We inspected London Care (Chestnut House) on 18 & 20 December 2018. This was an announced inspection. The provider was given 48 hours’ notice because the location is an extra care housing scheme; we needed to be sure that someone would be in.

At our previous inspection on 27 November and 6 December 2017 we found the provider was not meeting regulations in relation to the outcomes we inspected, we found a breach of regulation in relation to Safe Care and Treatment. The service was rated Requires Improvement.

At this inspection, we found the provider had now met the breach identified at the last inspection. We also found improvements had been made in relation to record keeping. Therefore, the rating for the key questions ‘is the service safe?’ And ‘is the service well-led?’ has improved to Good. However, the rating for the key question ‘is the service caring?’ has deteriorated to Requires Improvement following feedback from people.

London Care (Chestnut House) provides personal care and support to people living in an extra care housing scheme. This consists of 42 individual flats within a staffed building with some communal areas. At the time of our inspection there were 33 people using the service. A separate organisation was responsible for managing the building and flats. Each flat consisted of one bedroom, a lounge/kitchen and a bathroom and was individually furnished.

There was a registered manager 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.

Feedback from people was mixed, although some praised the carers for their caring attitude, others said that their care sometimes felt rushed and care workers did not always engage with them or go over a basic level of care.

People said they felt safe in the presence of care workers who supported them with their medicines and meal preparation. Care workers demonstrated a good understanding of people’s needs and were aware of which people needed more help and support than others. Carers also demonstrated an understanding of people’s preferences.

People lived independent lives and, those that were assessed as being able to, managed their own medicines, meals and also their health care needs.

Staff received training that was relevant to the needs of people using the service. They also received regular mentoring through office based and ‘field’ supervisions based on certain themes such as medicines.

People had signed tenancy agreements and consented to various aspects of their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care plans were completed in the presence of people and were focussed on maintaining a good quality of life, mainly around personal care, safe medicines management and a healthy lifestyle.

Where people had raised any concerns or formal complaints these were investigated by the provider. Similarly, incidents and accidents were documented. Follow up actions in relation to complaints and accidents were documented and there was evidence that the provider took action where needed to try and make improvements.

This inspection took place on 27 November and 6 December 2017 and was announced.

This was the first inspection of the service since it registered with the Care Quality Commission.

London Care (Chestnut House) provides personal care and support to people living in an extra care housing scheme. This consists of 42 individual flats within a staffed building with some communal areas. At the time of our inspection there were 39 people using the service. A separate organisation was responsible for managing the building and flats. Each flat consisted of one bedroom, a lounge/kitchen and a bathroom and was individually furnished.

There was a new manager at the service who had submitted an application to become registered. 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 using the service were happy with the care and support they received. They said they felt safe in the presence of care workers who were friendly and caring. We observed care workers speaking to people in a polite manner and supporting them with their medicines and they did so appropriately, taking their consent and recording on the MAR charts.

People were satisfied with the support they received with regards to their nutrition. The majority of people had their shopping done by relatives or ordered in ready meals that were delivered to their flats. Staff supported them to prepare their meals.

We found that although risk assessments were in place, the level of risk was not always documented correctly and therefore there was a potential risk of the necessary support plans not being in place. We also found other areas of record keeping were not always completed in sufficient detail.

Recruitment checks were robust and there were enough staff to support people. We found that staff received a thorough induction and the necessary ongoing mandatory training. They received regular one to one supervision.

People told us they knew how to raise any concerns. The provider recorded complaints on their online reporting system and carried out investigations into complaints received, taking action where necessary and addressing the concerns of the complainant.

Thorough quality assurance checks, including audits and feedback surveys were in place. There was an action plan that the provider had in place in response to issues found in audits.

We found a breach of the regulations in relation to safe care. You can see what action we have told the provider to take at the back of the full version of this report.