This inspection took place on 14 September 2016 and was unannounced. We last inspected this service on 11 March 2015 and awarded a rating of ‘good’ in all of the areas we looked at. We re-inspect the service earlier than planned because we had received concerning information that showed an increase in the number of incidents where people’s needs had not been met safely.

Chiltern View is a residential care home that provides accommodation and personal care for up to 36 older people, some of whom live with dementia. At the time of our inspection there were 24 people living at the home.

The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 service was not always safe because pressure care for people who needed it was not always provided in a timely way. People’s medicines were managed and stored appropriately and the provider had robust policies in place for the safe recruitment of staff. Staff were trained in safeguarding people and people had individualised risk assessments in place that gave guidance on keeping them safe.

Adaptations of the home environment had been made in order to meet people’s needs. Staff recognised people’s care needs and were trained to meet them. They understood their responsibilities to seek people’s consent before providing care in line with the requirements of the Mental Capacity Act 2005. They supported people to access healthcare services when required.

People were cared for by staff that were friendly, kind and caring. They supported people in ways that promoted their privacy, dignity and respected their views. They provided the support that was personalised to people and with support from the management team, they ensured people’s complaints and concerns were resolved. The registered manager, with support from the provider, ensured the service ran appropriately providing visible leadership and oversight at all levels.

This inspection took place on 11 March 2015 and was unannounced. When we last inspected the service in December 2013 we found that the provider was meeting all their legal requirements in the areas that we looked at.

The home provides accommodation and personal care for up to 36 older people, some of whom may be living with dementia. At the time of our inspection there were 30 people living at the home.

The home has a registered manager as is required by the CQC. 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 safe at the home. Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded and the causes of these had been analysed so that preventative action could be taken to reduce the number of occurrences. There were effective processes in place to manage people’s medicines.

There was enough skilled, qualified staff to meet the needs of the people who lived at the home. Robust recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. Staff were well trained and supported by way of supervisions and appraisals.

People had been involved in determining the way in which their care was to be delivered and their care needs. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

Staff treated people with respect and encouraged them to be as independent as possible. They were kind and caring and protected people’s dignity. Staff supported people to follow their interests and hobbies.

There was an effective complaints system in place. Information was available to people about how they could make a complaint should they need to and the services provided at the home. People were assisted to access other healthcare professionals to maintain their health and well-being.

People, their relatives and staff were encouraged to attend meetings with the manager at which they could discuss aspects of the service and care delivery. People and their relatives were asked for feedback about the service to enable improvements to be made. There was an effective quality assurance system in place.

During our scheduled inspection at Chiltern View on 23 July 2013, we identified non-compliance regarding cleanliness and infection control. We found that the provider could not fully evidence that the service had effective systems in place which protected people who used the service from poor standards of cleanliness and hygiene. We found evidence of poor standards of hygiene and cleanliness at that time. We imposed compliance actions with regards to this and told the provider they needed to make improvements in this area.

The provider submitted an action plan, which stated that affected areas of the home, furniture and carpets were to be thoroughly cleaned or replaced and increased monitoring of the environment and that thorough spot checks would be completed. It confirmed that this work would be completed by 18 October 2013. On 3 December 2013, we carried out an inspection to check that these actions had been implemented.

When we inspected Chiltern View on 23 July 2013 we found that most people had varying levels of communication which made it difficult for us to discuss their care with them in any depth. Therefore we used a number of different methods including observations, and talking with staff and people's relatives, to help us understand their experiences.

We found people were supported to have adequate nutrition and hydration. A relative that we spoke with confirmed that overall they were very satisfied with the service provided in this home saying, “….is happy here, … is safe and extremely well cared for.” One person who used the service said, "I’m happy here."

We also saw a number of responses from satisfaction surveys that had recently been completed and returned to the registered manager. Chiltern View also facilitated a "Family Association Group" a meeting held monthly to enable people who use the service and their relatives to share their views and opinions, and make suggestions for improvements.

However, we found that appropriate standards of cleanliness and hygiene in the home were not effectively maintained throughout the home.

When we visited Chiltern View on 11 May 2012 we found that most people had varying levels of communication which made it difficult for us to discuss their care with them in any depth. Therefore we used a number of different methods including observations, and talking with people’s relatives, to help us understand their experiences.

There was a calm and relaxed atmosphere in the home, and we observed that people looked clean and comfortable. When people required assistance and support this was recognised and addressed by staff, who we noted were caring and respectful in the way they delivered care. One person said “I’m on top of the world, it’s good here and they look after me well”.

We observed that where possible people were encouraged to make choices about different aspects of their lives, including what they had to eat and how they spent their time. One person told us “I’ve been here a while, I enjoy the food and just do what I want to do”. We noted that people looked at ease in the company of the staff who cared for them, and three relatives that we spoke with confirmed that overall they were satisfied with the service provided in this home. We also saw responses from satisfaction surveys that had recently been completed and returned to the manager. These included comments such as “Most certainly people are treated with respect”. “Very happy with the response and consideration of the carers”.

Chiltern View facilitated a “Family Association Group” which held monthly meetings to enable people who use the service and their relatives to share there views and opinions, and make suggestions for improvements.

Many people who use this service have difficulty understanding and responding to verbal communication. Only three people were able to tell us about their experiences of living in the home. A few other people made comments about specific issues, such as the staff. Most of the information about people's experiences of West Street was gathered through our observations and from speaking with family carers.

The majority of the people told us they liked the home, the care staff and the food. Our observations were that people generally looked well cared for. During our visit staff were attentive, they gave people choices and were supportive to them.