Chestfield House provides nursing care and accommodation for up to 31 older people, some of whom may also be living with dementia. The service is an adapted detached building in Chestfield near Whitstable. The accommodation is provided on two floors, with bedrooms on both the ground floor and first floor, accessed by a lift and a staircase. There are three shared bedrooms and most bedrooms have en-suite bathrooms. At the time of the inspection there were 30 people living at the service.

There was a registered manager employed at the service. 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 2008 and associated Regulations about how the service is run. The registered manager was responsible for the day to day running of the service.

We carried out an unannounced comprehensive inspection of this service in May 2016 the service was rated Requires Improvement. There were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we asked the provider to make improvements. We issued requirement notices relating to failing to collaboratively carry out an assessment of people’s needs and preferences, failing to mitigate risks to people, failing to assess and monitor the service effectively, failing to complete proper recruitment checks, failing to ensure staff were trained and failing to deploy sufficient numbers of staff. The provider sent us an action plan. We undertook this inspection to check they had followed their plans and to confirm they now met legal requirements. Improvements had been made and the breaches in regulation had been met.

Risks to people were assessed, identified, monitored and reviewed. However we found pressure relieving equipment that was not set correctly. Staff did not have clear guidance on the use of prescribed creams to make sure their skin was kept as healthy as possible. Other medicines were managed safely.

Some care plans had been rewritten and provided staff with more detail to help them provided people with personalised care. Other care plans remained generic and were in the process of being updated

Some audits and checks had not been consistently effective and shortfalls found during the inspection had not been identified. Other checks, such as the environment, had been completed and action taken to address any concerns. The area manager completed a ‘provider visit’ and audited the service The registered manager had taken action to address the shortfalls when they had been identified. We have made a recommendation regarding improving the audits.

People were protected from the risks of abuse, discrimination and avoidable harm. Staff knew how to report any concerns and felt confident that action would be taken. People’s money was safely managed. Staff knew how to keep people safe and understood their responsibilities for reporting accidents and incidents to the registered manager. People’s medicines were managed safely and they received them on time. The premises were maintained to help keep people safe.

People were supported by sufficient numbers of staff who knew them and their preferences well and who had been recruited safely. Staff had completed regular training and one to one supervision to keep them up to date with guidance and best practice.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People’s representatives and health profess

The inspection took place on 11 and 12 May 2016 and was unannounced.

Chestfield House provides nursing care and accommodation for up to 31 older people, some of whom may also be living with dementia. The service is an adapted detached building in Chestfield near Whitstable. The accommodation is provided on two floors, with bedrooms on both the ground floor and first floor, accessed by a lift and a staircase. There are three shared bedrooms and most bedrooms have ensuite bathrooms. On the day of the inspection, there were 28 people living in the service.

The service is run by a registered manager on behalf of the registered provider. 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 times insufficient staff were on duty to provide care safely. At other times, although people’s personal care needs were met, there were insufficient staff available to interact with people so they received stimulation and emotional support.

People’s care, treatment and support needs were assessed before they moved to the service and a plan of care developed. People’s care and treatment needs were not always recorded in full to guide staff on how to effectively support people in an individualised way. Assessment of risks to people’s safety and welfare had been carried out but lacked detailed guidance for staff to follow to ensure that safe practices were carried out. People were not always involved in care reviews and making decisions as their needs changed.

People were not fully protected by safe recruitment processes. The employment history of new staff was not explored thoroughly to ensure they were suitable to work with people.

Staff had completed some training to deliver care and support but this had not included all they needed to give them the skills or knowledge they needed to undertake their roles. Staff had regular supervision with a line manager to talk about training and development needs but staff appraisal requirements were not being met

The provider had quality assurance systems in place to ensure that care was given effectively, but where shortfalls had been identified, the action taken to address them was not always promptly completed. Policies and procedures were in place and in the process of being updated. Records were not all available for inspection.

Processes were in place to protect people from abuse. Staff understood how to protect people from the risk of harm and abuse. There was a safeguarding protocol in place that staff understood and said they would follow to help keep people safe.

Information had been gained about people’s likes, dislikes and history. People were spending long periods without stimulating activities and staff were currently too busy to spend time with people. External entertainers visited and special occasions were celebrated such as people’s birthdays. People were welcome to have guests to visit at any time, and to dine with them.

People had their health care, food and drink needs assessed and monitored and professional advice was sought as appropriate. People were offered choices at mealtimes, and where necessary support was provided to help people to eat and drink. People were not rushed and the dining room was welcoming so that dining was an experience to be enjoyed.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The appropriate assessments and DoLS applications had been made for people to ensure that people were not deprived of their liberty unnecessarily. All staff had received training in the Mental Capacity Act 2005 and understood how to apply the principles of the Act.

Medicines were stored safely and administered to people when they needed th

We carried out an inspection of the service on the 14 January 2014. We judged the service non-compliant with Regulation 9 – Care and welfare of people who use services. We asked the provider to send us an action plan, which would detail and tell us what action was being taken to address these areas of non-compliance. The provider sent us a detailed report of actions taken to achieve compliance with the Regulations.

This inspection was carried out by one Inspector, who visited unannounced on the 05 September 2014. During the visit we met and talked with people that used the service and their relatives/representatives, the manager, the nurse on duty and care staff. They helped answer our five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records. We found that action had been taken and improvements had been made by management and staff since our last inspection visit.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe. People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Records required to be kept to protect people's safety and wellbeing were maintained, held securely and available when required.

There were sufficient staff on duty at the time of the visit, to meet the needs of the people who used the service.

Staff training records showed that staff had completed essential training, which included subjects such as fire awareness, moving and handling, infection control and food safety. They had also completed training in relevant subjects such as dementia awareness.

Equipment at the home had been maintained and serviced regularly.

Is the service effective?

The service was effective. People’s health and care needs were assessed with them and/or their representatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Staff referred people appropriately to their doctor and other health and social care professionals, so that they had the care and treatment they needed.

Is the service caring?

The service was caring. People were treated with respect and dignity by the staff. Staff interacted well with people and knew how to relate to them and how to communicate with them. People living in the home made positive comments about the staff, with remarks such as “the staff are kind and helpful”.

Is the service responsive?

The service was responsive. Staff listened to people, and took appropriate action to deal with any concerns.

Action had been taken to address the area of non-compliance raised at the last inspection visit in January 2014.

Care staff noticed if someone was unwell, or needed a visit from a health professional such as a dentist or optician. The staff acted promptly to make appointments for people.

Is the service well-led?

The service was well-led. The manager had an open door policy, and was available to speak with people using the service, their relatives or staff.

There were systems in place to provide on-going monitoring of the home. This included checks of the environment, health and safety, fire safety and staff training needs.

Staff confirmed that they had individual supervision and staff meetings. This enabled them to share ideas and concerns.

People told us their needs were met in the home and that they were consulted about their care needs. Comments included, "They're lovely here - the carers, the food - it's great". One relative told us "mum has been here for many years; prior to coming here she would spend a lot of time in hospital, since being here she's not needed to go into hospital". Another relative told us that her relative had recently moved to the home and the care appeared to be of a good standard.

Care records were detailed and well structured. When people moved into the service they had had their needs assessed quickly. Care records were regularly updated, there was good evidence of methodical recording. However, during the visit we observed unsafe moving practice which led to concerns about the quality of training for staff in moving people. We could not be sure that people were protected from bad moving practice.

A training schedule was in place and it was evident there was a wide range of training. Supervision and appraisal was in place. From speaking with staff and looking at records we felt that staff were supported, though raised issues with training. Staff were able to give a good account of safeguarding vulnerable adults, however not all staff had received training.

Medication was stored correctly. There were procedures in place to ensure that medication was handled, ordered and disposed of correctly. We had concerns about two medication errors in quick succession.

We made an unannounced visit to the service and spoke to people who use the service, visitors, the deputy manager and to staff members. There were 30 people using the service. We met and spoke to most of them and everyone we spoke to said or expressed that they were happy living at Chestfield House.

People told us or expressed that they felt safe and well looked after. They said that the staff were kind and caring. People said “The staff are around and when I press my buzzer, they come quickly” and “The staff give me time, they are kind”.

People said they could talk about any problems to the manager and to the other staff. People said that they would be listened to and any problem would be sorted out.

People looked happy and relaxed in the company of each other and staff.

People said that the home was clean and that their bedrooms were kept clean. People said that they were happy with their bedrooms.

People told us that the food was good. People said “We always get a choice. They come round and tell you about the options. If you don’t like it you can have an alternative”.

A visitor said “My (relative) is very contented here. I cannot find fault, I have really made the best choice for them. They have good care here, the staff are very sweet.”

Another visitor said “It lacks a bit around the edges but they are so well looked after. They pick things up quickly and act quickly. They are doing a sterling job. Staff put on an Indian curry night for relatives and everyone. The staff dressed up, it was really beautiful. It was lovely”.

Another visitor said “A man came in with his Olympic torch. This really brightened everybody up”.

We spoke with people living at the home and a visitor. People spoke very positively about the staff, comments made included “They are very kind and thoughtful”, “The staff are very good, I don’t like a couple as much as the others, but that’s just life, they are all very good at their jobs”, and “I am perfectly happy here, I’m not interested in the activities, I just like being here”.

The visitor to the home also spoke positively about the staff and said she was always made to feel welcome.

People told us that they enjoyed the activities at the home and following the recent retirement of the activity coordinator three of the staff were now running the activities.

People said that the food was very good but that there wasn’t always a clear choice. Comments made about the laundry service provided at the home were “it’s a dream, they look after everything very well, and I don’t have to do it!” and “its fine, everything appears back again and is put away”.

People said that the home was looking increasingly “In need of a makeover” and that some areas looked “tatty and tired”.