Chirnside House was inspected on the 04 and 06 April 2018 and the first day of the inspection was unannounced. Chirnside House is registered to provide personal care for up to 30 people who may be living with dementia. At the time of the inspection there were 27 people receiving support.

Chirnside House is a ‘care 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. Chirnside House is situated on the outskirts of Lancaster and close to local amenities. The home has communal areas which consist of dining rooms and lounges. There is also a garden area for people to enjoy. There is parking available at the home.

At our last inspection in April 2016 the home was rated ‘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 home has not changed since our last inspection.

Medicines were managed safely. Staff responsible for supporting people with their medicines had received training to ensure they had the competency and skills required. We found some medicines were not dated on opening. We have made a recommendation regarding the implementation of best practice guidance in relation to medicines.

The registered manager completed a series of checks to identify where improvements were required in the quality of the service provided. Staff told us they were informed of the outcomes of these. We noted some of the audits were not documented, therefore action plans were not developed. We have made a recommendation regarding improving the audit recording process.

Staff were able to explain the support individuals required and the way in which they supported people who lived at the home. Relatives told us they were consulted and involved in their family members care. People we spoke with confirmed they were involved in their care planning if they wished to be.

Care records contained information regarding risks and guidance for staff on how risks were to be managed. We found two care records required updating. Prior to the inspection concluding we were informed this had been carried out.

Staff were knowledgeable of people’s needs and the support they required to maintain their safety. People who lived at Chirnside Hall told us they felt safe.

We found people had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate. People and relatives told us they were happy with the care at support provided at Chirnside House.

We found people who received support were able to raise their views on the service. People and relatives consistently told us they were asked their views on an individual basis. In addition, ‘residents meetings’ were held where people at the home were able to be informed of changes and give their opinion on the service provided.

During the inspection we observed people being supported to eat and drink in accordance with their assessed needs. People told us they were happy with the meals provided and we saw staff were attentive and discreetly observant when people were eating their meals.

We found the environment was clean and staff wore protective clothing when required. This minimised the risk and spread of infection.

Staff told us they were aware of the procedures to follow if they suspected someone was at risk of harm or abuse. Staff told us they would report any concerns to the registered manager or the Lancashire Safeguarding Authorities so people were protected.

There was a complaints procedure which was accessible to people who lived at the home.

This inspection was carried out on the 11 April 2016 and was unannounced. We last inspected Chirnside House in July 2014 and identified no breaches in the regulations we looked at.

Abbeyfield Lancaster Society Limited is a registered society and an exempt charity for tax purposes. The society owns a home on the outskirts of Lancaster. Chirnside House is registered to provide personal care and accommodation for up to 30 older people who may be living with dementia. Accommodation is provided over two floors, with a lift providing access to the first floor. There are a range of communal rooms, comprising of a lounges, dining rooms and kitchen areas. There are garden areas with seating for people to use. Car parking is available at the home. At the time of the inspection there were 29 people living at the home.

The home is managed by a registered manager. A registered manager has 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 were happy living at Chirnside House and the care met their individual needs. We were told, “I advise people to come here. It’s a superb home.” And, “I’m more than satisfied with everything here. I’m looked after very well.” People described staff as ‘very kind’ and ‘the salt of the earth’ and told us they were involved in their care planning.

There were systems in place to protect people at risk of harm and abuse. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We found individual risk assessments were carried out and care plans were developed to document measures required to reduce risk. Staff were knowledgeable of the measures and we observed these were followed these to ensure people’s safety was maintained.

We found medicines were managed safely. We saw people were supported to take their medicines in a dignified manner. We found medicines were stored securely.

We found appropriate recruitment checks were carried out. This helped ensure suitable people were employed to work at the home. We found there were sufficient staff to meet people’s needs. People were supported in a prompt manner and people told us they had no concerns with the availability of staff.

Staff received regular support from the management team to ensure training needs were identified. At the time of the inspection we found some gaps in the training records of staff. The registered manager informed us documentation was not available to evidence the training staff had undertaken, therefore further training was being planned. We have made a recommendation regarding this.

Processes were in place to ensure people’s freedom was not inappropriately restricted and staff told us they would report any concerns to the registered manager.

We found people were offered a variety of foods and people told us they liked the meals at Chirnside House.

People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate. During the inspection we spoke with three external health professionals who voiced no concerns with the care provided.

Our observations during the inspection showed staff treated people with respect and kindness. People told us they considered staff were caring and we saw a positive rapport between staff and people who lived at the home.

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s expressed wishes. During the inspection we noted people were supported to carry out activities which were meaningful to them.

There was a complaints policy which was understood by staff. Information on the complaints procedure was available in the dining room of the home.

We found systems were in place to identify if improvements were required. Quality assurance checks were carried out to monitor the service provided.

During our inspection we looked at how well people were cared for, cleanliness and infection control, the way staff were recruited, whether the staffing levels in place were adequate to meet the assessed needs of people living at the home and the quality monitoring systems in place.

The summery is based on our observations during the inspection. We spoke individually with four people living at the home, two relatives, a senior carer, a care worker, the laundry assistant, a member of the domestic staff team and the registered manager.

This helped to 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.

Is the service safe?

People told us that they felt safe and secure. From our observations it was clear that people were relaxed and comfortable living at the home. We saw that people were treated with respect and dignity by the staff team and their rights protected.

The home had information and procedures in relation to the Mental Health Act and Deprivation of Liberty Safeguards although no application had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

We looked at the recruitment of new staff. This showed that people had only started working at the home, after all the necessary checks and clearances had been obtained and deemed to be satisfactory. This helped to ensure that people were not put at risk.

Is the service effective?

There was an advocacy service available if people needed it. This meant that when required, people could access additional support.

People told us that they were very pleased with the level of care that was being delivered to them and that their assessed needs were being met. From our observations and through speaking with staff it was clear that there was a good understanding of each person’s assessed needs and that personal preferences were accommodated. A relative told us, “They cater for individual needs and to a high spec, they know my mum, I can tell. She is happy here”.

Care needs had been assessed and people had been involved, as far as they wished or were able, in writing their plans of care. Although some people spoken with were unsure about their current care plan, they were unconcerned by this. On the care plans we looked at, most had been signed by the person or a close relative, to confirm their understanding and agreement to the content. People’s preferences, interests, aspirations and diverse needs had been recorded and care and support provided in accordance with people’s wishes.

The visitors we spoke with confirmed that that were able to see people in private and at a time of their choice. The relatives we spoke with also said that they had good communication with the staff team and were always informed of any changes or concerns.

Is the service caring?

People were supported by kind and caring staff. We saw that care workers showed patience and gave encouragement when supporting people. A relative told us, “They (the staff) are fantastic I could not fault them at all”. A person living at the home said, “They (the staff) are very nice people, very good. I am alright here, it is homely”.

People using the service, their relatives and friends and other interested people had been given opportunity to complete a satisfaction questionnaire that was freely available in a communal area of the home. We saw this covered a wide range of issues. The registered manager explained that if any comments, concerns or complements were highlighted, outcomes would be analysed and evaluated. Action would then be taken to address any concerns, where at all possible. However we were also told that very few questionnaires were actually completed and returned. People preferred to speak directly with the registered manager. A person living at the home and the relatives spoken with confirmed this.

Is the service responsive?

People said that they knew how to make a complaint if they were unhappy about anything. Although no formal complaint had been made for quite some time, documents were available to record the complaint, the name of the person making the complaint, the process of investigation and the outcome. We saw that there was an ‘open door’ policy with people expressing their views, or queries as they arose. This meant that any concern or query could be dealt with immediately. People living at the home and the relatives we spoke with confirmed this to be the case.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s preferences. This helped to ensure that people were provided with an individualised service that met their specific requirements.

Is the service well-led?

The service worked well with a range of health professionals to make sure that people received their care in a joined up way. Records were kept of all health professional visits in respect of each person, which included the reason for the visit and the outcome.

Staff told us that they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes in place. This helped to ensure that people received a consistent service at all times.

Staff also told us that they felt very well supported by the registered manager and that they had opportunity to have their say that helped influence change. We were also told that the staff team worked well together for the benefit of the people living at the home. We saw that the staff team was stable meaning that people living at the home were cared for and supported by staff who knew them well.

A range of routine audits were in place including care reviews and fire safety. This helped to ensure that a consistent service was maintained that helped to protect people and keep them safe.

On the day of our visit we spoke with the registered manager, staff, relatives and residents, who were at home. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Chirnside.

People told us what it was like to live at Chirnside. They described how they were treated by staff and their involvement in making choices and decisions about their care. People also told us how they had access to a range of care and support services and how they made their views known about the quality of care delivered. This was because the inspection focused on these important topics along with what systems were in place. This enabled people to raise concerns and complaints as well as making comments.

People spoke positively of the care they received and described staff as, “Very kind and caring”. One relative told us, “Staff are very helpful. They are always around when we visit. Nothing is too much trouble”. One person living at the home said, “I really do like it here, I can do my own thing it really has given me a good life”.

We were shown around the building and checked maintenance records for fire, water, gas, equipment and electrical safety. People we spoke with told us they liked the facilities available to them at the home. This included comments about individual rooms. One person said, “I have everything I need in here its home from home”.

We spoke with a range of people about the home. They included, the registered manager, some of the staff members on duty, people who lived at the home and some visiting relatives and friends. We also had responses from external agencies including social services in order to gain a balanced overview of what people experienced using the residential services of Chirnside residential home.

People were seen to be cared for in ways that suited them. Those we spoke with told us that they were involved in the planning of their own care. We saw that people were given opportunities to inform staff of their personal support requirements. Staff were found to be involved in assessing people's needs, and there were systems in place to monitor how those needs were met. We observed some of the staff working alongside people in positive ways. People living at the home told us that they felt safe. One person said that staff were always there when you needed them. One visitor we spoke with thought the home had a good number of staff on duty who were, “very courteous”. One person told us, "I call in at different times and it is always the same, very relaxed with staff around.” Another person said, “We are very well looked after.”

People we spoke with were extremely complimentary about the home and the staff working there. Everyone spoken with told us how kind and good the staff were. Residents felt their needs were being met and they were encouraged to be as independent as they were able.

Comments we received included:

From some of the residents:

“No-one is woken up we can get up when we want.”

“The food is wonderful I have put on weight.”

“I know my key worker, we get together once a month to check I can still do the things on my care plan, and see if anything needs changing.”

“I’m off to the hospital with x (carer) she stays with me while I am there.”

“I have no complaints or grumbles.”

“Staff here are very good, we are well looked after.”

“The staff here are great, so caring.”

“I wouldn’t want to leave here.”

“It is very safe here.”

From the staff working at the home:

“I like the home because we have the time to spend with the residents.”

“I am proud to work here, it’s a very well run home.”

“The standards here are high.”

“The residents are happy and we have enough staff.”

“It’s a great place to work it’s like being at home.”

From two relatives visiting the home:

“If there are any problems I just go and talk to someone.”

“My relative is very well cared for, it’s a lovely home.”