We undertook an unannounced inspection of Chesham Bois Manor on 31 May 2018.

Chesham Bois Manor is a care home which is owned by B&M investments Limited. It provides care for up to 48 older people with a variety of physical disabilities and mental health issues. At the time of the inspection there were 37 people living at the 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.

At our last inspection in December 2016 we found breaches of Regulations 11 and 12 Health and Social Care Act (Regulated Activities) Regulations 2014 and Regulation 18 Care Quality Commission (Registration) Regulations 2009. These related to the service not always working to the principles of the Mental Capacity Act 2005, risks and emergency evacuation plans not always being appropriately managed and not ensuring all required notifications were made to the Care Quality Commission (CQC). At this inspection we found action had been taken and improvements made.

Staff worked to the core principles of the Mental Capacity Act (MCA) 2005. Mental capacity assessments had been conducted and people were supported to make decisions.

Risks to people’s safety were well managed. Risk assessments were carried out and promoted positive risk taking, which enable people to live their lives as they chose. Personal emergency evacuation plans (PEEPS) were in place, accurate and up to date.

The service submitted appropriate and timely notifications. A notification is information about important events which the provider is required to tell us about in law.

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. On the day of our inspection the registered manager was on annual leave. The service was being led by the deputy manager.

Staff supported people with kindness and compassion and went the extra mile to provide support at a personal level. Staff knew people well and many referred to them as family. Staff respected people as individuals and treated them with dignity whilst providing a high level of emotional support. People and their relatives, were fully involved in decisions about their care needs and the support they required to meet those individual needs.

People were positive about the food and told us they enjoyed the meals. Where people had specific dietary needs, these were met.

People were safe living in the home. There were sufficient staff to meet people's needs and staff had time to spend with people. The service had safe, robust recruitment procedures to ensure staff were safe to work with vulnerable people. People received their medicines safely.

People received effective care from staff who had the skills and knowledge to support them and meet their needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to access health professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.

People had access to information about their care and staff supported people in their preferred method of communication.

The service was responsive to people's needs and ensured people were supported in a personalised way. People's changing needs were responded to promptly. People had access to a variety of activities that met their individual needs.

The registered manager monitored the quality of the service and looked for continuous improvement. There was a cle

This inspection took place on 9, 14 and 16 December 2016. It was an unannounced visit to the service.

We previously inspected the service on 28 January 2016. The service was meeting the requirements of the regulations at that time.

Chesham Bois Manor is a care home for older adults some of whom are living with dementia. It is registered to provide accommodation for 48 people. At the time of our inspection 41 people lived at the home.

The service had 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.

People were not always protected from avoidable harm. Some risk assessments had been completed for instance, for falls and moving and handling. However, we saw where risk assessments had been completed for pressure damage, these were not always accurate. This meant people may not have had access to the correct support to prevent damage to skin.

People were not always protected from the risk of fire. At the time of our inspection the home was undergoing major refurbishment work. As a result some people had moved bedrooms. One person had moved bedroom as their needs had changed and they could not access their existing room due to reduced mobility. Another person’s needs had changed as they were no longer able to walk. On day two of the inspection we checked the details regarding what support people required in the event of a fire. This information had not been updated, which meant staff did not have the correct information on how to support people in the event of a fire. We acknowledged that permanent staff did have knowledge of how people needed to be supported.

The service did not always follow the core principles of the Mental Capacity Act 2005. Where people had been assessed as incapable of consenting to care and treatment, the service did not always obtain documentary evidence to confirm people acting on behalf of residents had the legal authority to do so

The service was not always well led. The service failed to notify CQC of some events when it was legally required to do so.

We found records were not always well maintained. At times we found it difficult to find information as it was not readily available. We have made a recommendation about this in the report.

We found people had access to food and drink. People gave us positive feedback about food. Comments included “The food is fantastic” and “The food is not bad.” However, staff did not always ensure people received the support they required at meal times.

Staff were appointed following a recruitment process; however, the service did not always ensure risk assessments for staff were completed when necessary. We have made a recommendation about this in the report.

People told us they felt safe, we received positive feedback from people who lived at the home. Comments included “I feel safe and they check on me during the night,” “I’m safe here and I’m not shouted at” and “I have no complaints and feel safe.”

People and their relatives told us how caring the staff were, comments included, “I like it here, it’s a nice place, the staff are alright and the people are quite nice,” “This is a nice hotel, and people would give their right arm to be here” and “My mother is looked after very well, and she’s happy with the staff, who are more caring than in another home we’ve seen.”

People had access to a wide range of activities. The home actively encouraged people from outside to visit the home. An entertainer visited the home on a regular basis. People were supported to have the right care and support as the service monitored people’s progression through a mapping process.

Staff had improved the environment to ensure it provided opportunities for people

We spoke with three people using the service and a relative of a person using the service. One person told us "they could not see what else the provider could do to improve the service as it was so good." One person told us " they witnessed people were given choices" and "staff interacted well with people". Another person told us "care was very good and staff were respectful".

We spoke with five staff including the manager. Staff told us "they ensured choice and engaged with families in learning about a person's preferences if they were not able to communicate this themselves". Staff also told us "staff worked well as a team" and another told us "staff were well supported".

We found in the four care records we sampled people had a comprehensive risk assessment and care plan which was regularly reviewed with the person and/or their representative.

We found the provider protected people using services against the unsafe use and management of medicines and when errors had occurred the risks were managed as safely as possible and staff received further training and competency assessment.

We looked at the staff training record and staff allocation record and found there were sufficient skilled and experienced staff at all times to safeguard the health, safety and welfare of people.

We found there had been no complaints but the provider had in place a complaints policy which was given to people and the provider could support access to an advocate.

People told us they liked living at Chesham Bois Manor. They said the staff treated them with care, kindness, respect and dignity. Personal care was given in privacy, and people were given choices regarding rising and bedtimes, clothes to wear and activities.

We were told meals were very good, portions were sufficient, and other food choices were available if they did not want the meal offered.

People told us their bedrooms and bathrooms were cleaned daily, as were the public areas. They said the in-house laundry was excellent.

People told us they were aware of the complaints procedure. They said they were confident any concerns or complaints would be dealt with to their satisfaction. Relatives told us they were happy with the care given, they felt involved, and they were kept informed of any changes to their relatives’ condition or treatment. Relatives also told us the staff were helpful and respectful, and the manager was approachable and kind.

People told us that staff respected their privacy and dignity. Personal care was provided in the privacy of their bedroom and they were provided with choices.

People said that they could not remember if they had an assessment prior to being admitted into the home.

People told us that the GP visited the home weekly or as and when required. They said that staff supported them with their daily medication.

People said that they were enabled to participate in activities of their choice.

People told us that they felt safe living in the home and were aware of how to raise a concern.

They described staff as excellent and kind. They said that staff spoke to them in a calm and polite manner and treated them fairly and equally.