We undertook an unannounced inspection of Cheriton Care Home on 15th December 2017. Cheriton Care Home 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. On the day of our inspection 36 people were living at the service, some were living with dementia.

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 inspection, the service was rated Good.

At this inspection we found the service remained Good overall.

People and their relatives complimented the compassionate nature of staff and told us staff were caring. On the day of our inspection we saw examples of kind and compassionate interactions that demonstrated staff knew people well. People's dignity, privacy and confidentiality were respected.

People told us they were safe. Staff knew what to do if they had safeguarding concerns and were aware of the provider's whistle blowing policy. People were supported by sufficient staff to keep them safe and the provider ensured safe recruitment practices were followed. Staff training was ongoing and the records confirmed staff received supervisions.

People's care plans contained risk assessments that covered areas such as falls, mobility or nutrition. Where people were at risk, their records outlined management plans on how to keep them safe.

People's medicines were stored securely and administered safely.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to maintain good health and access health professionals when required.

Staff ensured people were supported with their meals when required and people were referred to a dietician or Speech and Language Therapist if required.

People were assessed prior to coming to live at Cheriton Care Home and people told us staff knew them well.

People's care files gave details of the level of support required and people's wishes and choices. These also contained information about people's personal histories, medical information, their likes and dislikes.

Information on how to complain was available to people and the provider had a complaints policy in place. The registered manager ensured when a complaint had been raised it had been investigated and responded to in a timely manner.

The registered manager ensured various audits were being carried out, where improvements were identified we found evidence that these had been carried out.

We saw evidence that the management team was committed to making improvements and had already made positive changes. As a team staff were focused to deliver good care and to deliver it in person centred ways. The registered manager informed us of notifiable incidents in accordance with our regulations

We last inspected Cheriton Nursing Home in October 2013. We found the provider was not meeting five of the essential standards of quality and safety. On the 18 February 2014 we undertook a follow up inspection of Cheriton Nursing Home. We observed care, reviewed nine care plans and spoke with eleven people who used the service and a visiting relative. We also spoke with the operations manager and twelve staff.

People we spoke with who lived in the home were positive about the care and support they received. One person we spoke with told us “They are so kind, they think about what I need and make me comfortable”. Another person told us “Overall I am happy here. I feel staff listen to me”. We saw evidence that good care and support was being provided.

We reviewed the care plans of people living at Cheriton nursing home. We found that monitoring charts were now being consistently completed. We found that care plans contained information which was designed to meet their specific needs.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. We looked at nine staff files and saw that there were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. New members of staff received a comprehensive induction. Records we reviewed showed that staff received appropriate professional development.

People we spoke with who lived in the home were generally positive about the care and support they received. One person we spoke with told us “it is very good here, there is always someone around. I couldn’t have a better place.” We saw some evidence that good care and support was being provided.

People who used the service were not always given appropriate information and support regarding their care and treatment. We noted one person who was recieving personal care was not always included in the conversation about the care being given.

However, we identified shortfalls in the documentation and planning of care. We found there were some inconsistencies between assessments and guidance for staff and that some files lacked sufficient information to ensure that people’s assessed needs were being met.

People were not always supported to be able to eat and drink sufficient amounts to meet their needs. Staff did not always spend the time needed to ensure people received the correct support and interaction.

People who used the service were protected from the risk of abuse. The provider had a procedure in place. Staff were able to identify what constituted abuse and their responsibilities in relation to this. People and family members we spoke with told us they felt safe living at the Cheriton.

We found that the home was clean and hygienic and that all staff had completed training in infection control.

Staff told us that they felt supported. However the provider did not have processes in place to ensure that people were assisted and care for by trained and experienced staff.

We spoke with two staff, three people living in Cheriton Nursing Home and family members who were visiting the home. We also examined records and used an observation tool; short observational framework for inspection (SOFI) to observe staff interacting with people living in the home. People we spoke with who lived in the home told us they were generally happy with their care and were well treated by the staff.

We found that the home had sought people's consent before they received any care or treatment and the staff acted in accordance with people's wishes.

The care plans we saw provided details of people's individual needs, wishes and preferences. However in practice we found that care plans and risk assessments had not been reviewed as described by the provider. Therefore we could not be certain that the care plans met the needs of people cared for. People also told us that care was not always delivered in line with their preferences.

The home had safe systems in place for the storing and administering of medicines and staff received appropriate training in this area.

We found that appropriate checks were undertaken before staff began work and there were effective recruitment and selection processes in place. Staff had also received appropriate induction training.

People had been made aware of the complaints procedure. People told us they rarely made complaints but were confident they would be listened to and the complaints acted on.

We spoke with three members of staff, four people living in the home, three family members visiting the home and examined records, surveys and meeting minutes. One person told us "It's a marvellous place to live". Another person who lived there said that they were treated very well by the staff. A family member visiting told us "The manager always follows through on requests, if you ask for something to be done, it’s usually done straightaway".

We found that people and their representatives had been involved in planning their care. We saw that the staff were familiar with people's needs and gave them opportunities to make choices.

The home had effective systems in place to ensure that safeguarding incidents were robustly dealt with. Staff were able to explain the process for reporting safeguarding incidents. There was safeguarding information displayed around the home for the staff and people using the service to refer to.

Staff had received an appropriate induction and were also supported through a system of regular supervision and appraisals. Staff we spoke with felt supported by the management team particularly in furthering their skills and development. Training was appropriate to staff roles and regular refresher training was provided.

The home's quality assurance systems ensured that the performance of the home was adequately monitored, and the views of people living in the home and their representatives were taken into consideration.

People said that they were well cared for. One person told us, "most of the staff are excellent; I have no complaints." Another person said of the staff, “they are very good indeed; they do everything for me". People told us that they rang their call bells when they needed assistance and most of the time the staff responded quickly, although this was not always the case.

Some people told us that they enjoyed regular entertainment in the home. They told us about visiting musicians and "dancing dogs". Other people told us they preferred their own company and they stayed in their rooms. One person however who was mostly confined to bed, said that sometimes they were lonely and they wished that the staff had more time to stay and chat.

We spent some time observing staff interacting with people and providing care and support to them. People were clean and well presented and appeared to be content and relaxed in the company of staff that they were familiar with. Staff were gentle, warm and attentive, friendly and informal, but at all times polite.

We spoke with nine people that live in the home during our visit. We saw some of these in their rooms and others in communal areas. Each of the people made satisfactory comments about the home and staff. Most of the people were complimentary about the food and everybody enjoyed the range of activities and entertainment arranged. People told us they felt safe and although they were unaware of the procedure for making complaints those we discussed this with said they would speak with staff or management if they were unhappy.

Springfield Court Care Centre provides accommodation which includes nursing and personal care for up to 45 older people. At the time of our visit 40 people were using the service. The home has two levels, with a dementia care unit for up to five people situated on the ground floor. There were communal lounges on each floor with a central kitchen and laundry. When we inspected the dementia care unit, we saw a great deal of work and effort had taken place since the unit opened to create a dementia friendly environment.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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. We found the service to be well led.

Where plans contained information and guidance for staff on how to provide care and support, it was not always clear if this guidance was followed. We found in some care plans that documents were incomplete. This meant there was a risk that people may not always receive care that was responsive to their needs

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out appropriate checks when they employed staff. We found staff treated people with dignity, respect, kindness and compassion.

Staff understood their responsibilities and the actions they needed to keep people safe from harm and abuse. We saw evidence that thorough investigations had been carried out in response to safeguarding incidents or allegations and these had also been reported to CQC by the provider.

We saw staff supporting people in the dining rooms at lunch where a variety of choices of food and drinks were being offered. Where required specialist diets were available such as pureed or fortified foods. People spoke positively about the food choices available to them.

The home had a programme of activities in place for people, including meaningful activities for people living with dementia. We saw people were encouraged and supported to remain independent where they could. The director of nursing told us of their future plans with supporting people to maintain their independence. This will involve people being able to make their own drinks and where they want to help with domestic chores.

Training records were up to date. Staff received regular supervisions and appraisals, where they could discuss personal development plans, which meant that staff were properly supported to provide care to people who used the service.

Arrangements were in place for keeping the home clean and hygienic and to ensure people were protected from the risk of infections. During our visit we observed that bedrooms, bathrooms and communal areas were clean and tidy and free from odours.

Staff acted in accordance with the requirements of the Mental Capacity Act 2005. Where people did not have the capacity to make the decisions themselves, mental capacity assessments were in place and records showed that decisions had been made in line with best interests. Where required Depravation of Liberty Safeguarding applications had been submitted by the registered manager.

The registered manager investigated complaints and concerns. People, their relatives and staff were supported and encouraged to share their views on the running of the home. The provider had quality monitoring systems in place. Accidents and incidents were investigated and discussed with staff to minimise the risks or reoccurrence.