Our last inspection report of this service was published on 01 July 2016 and related to an inspection that had taken place on 03 and 04 February 2016. At the inspection in February 2016 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to Regulation 17, Good governance, Regulation 18, Staffing and Regulation 19, Fit and proper persons employed.

We asked the provider to take action to meet the regulations. The provider sent us a report of the actions they were taking to comply with Regulations 17, 18 and 19 on 09 September 2016. They told us they had already taken the action specified in the plan and were meeting the regulations.

We returned to carry out a comprehensive inspection on 05 June 2017. The inspection was unannounced. At this inspection we found that the provider had implemented new ways of working to address the breaches from the previous inspection which had resulted in an improvement to the service provided.

The Chimnies Residential Care Home is registered to provide accommodation and personal care for up to 29 people over the age of 65 years. There were 21 people living at the service on the day of our inspection. Some people living at the home were quite independent, only requiring minimal help and others were frail with various care needs such as Parkinson’s disease or diabetes.

The accommodation is set over two floors in a large well maintained former vicarage with building extensions added over the years. Outside are well maintained gardens where people can enjoy sitting outside with good views in a rural setting.

There were two registered managers based at the service. 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. Chimnies Residential Care Home was a family run business owned by two providers, one of whom was one of the registered managers.

Safer recruitment practices were now being used. New staff went through a thorough application and vetting process to make sure they were suitable to work with the people living in the service. There were enough staff employed to meet the assessed needs of people. Many staff had worked at the service for a number of years and lived locally so were available and happy to cover short notice staff absences.

The provider had made additional training available for all staff to refresh and update their skills and knowledge as this was an area found to be of concern at the last inspection. Staff told us they found this had been of benefit and was an improvement made to the service. Staff were supported to carry out their role through regular one to one supervision meetings.

The premises were well maintained and the appropriate checks and servicing of equipment had been carried out. Fire evacuation documentation and practical drills required some improvement as these had not been carried out. We have made a recommendation about this.

Individual risks to people had been identified and assessments were carried out to make sure control measures were in place, helping to manage and control the risks. An initial assessment was undertaken with people before they moved in to the service. Care plans were developed to help staff to support people with their assessed needs in the way they wanted.

All aspects of medicines administration continued to be managed well. People received their medicines in a safe way and as prescribed. Accidents and incidents were recorded well by staff and monitored by the registered manager to check for trends or concerns.

People’s rights were protected as staff had a good understanding of the Mental Capacity Act 2005. People were given choices and supported to make their o

The inspection was carried out on the 3 and 4 February 2016 and was unannounced.

The Chimnies Residential Care Home provides residential care for up to 29 people over the age of 65. The accommodation is set over two floors in a large, well maintained detached house. There are communal lounges, kitchen, offices, private bedrooms with washing facilities and communal bathrooms. Outside there are well kept gardens for the residents to enjoy. There were 22 residents living in the home when we inspected.

There were two registered manager at the home, one of whom was also part of the registered company that was the 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.

People told us they felt safe at the home and relatives also said they thought their relatives were safe.

The provider had a recruitment policy in place but this was not being followed. Some staff records showed that checks through the Disclosure and Barring Service (DBS) were carried after they had started working at the home. Some staff had previously worked at the home and the provider and registered manager relied on references from their past employment with the provider.

The provider had a safeguarding policy in place and staff were aware of the responsibilities to report any concerns they might have. Safeguarding training was out of date for staff. Risk assessments were in place for most people, however, some risk to people and how to reduce those risk were not in place. We have made a recommendation about this. There were environmental risk assessments in place and the building was well maintained. There were no personal evacuation plans in place for people living the in home. We have made a recommendation about this.

Accidents and incidents had been responded to appropriately and involved the relevant health care professionals.

There was no formal tool for assessing staffing levels at the home but we saw that there were enough staff on duty to meet people’s needs.

People were protected from the risks associated with the management of medicines. The provider was following their medication policy. The provider was not carrying out medication audits.

The provider did not have a training policy in place and theirs and staff training was out of date. They did not have a training matrix to ensure an overall view of what training was needed and when it needed to be update. Staff had not received training on the Mental Capacity Act 2005. The staff and provider and manager did not have a good understanding of the MCA or DoLS and how this needed to inform care given to people. We have made a recommendation about this

People were supported to access health care professionals such as opticians, dentists and GP’s. When people’s needs changed referrals were made to the appropriate professionals such as dieticians and the memory clinic. End of life care plans had been put in place and the palliative care teams and hospice were involved where needed. People told us they thought the home was responsive to their needs. The registered managers recognised when they were unable to meet people’s needs and took steps to ensure that people were supported so that their needs could be met elsewhere.

People were supported to maintain a healthy and nutritious diet. People told us they enjoyed the food and there was plenty of choice. People’s weights were monitored on a regular basis.

Staff were kind and caring to people and they knew them well. Care plans had pre admission plans which fed into person centred care plans. People’s likes and dislikes had been recorded.

Staff told us about how they protected people’s privacy and dignity and we saw staff knock on doors before enterin

We carried out a planned review to this service on the 26 November 2013. At that visit we made two compliance actions, as we found that the provider did not have systems in place to protect people who used the service against the risks associated with the unsafe use and management of medicines; and the provider did not have sufficient effective systems in place to regularly assess and monitor the quality of service that people received. The provider sent us an action report which told us what action was being taken to address these areas of non-compliance.

We found at this visit that medicines were being safely administered and appropriate arrangements were in place regarding recording and obtaining medicines.

Quality assurance systems had been implemented that included medication audits, health and safety checks and cleaning schedules to ensure people received good quality and safe care. The provider had committed to seeking support from a care quality consultant in order to improve the current quality monitoring systems in operation.

During our inspection we spoke with several people who used the service, staff and the hair dresser.

People that used the service told us that they were happy with the service provided. They said that the staff were good, and the home was nice and clean. People told us “I am very well looked after here” and “The staff are kind and look after us well”.

People were asked for their consent before any care or treatment was given.

Care records showed that the people were supported with their care in a way that was individual and in accordance with their wishes. The care records reflected the health and personal care that people needed.

Medications were not recorded or handled appropriately and safely. People who used the service may not have received their medication as prescribed.

We found that staff received training appropriate to their role and this was being refreshed in a timely way.

Quality assurance systems were not fully in place to ensure people received good quality safe care.

We spoke with twelve people living in the home they all said that they like living there. They spoke about the friendliness of the staff, how they felt able to do what they wanted each day. They told us that the meals provided were good and that they had been given plenty of choice at each meal. They said the meals were mostly home cooked and had always been well presented.

People told us that the staff were very supportive, one said “nothing is ever too much trouble”, another said ”we are never rushed we are encouraged to do things for our selves, but staff are there when you need the help.”