This inspection took place on 9 and 10 January 2019 and was unannounced.

Chaucer House is a 'care home'. People in care homes receive accommodation and nursing or 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 the inspection.

Chaucer House is a purpose-built care home, registered to accommodate up to 60 people. At the time of the inspection there were 41 people living at the service.

We last inspected the service on 23 and 24 November 2017. We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and the service was rated Requires Improvement. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good.

At this inspection we found there had been a deterioration in the quality of service people received: leadership and management was poor, and people had not received safe care. We have rated the service Inadequate overall.

At the time of our inspection, there was a registered manager in post. 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.

There was not sufficient staffing to meet people’s needs. The service continued to rely heavily on agency staff, which meant people did not receive care from a consistent staff team. Risks to people had not been assessed and minimised in all cases. For example, one person did not have adequate information to for staff to support them with their catheter care. Medicines were not managed consistently safely. There were issues with medicines ordering, which lead to potential harm for one person. Staff did not always follow best practice around the labelling of opened medicines.

Accidents and incidents were documented by staff, and action had been taken to try to avoid the risk of the incident reoccurring. However, action taken did not always reduce the number of accidents, and no further follow up had been made.

Staff continued to not receive regular supervision to support them to carry out their roles. Staff had received some training, however had not received training in supporting people with behaviours that could challenge. New staff completed the providers induction process. Staff recruitment files showed the provider followed safe recruitment processes.

Some people had recently had DoLS applications authorised by the local authority. We found the conditions on people’s DoLS were not consistently being met. People were supported to have choice and control of their lives. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act were being complied with and any restrictions were assessed to ensure they were lawful, and the least restrictive option.

Quality monitoring systems had identified the shortfalls but the registered manager and provider failed to make improvements for issues identified during this inspection. This included care planning, risk assessments, staffing and the management of medicines.

Care plans we reviewed lacked person-centred details on how best to support people as individuals. One person had lived at the service for a number of weeks, and yet did not have a detailed care plan in place.

Staff we spoke with understood their responsibilities to safeguard people from potential harm and abuse. People were protected by the prevention and control of infection. The service was clean, well maintained and without odour. The service was purpose built, and since ou

This inspection took place on 23 and 24 November 2017 and was unannounced.

Chaucer House is a ‘care home’. People in care homes receive accommodation and nursing or 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 the inspection.

Chaucer House is registered to accommodate up to 60 people. At the time of the inspection there were 41 people living at the service.

We carried out a comprehensive inspection on 19 and 21 September 2016 and the service was rated Outstanding. This inspection was prompted by information from the local authority, other healthcare professionals and relatives that there were increased risks to people’s safety, health and welfare following the registered manager leaving. This inspection examined those risks.

There had been a change in the management of the service since our last inspection. There was a registered manager leading the service. 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 registered manager had started working at the service in August 2017.

There were not sufficient staff on duty to provide consistently safe, effective and person centred care. There had been a reliance on high levels of agency nursing and care staff; however, at the time of the inspection, the amount of agency staff had reduced. Staff did not always have the skills to provide the care and support people needed. Staff had not received consistent supervision and appraisal. The registered manager had increased the number of staff on duty, following the inspection; they told us that another member of staff would be on duty during the day. We will check this at our next inspection. Staff were recruited safely. New staff completed an induction when they started work at the service.

Potential risks to people’s health and safety had not been consistently assessed and there was not always detailed guidance for staff to following to mitigate risk. The high use of agency staff meant that people were at risk of not receiving safe care. During the inspection, we observed staff and staff told us how they supported people safely.

Checks to the environment and equipment were completed to ensure they were safe. Shortfalls were identified, however, action to mitigate risk to people’s safety was not always taken quickly.

Before the inspection, concerns were raised about unsafe management of medicines. The registered manager had taken action to reduce medicines incidents, these had been effective. During the inspection, medicines were being managed safely.

Each person had a care plan. The care plans contained information about people’s lives before they came to live at Chaucer House. However, the care plans did not consistently contain details about people’s care and support that was unique to them. During the inspection, we observed and staff told us about people’s preferences and how they provided person centred care. People were assessed before coming to Chaucer House. The registered manager assessed the person’s mental health, physical and social needs, including equality and diversity but this had not always been reflect in the person’s care plan.

Some people were receiving end of life care. There were not always enough staff to provide the skilled care and support to the person and their family. There were not detailed care plans in place to guide staff about the person’s wishes and the support required.

People and relatives told us, that staff were kind and caring. However, they told us that staff did not always maintain their dignity and treat them with respect, they felt this was due to not having sufficient numbers of staff on duty.

The inspection took place on 19 and 21 September 2016 and was unannounced. This was the first inspection of the service since it was registered with us in September 2015.

Chaucer House provides accommodation with personal and nursing care for up to 60 adults. The service is divided into two separate units for people with nursing needs and people living with dementia. There were 28 people living at the service at the time of the inspection. In each unit people had access to a number of seating areas and a dining room. There is a separate hairdressing room, shop, cinema room, family room and a bar on the top floor. There is a garden to the rear of the home.

A registered manager was 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.

People’s care needs and the staffing levels available were regularly reviewed to assess if there were sufficient staff on duty at all times. Some people said there were enough staff and others that staff did not always have time to talk to them. During the inspection staff took time to talk to people, support them when they required and did so in an individual manner.

Relatives said their family member was cared for in a safe place. Staff knew how to recognise any potential sign of abuse and report them in order to help keep people safe.

Assessments of risks to people's safety and welfare had been carried out and action taken to minimise their occurrence, to help keep people safe. Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order. Accidents and incidents were monitored and had been used as learning events to improve the standard of the service.

Medicines were stored safely and administered by qualified nurses. A clear record was kept of the medicines given to each person to ensure they received their medicines as prescribed by their GP.

A schedule of cleaning was in place to ensure the service was clean and a lead nurse was responsible for ensuring practices minimised the spread of any infection.

People’s health care was effectively monitored and professional advice was sought as appropriate. The service understood the importance of ensuring people were offered regular drinks and snacks and a hostess had been employed to facilitate this. Mealtimes were important social occasions. People were offered a choice, support was provided and people were not rushed.

New staff received an induction which included shadowing new staff and spending time with people. Staff were provided with training in the areas necessary for their role, and this was refreshed on a regular basis. This included specialist training in supporting people living with dementia and end of life care. All staff had received training in the Mental Capacity Act 2005 and staff understood the principles of the Act and how to apply them. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. DoLS applications had been made for people who lived in the home to ensure that people were not deprived of their liberty unlawfully. .

The environment had been adapted for people living with dementia and a disability. There was specialist equipment to aid people with mobility needs and visual aids to help direct people to where they wanted to go.

Staff were consistently kind, caring and compassionate, and treated people with dignity and respect. Care was personalised and had been adapted to meet the individual needs of people. Staff had positive relationships with people and their family members who they knew well. People were actively involved in making decisions that affected their daily lives and their wishes were respected whe