About the service: Chaston House is a residential care home providing personal care to nine people aged 65 and over at the time of the inspection.

People’s experience of using this service:

People were happy with the service they received at Chaston House. One person said, “You get exactly the care you need when you need it.”

During this inspection we found one breach of regulations. This was because recruitment practices were inconsistent. There was a lack of references for some staff as well as a reliance on former employer’s criminal checks on staff.

There were discrepancies with the recording of safeguarding incidents, however, staff knew what to do if they suspected abuse. There was enough staff in place. People were risk assessed to ensure their needs were met safely. Medicines were administered safely. There were infection control measures in place. Lessons were learned when things went wrong.

People’s needs were assessed. Staff received training how to do their jobs. Staff told us they received induction and supervision. People enjoyed the food they were provided and were supported to eat and drink healthily. The service was adapted to meet people’s needs. People were supported with their healthcare needs. People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People and their relatives told us they were treated well. Staff understood equality and diversity. People could express their views and be involved with choices around their care and treatment. People told us their privacy and dignity was respected and their independence promoted.

People’s care plans recorded their needs and staff understood these needs. People participated in activities within the home. People were able to make complaints and when doing so these were responded to appropriately by the service. The service worked with people who were at the end of their lives and respected their wishes.

People told us they thought highly of the management team, however, we had concerns around the overall managerial oversight and felt improvements could be made to aspects of the service. The registered manager told us about changes they had made and those they wished to make. The service completed audits to monitor the safety and care of people using the service. The service had links with other agencies.

Rating at last inspection: At the last inspection the service was rated Good. (report published on 27 July 2016)

Why we inspected: This was a planned inspection

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report

Follow up: We will continue to monitor intelligence we receive about this service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

The inspection took place on 27 and 28 June 2016. The first day was unannounced and we told the provider we would return on the second day to finish our inspection. The service was last inspected on 19 February 2014 and at the time was found to be meeting all the regulations we looked at.

Chaston House is owned by Chaston House Limited. Chaston House offers accommodation and personal care for up to 11 older people. There were seven single rooms and two shared rooms. At the time of our inspection, 11 people were living at the service, nine of whom were living with the experience of dementia.

There was a registered manager in post who had been managing the service for the past eight years. 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.

Areas of the home were in need of upgrading and redecoration. Some carpets were stained and worn, flooring was damaged in one of the bathrooms, and there was a malodour in the main lounge on the first day of our inspection. We have made a recommendation for the provider to address this. The home was clean and tidy and free of hazards.

A range of activities were provided at the home, and we saw a program of activities displayed. However, we saw very few activities organised on both days of our inspection.

Medicines were stored securely and staff followed the procedure for recording and safe administration of medicines. Staff received training in the administration of medicines, and this was refreshed annually. The registered manager undertook regular audits of medicines.

The provider had processes in place for the recording and investigation of incidents and accidents. Risks to people’s safety were identified and managed appropriately.

There were enough staff on duty to meet people’s needs in a timely manner.

People felt safe when staff were providing support. Staff had received training and demonstrated a good knowledge of safeguarding adults.

Recruitment records were thorough and complete and the provider had ensured that staff had a Disclosure and Barring Service (DBS) check prior to starting work.

The registered manager told us that some of the people living at the service had mild dementia, and there were no restrictions in place at present but they told us that they would refer people to the local authority if they were aware that a person was losing the capacity to make their own decisions about their care and treatment.

People’s capacity to make decisions about their care and treatment had been assessed. Staff had undertaken training about the Mental Capacity Act 2005 (MCA) and were aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS).

Staff received regular supervision and an annual appraisal, and told us they felt supported by their manager. There were regular staff meetings and meetings with people and their relatives.

Staff had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service.

There was a complaints process in place and people told us they knew who to complain to if they had a problem. People and their relatives were sent questionnaires to gain their feedback on the quality of the care provided.

People told us they felt safe at the home and trusted the staff. They told us staff treated them with dignity and respect when providing care. Relatives and professionals we spoke with confirmed this.

We saw people being cared for in a calm and patient manner. There was a relaxed, unrushed atmosphere which facilitated good communication between staff and people using the service.

People gave positive feedback about the food and we observed people being of

At our inspection on 9 October 2013 we found that the service was not meeting essential standards of quality and safety in a range of areas. For example, people and/or their representatives had not been involved in planning their care and they had not been consulted about cameras that had been installed in the home which would infringe on their privacy. We found that people's needs had not been fully assessed and care plans and risk assessments did not contain sufficient detail for staff to ensure people's needs were met effectively. In addition to this we found that the arrangements for safeguarding people were unsatisfactory and staff were not receiving adequate support in terms of supervision and annual appraisals to assess their performance and identify training and development needs. We found that some records did not contain sufficient detail and other records were unavailable for us to view.

During this inspection we spoke with the manager, three other members of staff and spoke with two people who use the service. The people who use the service had complex needs which meant they were unable to share their experiences with us. We found that steps had been taken to involve people and/or their representatives in care planning and the cameras that were previously installed in the communal areas of the home had been removed.

We found that care plans and risk assessments had been reviewed and updated to contain more detailed information about people's needs and how staff should meet these. However, some of the information was not personalised and did not include people's likes and dislikes.

Adequate arrangements were in place to ensure that people using the service were protected from abuse.

Systems had been implemented to ensure that staff received regular supervision and annual appraisals to assess their performance and identify training and development needs.

The records we viewed were generally up to date, in good order and could be located promptly.

We spoke with the manager, one other member of staff and three people who use the service. We were unable to speak with some people as they had complex needs and were unable to share their experiences with us. Therefore we used a variety of methods such as observation, looking at care records and speaking with staff to gain information about their experiences.

We observed some positive interactions between staff and the people using the service. We observed the lunchtime meal and saw staff talking with people and assisting them in a sensitive manner and offering them choices. The people we spoke with were positive about the staff and one person said, "staff are lovely" whilst another told us, "they're pretty good."

We saw that staff had attended recent training provided by the local authority in areas such as food hygiene, dealing with challenging behaviour, nutrition and dementia, mental capacity and therapeutic activities. The staff we spoke with said that there had been a lot of training offered in the last few months and that this had supported them in their role.

We found that people and/or their representatives were not always involved in planning their care and people's privacy and dignity was not always respected. We also found that people's needs had not been adequately assessed and care plans were incomplete and therefore did not fully inform staff about how to meet people's needs. Identified risks were not being appropriately managed.

The service had inadequate systems in place to ensure that people were protected from abuse.

Not all staff were receiving regular supervision to ensure they received adequate support in terms of their performance and development.

There were gaps in the records kept by the service and not all records could be promptly located when required.