Chester Court is a care home that provides accommodation and personal care for a maximum of 41 people. At the time of the inspection there were 41 people living at the service, some of whom were living with a dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection in February 2016 we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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 told us they felt safe and safeguarding procedures were in place which staff followed. Incidents of a safeguarding nature continued to be reported to the appropriate authorities and investigated. Staff understood their responsibility in safeguarding people and told us of the action they would take if they had concerns.

People and relatives spoke positively about the service. We saw positive relationships between staff and people. Staff treated people with compassion and kindness during their interactions. Staff we spoke with described ways in which they worked which demonstrated a caring attitude.

We found care plans were person-centred and consistent in the level of detail and information they contained. Person-centred care planning is a way of helping someone to plan their care and support, focusing on what is important to them. Staff knew people well and delivered personalised care to people. Risk assessments related to the delivery of care and the environment were up to date. Emergency plans were in place and health and safety checks in the environment were carried out to ensure it remained safe.

The administration and management of medicines continued to be safe.

Consent to care and treatment was sought in line with the Mental Capacity Act 2005 (MCA). The best interest’s decision-making process had been consistently followed for people who lacked capacity to make certain decisions themselves.

The service was homely and had been personalised to meet the needs of people. Staff followed infection control procedures and the home was clean, tidy and had no malodours.

People were offered a choice of meals. We received mixed feedback regarding the food available. People were offered an alternative meal if they did not like the choice on offer. The environment for dining was helpful in making the meal time experience pleasant for people. Records were available to highlight if people required a specific textured meal due to swallowing difficulties.

Safe recruitment procedures were followed during the employment of new staff. Staff told us they felt supported and had received regular supervisions and appraisals. Newly recruited staff received an induction and training the provider had deemed to be mandatory was completed by staff.

There were enough staff employed to safely meet the needs of people living at the home.

A range of checks and audits were carried out to monitor the quality of the service. Care records were complete and up to date, they were maintained to a good standard and stored securely so they remained confidential. Incidents were reflected upon and analysed. Where learning was identified systems were changed to reduce the risk of repeated incidents.

People,

The inspection took place on 22 February 2016 and was unannounced. This meant that the provider and staff did not know that we would be visiting.

We last carried out an inspection on 25 September 2014, where we found the provider was meeting all the regulations we inspected.

Chester Court accommodates up to 41 older people, most of whom have nursing needs. There were 41 people living at the home at the time of the inspection.

There was a manager in post. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected. We spoke with the local authority safeguarding officer who told us that there were no organisational safeguarding concerns regarding the service.

We spent time looking around the premises and saw that all areas of the building were very clean and well maintained. There were no offensive odours in any of the bedrooms or communal areas we checked.

Safe recruitment procedures were followed. Some people and staff told us that more staff would be appreciated. We observed that staff carried out their duties in a calm, unhurried manner on the day of our inspection. The manager provided us with information which showed that staff had completed training in safe working practices and to meet the specific needs of people who lived there such as specialist feeding techniques.

We checked medicines management. We found that there were safe systems in place to receive, administer and dispose of medicines. One of the medicines fridges was faulty and a new one had been ordered.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals.” The manager had submitted DoLS applications to the local authority to authorise in line with legal requirements.

We observed that staff supported people with their dietary requirements. Staff who worked at the home were knowledgeable about people’s needs. We observed positive interactions between people and staff. There was an activities coordinator employed to help meet the social needs of people.

There was a complaints procedure in place. Feedback systems were in place to obtain people’s views. Meetings and surveys were carried out.

A number of checks were carried out by the manager. These included checks on health and safety, care plans, infection control and medicines amongst other areas. We checked the maintenance of records and noticed that there were some recording omissions in several of the food and fluid charts we viewed. The manager addressed this immediately and instigated a new system to ensure that these were completed accurately.

Staff informed us that they were happy working at the home and morale was good.

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 effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

People were cared for in an environment that was safe. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. We saw that systems were in place to ensure people's medications were safely managed. Other risks to people's safety were assessed and managed in the way care was delivered and reviewed. Accidents were recorded and monitoring arrangements were in place to identify and address patterns and trends.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager and the deputy manager demonstrated that they were aware of these and had made applications in line with the policies and procedures following a recent court ruling that had affected the way these safeguards were applied. The manager told us they were awaiting decisions regarding these applications.

Is the service effective?

People told us they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs.

Is the service caring?

People and visitors made positive comments about the care. One relative said, "It is nice and homely and there is a nice atmosphere” Another relative commented, “I meet with a nurse and go through the care plan each month to check on any changes needed. I find the staff very accommodating”. We observed patient and good humoured interactions between the staff on duty and the people living at the home. One relative said, "There is a lot of friendly banter between residents and staff going on most days."

Is the service responsive?

People's needs had been assessed before and after they moved into the home. A relative told us they were involved in the care provided. Records confirmed people's preferences and wishes. People had access to activities that were important to them. Night time routines were individualised to people's needs. We saw in records that the home referred to outside specialists for support in caring for people.

Is the service well led?

The home had an experienced registered manager. Quality assurance processes were in place. We saw people had been asked for their views about their care. Staff told us they were clear about their responsibilities.

We saw that people's needs were assessed and their care was delivered in a planned way by taking account of people's preferences and managing risks. We found people had varied and complex needs and were supported to make use of specialist and community based health services. One relative said, "I can't believe how well my husband has done since he came here. He is so much better now." Another relative said, "It is very good here and it is not easy for the staff but we are happy with the care here."

Records showed and staff confirmed the provider had systems in place which ensured that staff were recruited who were appropriately qualified and able to do the job.

We found the provider supported staff through training, supervision and appraisal so that people were cared for by a skilled team of nurses and care staff. One of the people we spoke with said, "They are all good nurses here, all the staff are good, I can't say enough about it."

We saw the provider had various systems for checking the quality of the service and identifying where improvements could be made for the benefit of people living at the home.

The records showed and people confirmed that the home responded to concerns and complaints. One person said, "The boss is good she listens to both sides and forms an opinion." Another person said, "I feel I could go to the staff with my concerns and they would listen."

We spoke with several people using the service. The comments we heard were all positive and included:

• “It’s like a community here … we all join in.”

• “I like my own company and they respect that.”

• “My daughter initially didn’t want me to move in, but she now thinks it’s marvellous here.”

• “They’re very friendly (the staff) and they’re there for you.”

• “I’ve been out and about, the food’s good and I get good portions.”

• “This place is 100%.”

• “I can speak to (name) the manager if I was concerned, but I have none.”