Chyvarhas is a ‘care home’ that provides accommodation for a maximum of 36 adults, of all ages with a range of health care needs and physical disabilities. At the time of the inspection there were 29 people living at the service. 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.

Chyvarhas is situated in the town of Callington. It is a purpose built single storey building with a range of aids and adaptations in place to meet the needs of people living there. It is close to the centre of Callington with links to public transport. There is a main lounge/dining area with three ‘wings’ where peoples bedrooms are located. In the foyer there is a fourth ‘wing’ where peoples bedrooms are also situated. All rooms were single occupancy. There was a large communal lounge/ dining area but smaller lounge areas were situated throughout the home for peoples use. There were a range of bathing facilities in each area designed to meet the needs of the people using the service. There was a garden which people could use if they were being supported.

The last inspection took place on the 28 March 2017. The service was rated as Requires Improvement at that time. There were concerns around how risks for people were managed, how staff supported people who may become anxious, medicines were not always recorded safely and records had not been completed satisfactorily.

This unannounced comprehensive inspection took place on 5 June 2018. At the previous inspection (March 2017) the registered manager had been in post for a matter of days. Since that time she has remained in post and has worked with the staff team to implement the necessary changes. At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection. The service is now rated as Good.

The service is required to have a registered manager and at the time of the inspection there was a registered manager 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 and associated Regulations about how the service is run.

Staff told us with the change of registered manager and also changes at senior management level there had been a number of positive improvements to the service. Staff told us that there “Is now a process for everything we do, we know what is expected of us.” Staff felt that as their roles were clearer this meant that staff knew who was responsible for each task and these were now completed. Staff were also clear about how they needed to record information to evidence how they supported and monitored a person’s health and the process to follow if a person had an incident. We found records were up to date and reflected the person’s individual needs. Accident and incident records were also completed and audited by the management team.

The senior managers met regularly and had redesigned their performance management system in order to improve reflective practice, increase sharing and improve communication across the organisation.

People, relatives and staff all told us they found the new management structure more open and approachable. They felt their views on the running of the service were sought and were complimentary about the changes to the service. A person told us “Things have definitely improved, especially recently with the new manager, and the new staff are just as caring as the staff I’ve known for many years.”

Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care

The inspection took place on 28 and 30 March 2017 and was unannounced. Chyvarhas provides care for people who may require nursing care and for people who are living with dementia. Chyvarhas is owned by Cornwall Care and provides care and accommodation for up to 40 people. On the day of the inspection 33 people lived in the home.

A manager was employed to manage the service who was in the process of registering with the Care Quality Commission. 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.

The provider did not always act to keep people safe. People’s call bells were not always connected or within their reach which meant they were not able to call for assistance should they need it. Staff were not always aware of how to help alleviate people’s anxiety and did not always act to help people when they were experiencing anxiety. People did not always have risk assessments in place to guide staff how to reduce risks to people. Where people had experienced incidents, these had not been recorded accurately or monitored to ensure any learning was identified and implemented to reduce future risks.

People were supported with their medicines by trained staff, however staff were not ensuring they recording accurately what medicines they had administered and when. This meant it was not clear what medicines had been administered and what time people could safely receive their next dose. People were supported to see medical professionals, however records regarding what action had been taken in relation to people’s health concerns, and why, was not always accurate or up to date.

People were involved in planning their care and staff sought their consent prior to providing them with assistance. Staff had received training about the Mental Capacity Act but where people lacked the capacity to make decisions for themselves, processes had not always ensured people’s rights were protected. Where people’s liberty was restricted in their best interests, the correct legal procedures had been followed.

People told us they were able to choose how they spent their day and that group activities were available. However staff members told us they did not have time to spend with people, beyond providing personal care. Feedback sought by the provider showed people and relatives felt activities were not personalised and staff did not have time to spend with people. People’s care plans did not always contain information about how people liked to have their care provided or what pastimes they were interested in.

The provider had not always acted to ensure the quality of the service was maintained. Feedback had not always been acted upon and gaps in records had not been identified.

People were supported by staff who treated them in a caring way and respected their privacy and dignity. People’s complaints were taken seriously and acted upon.

People told us they enjoyed the food. Mealtimes were a positive experience and people told us meals were of sufficient quality and quantity. There were always alternatives on offer to choose from and people were involved in planning the menus and their feedback on the food was sought.

Recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

Staff had received training relevant to their role and there was a system in place to remind them when it was due to be renewed or refreshed. The manager was in the process of identifying what furth

We gathered evidence against the outcomes we inspected to help answer our five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

During our inspection of Chyvarhas we saw evidence to support a judgement that this service was safe.

People were safe because staff knew what to do when complaints were raised and where concerns had been raised we found the home had taken appropriate action to ensure people were safe from harm. People told us they felt able to “speak their minds”.

We saw Chyvarhas understood the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

We found there was enough qualified, skilled and experienced staff to meet people’s needs. We were told the service regularly monitored people’s needs and adjusted staffing levels to meet people’s needs if they changed.

Is the service effective?

During our inspection of Chyvarhas we saw evidence to support a judgement that this service was effective.

People’s health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

The home worked with other services to ensure people’s health needs were met. This included professionals such as GPs, dieticians, tissue viability nurses and district nurses.

People were asked for their consent for any care or treatment and the home acted in accordance with their wishes. Where the home assessed people did not have the capacity to consent, they acted in accordance with legal requirements.

We spoke with one visitor and they confirmed they were able to visit the home whenever they wished.

Is the service caring?

During our inspection of Chyvarhas we saw evidence to support a judgement that this service was caring.

We saw and heard staff ask permission and then explain what was going to happen when they provided care. For example, “Is that okay?”, “May I?” and “Please can you?” We saw staff paid attention to the choices we all make in our daily lives, such as “would you like salt and pepper?” or “would you like some sugar in your tea?” We observed staff responded to people in a kind and sensitive manner adjusting their own stance to ensure they were at eye-level with the person they were talking with.

People were treated with dignity and respect by the staff. Some of the comments received from visitors to Chyvarhas included “X has been in Chyvarhas for eighteen months. I have nothing but praise for the care he receives. The only thing that could be better is the food” and “I have always found the management and care staff to be friendly and helpful with any issues dealt with in an efficient and caring manner. I am happy that X’s individual needs are being met and that they are being well looked after”.

People’s individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. Where people were unable to be communicate their choices the home had worked with people’s families to write details of their known daily routines on their behalf. We saw staff provided support in accordance with people’s wishes.

Is the service responsive?

During our inspection of Chyvarhas we saw evidence to support a judgement that this service was responsive.

People confirmed they could have what they wanted at meals if they did not like what was offered. People were able to take part in a range of group and individual activities such as dancing, scrabble games and craft work.

People who used the service and their representatives were asked for their views about their care and treatment.

Is the service well-led?

During our inspection of Chyvarhas we saw evidence to support a judgement that this service was well-led.

We were able to talk with staff and they were all positive in their attitude on how the home was organised and run. The home had a manager registered with the Care Quality Commission.

We met with the, deputy manager, staff and people who used the service. We spoke with three people who told us they were happy at Chyvarhas and that their care needs were met.

We saw that people who used the service were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We observed the lunch time meal and saw staff respected peoples' dignity when assisting them to eat.

During our inspection, we found people’s privacy, dignity and independence were respected. Where people were able to express their views and experiences, these were taken into account in the way the service was provided and delivered in relation to their care.

People were protected from abuse and staff were trained and supported to carry out their roles.

Staff told us training was provided, and also confirmed they had received supervision.

Care plans and associated documentation provided sufficient detail to direct and guide staff as to the actions necessary to take in order to meet people’s assessed care needs. People's records were personalised and provided clear information about the person’s wishes and abilities.

Some of the people who used the service were not able to comment in detail about the service they receive due to their healthcare needs. We spoke to one visitor who told us that they were pleased their relative lived at Chyvarhas. We spoke to people and spent time observing people and staff over a meal period. We saw people’s privacy and dignity was respected and staff were helpful. We saw people chatted with each other and with staff.

During the observations we saw staff helping people to mobilise. We saw staff assisting people to eat their lunch. We saw people talking to each other at lunch.

We witnessed staff interaction with people which was generally positive.

We heard care workers ask people what they would like to do and gave them ideas if they could not make a choice.

People experienced care, treatment and support that met their needs and protected their rights.

People we spoke with said that they enjoyed the food they received. We were told the food was of a good standard, and we saw the food provided at lunch was hot, well presented and in sufficient quantities. We saw people were offered choices at meals.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found staff received appropriate professional development and supervision.

People told us that the staff were kind and always did their best. A visitor told us that they had had misgivings about their relative moving into a care home, but they were now reassured and were involved in their relative’s care.

People who were able told us that they liked living at the home. People we spoke with were pleased with the staff looking after them and the care they received. They told us that ‘Staff are excellent’ and ‘I couldn’t be in a better place, I am so well looked after’. Not everybody at the home was able to tell us what it was like to live at Chyvarhas and for those people we observed care being provided.

People using the service told us they were happy with the standard and choice of food available. People who were able also told us that they could make choices about how and where they spend their day. One person told us that they wanted more activities to do. People told us that they liked having access to outside and the garden was seen to be in use.

People told us that they felt supported by the staff and that made them feel safe.

The inspection took place on 12 and 13 March 2015 and was unannounced. Chyvarhas is a nursing home providing care and accommodation for up to 38 older people, some of whom are living with dementia and mental health needs. On the day of the inspection there were 34 people living at the home, 29 of whom had identified nursing needs. This was due to double rooms being used for single occupancy. Chyvarhas is part of Cornwall Care Limited.

The service had 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.

We observed a calm and relaxed atmosphere within the service. People and staff were chatting and enjoying each other’s company. Comments included; “Staff are very kind.” People told us they were happy living there.

People and their relatives were happy with the care staff provided. Professionals and relatives said staff were knowledgeable and competent to meet people’s needs.

People were encouraged and supported to make decisions and choices whenever possible in their day to day lives. People had their privacy and dignity maintained and we observed staff supporting people and being patient and understanding.

People were protected by safe recruitment procedures. Staff were supported with an induction and ongoing training programme to develop their skills and staff competency was assessed. Everyone we spoke with felt there were sufficient staff on duty. Staff told us they had enough time to support people and didn’t need to rush them. A relative said; “always someone about”, when we asked them about the availability of staff. A new staff member commented; “so much time to get to know people.”

People had access to healthcare professionals to make sure they received appropriate care and treatment to meet their health care needs such as GPs and CPNs (Community Psychiatric Nurses). Staff followed the guidance provided by professionals to help ensure people received the care they needed to remain safe. For example some people had one to one staff support.

People’s medicines were managed safely. However an error in the recording of medicines was highlighted on the first day of our visit. This was rectified before the completion of the inspection to keep people safe. Medicines were managed, stored and disposed of safely. Nurses administered all medicines and had been appropriately trained and confirmed they understood the importance of safe administration and management of medicines.

The registered manager and staff had sought and acted on advice where they thought people’s freedom was being restricted. This helped to ensure people’s rights were protected. Applications were made and advice sought to help safeguard people and respect their human rights. Staff had undertaken safeguarding training, they displayed a good knowledge on how to report concerns and were able to describe the action they would take to protect people against harm. Staff were confident any incidents or allegations would be fully investigated. People who were able to told us they felt safe.

People were supported to maintain a healthy, balanced diet. People who were able to told us they enjoyed their meals and an observed lunchtime did not feel rushed.

People’s care records were comprehensive and detailed people’s preferences. People’s communication methods and preferences were taken into account and respected by staff.

People’s risks were considered, well-managed and regularly reviewed to keep people safe. Where possible, people had choice and control over their lives and were supported to engage in activities within the home and outside where possible. Records were updated to reflect people’s changing needs. People and their families were involved in the planning of their care.

People and staff described the management as very supportive and approachable. Staff talked positively about their jobs and took pride in their work. Visiting professionals and staff confirmed the management of the service was “always very good.”

People’s opinions were sought formally and informally. Audits were conducted to ensure the quality of care and environmental issues were identified promptly. Accidents and safeguarding concerns were investigated and, where there were areas for improvement, these were shared for learning.