The inspection took place on the 6 and 7 December 2016 and was unannounced.

Chatterwood Nursing Home, to be referred to as the home throughout this report, is a home which provides residential and nursing care for up to 24 older people. The home is currently in the process of being extended and extensively refurbished to provide a larger kitchen and laundry area, additional bedrooms and living accommodation. This refurbishment will also provide people living at the home to have their own private en-suite shower rooms. Building works were on-going at the time of the inspection.

The home is situated over two floors and most rooms on the ground floor offer en-suite toilet and sink facilities as well as a communal shower room. Upstairs most rooms offer people with a sink for hand washing and basic personal care tasks such as cleaning teeth for example. There is currently no bathroom on the upper floor due to the building works however plans are in place to replace the previously used bathroom to ensure this facility is available to those living upstairs. The ground floor offers a communal lounge which leads through to a dining room and conservatory area. In the dining room a small area is available for people, visitors and staff to make hot and cold drinks. The conservatory doors open onto a patio area with seating for people to enjoy. The home is situated in a semi-rural residential area on the outskirts of the village of Liss. At the time of the inspection 17 people were living at the home.

The home has a registered manager 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.

Relatives of those using the service told us they felt their family members were kept safe. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. Appropriate risk assessments were in place to keep people safe.

People were kept safe as the provider ensured sufficient numbers of staff were deployed in order to meet people’s needs in a timely fashion. In the event of unplanned staff shortages the provider sought to use existing staff including the registered manager to deliver care.

People were protected from the unsafe administration of medicines. Nurses were responsible for administering medicines and had received additional training to ensure people’s medicines were administered, stored and disposed of correctly. Nurse skills in medicines management were regularly reviewed by managerial staff to ensure they remained competent to administer people’s medicines safely.

The provider used robust recruitment processes to ensure people were protected from the employment of unsuitable staff.

New staff induction training was followed by a period of time working with experienced colleagues to ensure they had the skills and confidence required to support people safely.

People were supported by staff who had up the most relevant up to date training available which was regularly reviewed to ensure staff had the skills to proactively meet people’s individual needs.

People, where possible, were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people during their daily interactions. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes.

On the day of the inspection there were 18 people who use the service present. We spoke with five people, one person’s relative and three staff. We also spoke with the registered manager, the new manager who was due to take over the service from 30 May 2014 and the nominated individual.

At this inspection we followed up on three areas of previous non-compliance, to ensure that the provider had addressed the issues related to these outcomes. These were in relation to care and welfare, management of medicines and records. We found that overall the provider had taken appropriate actions to address the issues as detailed in the action plan that they had provided to the Care Quality Commission following the previous inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service responsive?

• Is the service caring?

• Is the service effective?

• Is the service well led?

This is a summary of what we found: If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Where risks to people had been identified there were risk management plans in place to safely manage them. We saw that there were sufficient staff to meet people’s needs. Where people were required to be hoisted there were enough staff to ensure this was done safely.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to this service. The DoLS are a legal process supported by a code of practice to ensure that people who lack the mental capacity to make decisions about where to live are not deprived of their liberty, other than in accordance with the law. At the time of our inspection no-one was subject to DoLS; however, we saw evidence that the service was aware of how to make an application. There was a policy in place to provide guidance for staff. Both the registered manager and the new manager informed us that they had received appropriate training and were familiar with the process.

The system to manage medicines had been changed since the last inspection to make it safer. We saw that there were records in relation to the receipt and disposal of medicines. Staff told us that the new system was much safer. People told us “We get our medicines as we need them.”

Relevant checks had been made in relation to the recruitment of staff.

We found that at this inspection appropriate records had been kept to ensure that people’s care was provided safely.

Is the service effective?

We saw that people had appropriate care plans in place to meet their identified needs. For example, where people required a thickening agent in their drink we saw that this was documented in their care plan. People had their own thickeners with prescribing guidelines printed on them.

We spoke with people who told us that their needs were well met. One person said “They understand what I want and how” and “I don’t think my daughter could have found me a better place”.

Is the service caring?

We observed that staff interacted with people throughout the inspection. They were kindly and respectful in their communications. One person’s relative told us “I have never heard a cross, impatient or unkind word.” People told us “Staff are kind and caring” and “Staff treat me as a person.” We observed that staff knocked before they entered people’s rooms. They asked people’s opinions and provided them with choices.

We noted that when a person was hoisted in the lounge, staff used a screen to ensure their privacy. We spoke with staff who told us that they always used a screen if they provided care to people who shared a room to ensure their dignity was maintained.

We observed that staff took their time when they attended to people and did not appear to rush them. At lunch staff went and checked that people were alright and gently encouraged people to eat.

Is the service responsive?

Appropriate checks had been completed to ensure people’s pressure reliving mattresses were on the correct setting. Where it had been identified that people had redness to their skin, their care was reviewed and there were care plans in place.

We spoke with people who told us that they thought the service was responsive to changes in their needs. One person told us “They are very good at getting us to hospital appointments.” Another person’s relative told us “X had a problem with her eyes and cream was obtained.”

People felt able to raise issues. One person told us “Yes, I can speak up, staff are approachable.” A person’s relative told us “The manager actively encourages feedback and is quick to respond.”

Is the service well-led?

The registered manager told us that they were due to leave the service at the end of May 2014. In order to ensure an effective handover between managers, the new manager had commenced their role at the beginning of May. This ensured that the new manager was given time to work with the registered manager in order to gain an understanding of the people who use the service and the operation of the service.

There had been a recent change in the senior management team and the new regional manager had taken measures to make the systems for monitoring the quality of the service provided more robust. The registered manager told us that they found that the regional manager was effective as they provided practical advice and set targets for work to be completed. Staff told us that they felt supported by the management. One staff member told us “We work well as a team; care staff raise issues as they arise.”

We spoke with six people, four relatives and eight staff as part of this inspection. We observed the care people were receiving to see whether they had positive outcomes. People told us they were satisfied with the care and the staff “always respected their privacy and dignity”. A person commented “the girls take care of that”. We observed the staff supporting people in a respectful manner and t took into account people’s abilities.

The care plans were variable, as some were detailed and others did not always reflect people's current needs. People were supported with their food and fluids.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Medicines management was not robust and put people at risk of not receiving their medicines as prescribed.

People were supported to raise their concerns. Those using the service, and their relatives spoken with, felt confident any issues raised would be addressed.

People's records were not always maintained accurately and may impact on their care. The food and fluid records and care records were not accurate and reflective of people's needs.

During our visit we spoke with two people who used the service and two relatives. They all confirmed that staff respected their or their family member’s wishes. One person told us: “I am in control.” We heard staff offering people choices in relation to their care and support and waiting for a response or permission before continuing.

Everybody we spoke with was positive about the care and support provided by the service. Comments included; “I have no complaints about the staff, they are so gentle” and “There is a feeling of humanity, kindness and patience here.”

We observed staff interacting with people in a professional and patient way. For example, at mealtimes, staff described each part of the meal and supported people to eat at their own pace.

The registered manager was the infection control lead. Their role was to oversee local prevention and control of infection policies. We were able to see a copy of the home’s infection control policy. The service had procedures in place to monitor this essential standard.

Staff we spoke with told us about the supervision and appraisal processes that were in place. They confirmed they had received supervision regularly throughout the year and their annual appraisal was now due.

People and their relatives were given the opportunity to comment on the care and support at the home. One of the relatives we spoke with told us: “If we find anything wrong we raise it and it is dealt with.”

Everyone we spoke to told us they were happy with the care and support they received.

One persons’ relative told us about the home. “Very friendly, very accommodating, nothing seems too much trouble.” Another relative told us about how care workers care for her family member, “their approach is, this is her (my mother’s) home and I am welcomed into her home.”

One person living at Chatterwood House said “I am very lucky to live here.”