This unannounced comprehensive inspection took place on the 4 September 2017.

Cheney House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cheney House accommodates up to 34 people in one adapted building. The service provides residential care for older people including people living with dementia. At the time of this inspection 29 people were using the service.

At the last inspection in September 2017, the service was rated ‘Requires Improvement’. At this inspection, we found the evidence supported an improvement in rating of the service to Good.

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.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place and provided detailed information and guidance for staff about the potential risks people faced. The service learnt from incidents and accidents and acted to mitigate the risks of them occurring again.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. People were supported by sufficient numbers of staff to meet their needs.

People were supported to take their medicines as prescribed. Infection control procedures were in place and followed by staff to protect people from the risk of infection.

Staff were supported and supervised and completed induction and development training. This helped to ensure they had the skills, knowledge and expertise they needed to perform their roles. Suitable training was provided to ensure people's needs were met.

People's needs were assessed, and people were supported to maintain good nutrition and access healthcare to maintain their health and wellbeing.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff had received training and information which enabled them to provide care in line with the guidance of the Mental Capacity Act 2005.

The provider made the necessary improvements to the premises, which included redecoration and building upkeep to upgrade the service.

People received care from staff that knew them well and consistently treated people with dignity and respect. People were supported to maintain their independence and staff protected people's right to privacy.

People and their representatives were involved in developing their care plans, which enabled them to receive care and support in line with their preferences. People and relatives were involved in reviews of people's care to ensure the care provided met people's current needs.

A process was in place which supported people to raise concerns and complaints. People felt confident their concerns would be listened to and acted on.

People, relatives and staff had confidence in the leadership and governance of the service. The provider had effective systems in place to monitor the quality of all aspects of the service to ensure people received good care. Actions were taken, and improvements were made where required.

This unannounced comprehensive inspection took place on the 4 September 2017. Cheney House is registered to provide residential care for up to 34 people, including people living with dementia. At the time of this inspection 31 people were using the service.

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.

At the last comprehensive inspection on the 22 and 23 February 2017 the provider was in breach of legal requirements. This was because suitable arrangements were not in place to effectively monitor the quality and safety of the care people received at the service. The provider sent us an action plan telling us how they planned to make the necessary improvements and at this inspection we found the legal requirements were met.

Improvements had been made to the systems and processes to monitor the care people received and the staffing arrangements. Closer monitoring of the environment and repairs and refurbishment works would ensure people lived in a home that was always safe and well maintained.

We found that a fire exit door was awaiting a break glass cover to be fitted and in the interim a combination padlock had been fitted. However not all staff were aware of combination number to open the door in the event of an emergency requiring people to be evacuated from the building. Following the inspection the provider informed a new break glass cover had been fitted and the padlock was no longer in use. Having spare stocks of break glass covers would ensure the fire exit doors were always fully operational.

People were treated with dignity and respect. However due to not having personal toiletries available to meet their personal hygiene needs, their dignity could have been compromised. During the inspection the provider took immediate action to arrange for all people using the service to have personal toiletries made available.

The registered manager and staff understood their responsibilities to safeguard people from abuse. The staff recruitment systems were sufficiently robust to make sure the right staff were employed to keep people safe. In addition sufficient numbers of staff were available to meet the needs of people using the service.

Individual risks were identified and effectively managed. People’s medicines were appropriately managed to ensure they received their medicines safely.

Staff had a good understanding of people's needs and preferences and worked with people to enable them to communicate these. There were positive interactions between people and staff.

Staff received training that was relevant to their roles and responsibilities, ensuring they had the skills and knowledge required to support people effectively. Staff were supported in their roles, and had supervision meetings to discuss their performance, development and training needs.

Mental Capacity Assessments (MCA) had been carried out for all people using the service, the assessments identified where people required help to make specific decisions. Where people lacked capacity to make specific decisions, relatives and / or other health professionals had been involved in making best interests’ decisions on their behalf.

People were supported to maintain a healthy diet and to have access to healthcare services. Healthcare professionals were contacted in response to any deterioration or sudden changes in people's health and the staff acted on the instructions of the health professionals.

This unannounced inspection took place over two days on 22 and 23 February 2017.

Cheney House is registered to provide residential care for up to 34 people, including people who may be living with dementia. At the time of this inspection there were 32 people living in the home.

The service did not have 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.

The location had been without a registered manager since October 2016. The provider had appointed a new manager who had applied to the Care Quality Commission (CQC) to become the registered manager for the service.

Appropriate systems and processes were not in place to assess, monitor and improve the quality and safety of the service. Quality assurances processes were not always effective at identifying shortfalls and where shortfalls were identified these were not always addressed in a sufficiently timely manner to minimise the impact on people.

Staff recruitment procedures needed to be strengthened to ensure that all necessary risk assessments had been completed as part of staff selection process. Although there were enough staff on duty the way in which they were deployed meant that they were not always able to meet the needs and choices of people living in the home.

Staff had an in-depth understanding of peoples care and support needs and understood how to care for them safely. However individual care plans and risk assessments were not personalised or accurate and provided conflicting information regarding people's needs. This was discussed with the provider and they began an immediate review of all care plans and risk assessments in place.

People were supported to take their medicines as prescribed, however staff did not always follow the provider’s policies and procedures when administering medicines. Records showed that medicines were obtained, administered and disposed of safely.

People were supported to maintain good health and had access to healthcare services when needed; relevant health care professionals were appropriately involved in people’s care. Staff supported people to have sufficient amounts to eat and drink to help maintain their health and well-being.

People felt safe in the home and relatives had no concerns about people’s safety. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Staff received an induction to their role and training in areas that enabled them to understand and meet the care needs of each person. People received care from staff that were friendly, kind and thoughtful and their right to privacy and dignity were respected.

People's consent was sought prior to care and support being delivered by staff. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

There were opportunities for people and their families to share their experience of the home and the provider and manager actively sought feedback from people. Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy.

At this inspection we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

At the time of our inspection the provider did not have a registered manager in post.

We found that people’s care and treatment needs were recorded within the care plans and specified the daily support people required. We also saw that people’s preferred daily routines, likes and dislikes were recorded.

We saw the staff worked at a relaxed pace and the people we spoke with commented that the staff were “nice, friendly and helpful". A visitor told us the staff were approachable and always made them feel welcome when they visited the home.

We saw that people using the service, relatives and staff were regularly asked to provide feedback on the quality of service delivery. This meant that people had the opportunity to say where they thought improvements were needed.

The provider may wish to note that people with dementia have particular needs in terms of the environment and we found the environment fell short of providing a dementia friendly environment. The large communal lounge, which was used by the majority of people using the service, lacked the provision of magazines, books, newspapers and other materials to provide stimulation and engagement. We also found there was also a lack of features around the building such as appropriate signage to aid people’s orientation and support their remaining capacities. There was no evidence of any risk to people; however the environment did not promote the wellbeing of all people using the service.

We received concerning information that required us to carry out a responsive unannounced visit to Cheney House to check that the provider was protecting people from the risks of inadequate nutrition and dehydration.

We looked at the care plans and assessment records for three people who had experienced weight loss and had been identified nutritionally at risk.

We found the care plans and assessments relating to people’s nutrition and hydration were regularly reviewed and updated to reflect changes in their health status. We also found the provider had involved other healthcare professionals in meeting people’s nutrition and hydration needs.

During our visit we spoke with the manager, care workers and catering staff. We found the staff knew the needs of the people using the service well and were able to tell us how they met their individual nutritional needs. We saw within the food store there was a sufficient quantity of groceries fresh and frozen available. We saw that weekly menus provided people with a selection of hot and cold meals and alternative meals were available for people on a daily basis.

We saw that people had drinks, snacks and fresh fruit close to hand and access to call bells to be able to summon assistance.

This unannounced inspection took place on 23 September 2015.

Cheney House accommodates and provides personal care for a maximum of 34 older people. At the time of our inspection there were 27 people receiving care.

A registered manager was 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.

People were treated well and there were sufficient numbers of staff to keep people safe. The service had suitable recruitment procedures and staff were knowledgeable about how to protect people from abuse. People had risk assessments in place which were personalised to their needs and ensured they could carry out activities safely. Medicines were handled appropriately and people received them in a timely way.

Staff had the required knowledge and skills to provide effective care. All staff received an adequate induction and staff were required to complete mandatory training, and training that focused on dementia care. Staff received regular supervision and the service appropriately utilised the Mental Capacity Act to ensure people were protected. People were supported to eat and drink enough and they had their healthcare needs met by the service.

People were treated with kindness and compassion and were frequently laughing with staff. People felt listened to and they were not rushed. Staff understood the support people needed if they became distressed and staff were patient in ensuring people’s wellbeing. People’s privacy and dignity was maintained however further consideration was required to ensure this was supported whilst people received personal care for visiting healthcare professionals. People were able to maintain relationships that were important to them and were encouraged to make their own choices about how and where they spent their time.

People and their relatives were involved in care planning and care was individualised and focused on the person’s needs as a whole. Activities within the home were person centred to meet people’s individual needs. The service showed flexibility and people were encouraged to remain independent. People felt comfortable to raise concerns and the service had suitable systems in place to respond to complaints.

Quality assurance systems were in place however further improvements were required to ensure people received the care they required. There was mixed evidence about whether the service was well led and there were opportunities to improve this area. The provider showed a willingness to improve the service and the provider gave people, relatives and staff opportunities to provide feedback about the service.