people with complex behaviours would safeguard them and those around them more effectively.

Is the service effective?

People’s health care needs and the support they required in this area was well detailed in their care plan. Care records demonstrated that the registered manager and care workers identified changes in people’s health care needs and took prompt action to ensure health care support was provided when necessary.

A process for the induction of new staff was in place. This helped ensure that new starters received the necessary support and guidance to carry out their roles effectively.

A full training audit had been completed by the registered manager and the core training programme for staff had been improved. Arrangements had been made to ensure all staff were provided with training in accordance with the core programme. In addition, all staff employed at the home had been enrolled on national vocational training.

Is the service caring?

We spoke with four people who used the service and two relatives. The feedback we received was very positive. One person commented, “We could not have asked for better people to look after Mum” and told us they ‘couldn’t have been happier with the care provided.’

Another person we spoke with told us they were very happy with all aspects of the care their loved one received. They told us they visited the home on a daily basis and saw everything that happened. They said, “They are not just lovely with (name removed), they are the same with everyone – they are so nice with the residents.” She went on to say she felt she also received a good level of support from the registered manager and staff. “I am always welcome. They invite me for meals and help me with transport as well. Those little things make a really big difference.”

We spoke with a person who used the service who was supervising the setting up of the dining room for lunch. She told us she did this task every day and was clearly enjoying it. She said of the staff, “We have a right laugh here. They are good people. I get on with them all.”

Other comments we received from people who used the service included: “It’s nice here. In fact it’s not nice – it’s very nice.” “We have no problems here. You can give them the seal of approval.”

Is the service responsive?

We spoke with one person who described their experience when their loved one had started to use the service. They told us the registered manager had taken time to understand their relative’s needs and that a detailed care plan had been put in place that reflected their needs. They said they had found the process very reassuring.

We found the standard of people’s care plans was improved. Information about their needs, wishes and preferences was included in a clearer way, so staff had some understanding of how people wanted their care to be provided.

We found evidence that the provider and registered manager had sought the views of people who used the service and their relatives, and acted on them. Arrangements were in place to hold regular meetings with people and a number of changes had been made as a result of feedback they had given.

Is the service well led?

There was a new registered manager in place. The registered manager was fully aware of previous concerns identified about the service and was able to provide evidence of action taken to address them, as well as plans for further improvement.

The provider of the service now worked in the home on a daily basis, maintaining contact with people who used the service, their relatives and staff and ensuring the registered manager received sufficient support.

Formal systems to assess the quality and safety of the service were now in place and included regular monitoring of all aspects of the service provided. We also found evidence that the registered manager took appropriate action when any areas for improvement were identified.

We spoke with two community professionals who felt the service had improved significantly and who were satisfied with the service provided.

We carried out this inspection to assess the provider’s progress in addressing concerns in relation to record keeping, which we identified during our last inspection. Following the last inspection of the home we judged that people were at risk of receiving unsafe or ineffective care because accurate records about their care or the people providing their care were not maintained.

During this inspection we were assisted by the newly appointed manager who was going through the process of registration with the Commission. The manager was aware of the concerns and with the provider’s support, had taken a number of steps to address them.

The manager was able to give us a number of examples of significant improvements and also described improved quality monitoring processes, which would help ensure the improvements were maintained.

As part of this inspection we carried out an unannounced visit to the home. We observed routines throughout the day and interaction between staff and residents.

The home was busy with various activities going on. A visiting musician was entertaining some residents whilst others had a walk to the park. Residents were seen moving around the home freely, some choosing to sit out in the sun. There were a variety of visitors throughout the day.

We noted that staff supported people in a kind, respectful manner. Staff were seen to attend to residents’ requests promptly and in a pleasant way. The interaction between the staff and residents was very positive with lots of friendly discussion and joking.

We spoke with residents and in some cases, their relatives. In general, the feedback we received was very positive and most people expressed satisfaction with their care and spoke highly of staff.

One person commented, ‘’This is a place where the staff and managers really do care about the residents. I think the standard of care is brilliant.’’ A resident told us about the recent refurbishment that had taken place. He said he had felt involved throughout. ‘’It was marvellous. They came to me and asked me where I wanted my shelves and plug sockets. It was all done to my request!’’

Other comments included:

‘’I have always been very happy here. The care is very good.’’

‘’We have been more than satisfied with the whole package! No complaints whatsoever.’’

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, staff and from looking at records.

We asked five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

Staff knew what care people needed to keep safe and understood the risks to individual resident’s safety and wellbeing. Staff knew what measures they needed to take to protect people from harm.

Where people’s rights were restricted in their best interests, the manager had gained the appropriate authorisation and worked in accordance with the Mental Capacity Act and Deprivation of Liberty Safeguards.

Staff had clear guidance about supporting people with complex behavioural needs and had received training in areas such as de-escalation and physical intervention.

Staff were aware of their duty to report any suspected abuse or poor practice and felt confident to do so. Staff had received training in recognising abuse.

Staffing levels were adequate to safely meet the needs of people who used the service. People received their care from a consistent staff team who they were familiar with.

Staff were trained in important health and safety areas such as fire safety, infection control and moving and handling.

The manager and staff learned from events such as accidents, complaints and safeguarding investigations. However, records did not always reflect this. Records of audits, and the monitoring and analysis of adverse incidents would help ensure risks to people were quickly recognised and addressed. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to record keeping.

Is the service effective?

People we spoke with expressed satisfaction with their care and felt their needs were well met.

Residents appeared content in their surroundings and got along well with staff.

We saw some residents had experienced good outcomes due to the care they had received. For example, improvement in mental and physical health since their admission to the home.

People were supported to access support from community professionals such as District Nurses and GPs. The home had systems in place to ensure that any advice given by external professionals was incorporated in people’s care plans.

There were ample numbers of staff on duty to provide effective care and respond to people’s individual requests.

Staff had training in a number of areas to help them provide safe and effective care.

People’s care plans and risk assessment information did not always reflect all of their needs or was not fully up to date. This meant that people could be at risk of not receiving the right care. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to record keeping.

Is the service caring?

People we talked with spoke very highly of staff describing them in ways such as ‘kind’, ‘caring’ and ‘helpful.’

We observed people receiving support and saw that this was provided in a pleasant and respectful manner. Staff addressed residents with kindness and patience. Staff responded to resident’s requests straight away and appeared happy to do so.

People’s privacy and dignity was respected and promoted by the manner in which staff supported them.

The manager had introduced a new care planning tool called ‘This is me.’ This helped carers to understand the things that really mattered to people and made a difference to their daily lives. For example, their preferred daily routines, hobbies and important relationships.

Is the service responsive?

We saw that feedback from residents and their families was encouraged. The manager was able to give us examples of changes that had been made as a result of people’s feedback.

People that we spoke with told us they were able to raise concerns and felt that the manager was approachable. One person we talked with had recently had cause to raise a concern, which she felt had been responded to appropriately.

We saw examples of improvements made within the service as a result of feedback from other professionals. For example, the home had implemented a detailed improvement plan as a result of a recent local authority quality inspection.

There was evidence that changes in people’s care needs were identified by staff and responded to appropriately. For example, we looked at the care plan of one person whose general health had deteriorated. We saw that staff had been quick to seek medical advice and adapt the resident’s care plan in line with their new needs.

We were able to confirm that staffing levels were developed in line with the needs of residents. There were processes in place to ensure that additional staff could be brought onto duty if any residents required additional care.

The manager and staff learned from events such as accidents, complaints and safeguarding investigations. However, records did not always reflect this. Records of audits, and the monitoring and analysis of adverse incidents would help ensure people received an effective service. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to record keeping.

Is the service well led?

People told us the manager and provider were approachable and supportive.

The manager maintained a strong and regular presence in the home and was constantly available to residents, relatives and staff.

The manager listened to feedback from people who used the service and other professionals and took action in response to it.

Staff had good understanding of their roles and duties. Staff understood how to raise concerns and felt confident in their manager to deal with concerns appropriately.

There was a quality assurance system in place, which included the use of audits and the monitoring of adverse incidents and complaints. However, these were not always well recorded. Records of audits, and the monitoring and analysis of adverse incidents would help ensure any shortfalls in the quality of the service were quickly recognised and addressed. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to record keeping.

During the inspection, we spoke with three people who use the service. They told us they were happy with the care being provided and that the staff were helpful and friendly.

We found that people were asked for consent and the provider acted in accordance with people’s wishes. People who use the service received care in a way that met their needs and preferences.

The people we spoke with told us the staff prompted them when they needed to take their medicines and they were always given their medicines on time. We found there were arrangements in place to manage medicines safely. People were cared for by staff that had been through the appropriate recruitment checks.

The people we spoke with told us they had no concerns about the care they received and they would speak to the registered manager if they had any concerns. We found that there was an effective complaints system available, in case anyone wished to raise a complaint.

We spoke individually with three people living at Chaseside Care Home. The conversation with two of the people was somewhat restricted because of the effects of dementia. However these people told us they were happy living at the home and that they liked the staff team. We also spoke briefly with other people in communal areas of the home.

A more in-depth discussion took place with the third person who confirmed he was encouraged to made positive decisions for himself on a day to day basis. This person told us, “I feel very content here, almost too content. They all support me very well. I am very well looked after. They cater for all people here really well, they care for people. I feel safe here”

We observed that people were comfortable and relaxed in their surroundings. It was also clear that there was a positive relationship between the staff team and the people they supported.

In order to try to understand what it was like for people living at the home we also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us. We observed that people who used the service were supported to remain as independent as possible. We also saw that people were consistently treated with dignity and respect. For example, we saw staff offer assistance with personal care needs in a discreet and dignified manner and called the person by the name they preferred.

This inspection took place on 4 and 5 November 2015 and was unannounced.

Chaseside Care Home is located in Lytham St. Annes, Lancashire. The home is registered to provide accommodation and care for up to 22 older people. The majority of people accommodated have a diagnosis of dementia. At the time of our inspection there were 13 people who used the service.

At the time of this inspection the registered manager had just left the service to take up a position in another organisation. We were assisted during the inspection by the provider who had taken over the day to day running of the service until such time as a new manager was appointed and registered. 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 last inspection of the home took place on 14 May and 18 June 2015. During that inspection we found the service was in breach of a number of regulations in relation to consent, safe care and treatment, staffing and good governance. The service was placed in ‘special measures’ and given a period not exceeding six months to make significant improvements.

We found during this comprehensive inspection this provider had demonstrated improvements when we inspected. We have judged it is no longer rated as inadequate for any of the five key questions. Therefore Chaseside will no longer be in special measures. However, we had some outstanding concerns in relation to good governance and person centred care.

We found that systems to monitor safety and quality across the service had been improved and these were more effective in a number of areas. However, in relation to the safe management of medicines, audits were still not as robust as they should have been and as a result some errors were still occurring. This was of concern due to the potential risks to people of unsafe medicines practice. In addition, the previous failures of the service to manage people’s medicines safely meant that the provider should have prioritised this area for robust auditing and failure to do so was evidence that good governance was still not fully in place.

We found some good examples of person centred care planning that demonstrated the individual needs, wishes and preferences of people had been taken into account when planning their care. However, we found some examples where people’s care plans lacked specific information and in some cases, contained conflicting information.

During this inspection it was noted that the provider had improved practice in relation to the support of people who lacked capacity to consent to some aspects of their care. We found the provider was working in accordance with the Mental Capacity Act and associated Deprivation of Liberty Safeguards. However, we noted that the recording of information relating to people’s individual circumstances could have been clearer. We made a recommendation about this.

During this inspection we were able to confirm that the provider had implemented a tool to determine the necessary staffing levels in accordance with the needs of people who used the service. The provider was able to show us examples of adjustments to staffing levels in response to changes in people’s needs.

The training provided to staff had been reviewed and processes to monitor the training provided were in place. This helped to ensure staff received all their mandatory training and were provided with refresher training when necessary. However, we found that the training programme required some updating to remain in line with people’s needs and staff member’s different roles. We made a recommendation about this.

Risks to the health, safety and wellbeing of people who used the service were managed appropriately. People told us they, or their loved ones, received safe care and that care staff understood their needs.

Care staff demonstrated a good understanding of people’s needs and were able to confidently describe the measures they took to maintain people’s safety and wellbeing. Care staff were aware of the processes to follow in the event they had any safeguarding concerns about people who used the service and the role of external organisations.

People expressed satisfaction with the care they received and spoke highly of care workers. People felt they were treated with respect and kindness and told us staff supported them to access health care when they needed it.

The provider engaged regularly with people who used the service and their relatives. Regular meetings were held during which people were invited to express their views and opinions. In addition, regular satisfaction surveys were carried out. People who used the service and their relatives told us they felt comfortable in expressing their views and felt able to raise concerns.

During this inspection we found breaches of regulations in relation to governance and person centred care.

You can see what action we have taken at the end of this report.