About the service: OSJCT Chilterns Court is a care home that was providing personal and nursing care for 59 people aged 65 and over with a range of conditions.

People’s experience of using this service:

• People received person-centred care that valued them as unique individuals and protected their rights. People were supported by staff who showed kindness and compassion. Positive relationships had developed between people and staff which created a relaxed, friendly atmosphere in the service.

• The service was led by an effective and caring registered manager. The registered manager had made improvements to the service which had resulted in high quality care delivered by a positive and committed staff team.

• There were effective systems in place to protect people from harm and abuse. Where risks were identified these were assessed. There were plans in place to guide staff in how to support people to manage the risks.

• People were supported in a responsive way that recognised changes in people’s condition in a timely manner. Action was taken to ensure people’s needs were met.

• Staff were extremely positive about the support they received. Staff felt valued and listened to and were supported to access development opportunities to continually improve their skills and knowledge.

• There were effective systems in place to monitor and improve the service. People and relatives had opportunities to feedback about the service and this was used to develop improvement plans.

• 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.

Rating at last inspection: Rated Requires Improvement. Report published 3 May 2019. Service has improved its overall rating to Good.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected OSJCT Chilterns Court on 20 March 2018. This was an unannounced inspection.

Chilterns Court 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.

The care home accommodates up to 64 people in a purpose built building. The accommodation is spread over three floors. Bluebell is the nursing unit which supports people with rehabilitation following a hospital admission and supports people to prevent admission to an acute hospital setting. Tulip unit specialises in providing care to people living with dementia. Snowdrop is a residential care unit. During our inspection there were 61 people living at the service.

There was a registered manager in place. 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.

At our last inspection on 25 January 2017, we found a breach of regulation 17. We asked the provider to take action to make sure people’s records were completed and maintained. At this inspection on 20 March 2018, we found some improvements had been made. However, further improvements were still required in some areas.

People's care plans were not always current and were not always updated when people’s needs changed to reflect those changes. The provider’s quality assurance systems were not always used effectively to drive improvement. Where people were thought to be at risk of malnutrition, the malnutrition universal screening tool (MUST) were not always calculated correctly.

Most people were supported to maintain a balanced diet. On the day of the inspection, we observed pleasant dining experiences across the home. However, one person on a fat free diet was not managed well.

People told us they felt safe living at Chilterns Court. Risks to people’s well-being were assessed and managed safely to help them maintain their independency. Staff were aware of people’s needs and followed guidance to keep them safe. Staff clearly understood how to safeguard people and protect their health and well-being. There were systems in place to manage people’s medicines. People received their medicines as prescribed.

Chilterns Court continuously recruited staff to ensure people’s needs were met. The home had staff vacancies which were covered by regular suitably qualified and experienced agency staff to meet people's needs. Same agency staff were used to maintain continuity. The management team were doing all they could to ensure safe staffing levels. The home had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

People had their needs assessed prior to living at Chilterns Court to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.

People were supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff told us they were well supported by the management team. Staff support was through regular ‘trust in conversation’ (one to one meetings with their line manager), and team meetings to help them meet the needs of the people they cared for.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The registered manager and staff had a good understanding of the MCA and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The regi

This inspection took place on 25 January 2017 and was unannounced. We carried out this inspection as result of concerns raised about the service.

OSJCT Chilterns Court Care Centre is a new home that registered with the Care Quality Commission in December 2016. The registered manager, many of the staff team and people using the service had moved to the new location from the previous location which had closed. OSJCT Chilterns Court Care Centre supports up to 64 people who require personal or nursing care. The accommodation is situated over three floors. The nursing unit supports people with rehabilitation following a hospital admission and supports people to prevent admission to an acute hospital setting. During our inspection there were 53 people using the service.

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 2008 and associated Regulations about how the service is run.

People were positive about living at OSJCT Chilterns Court Care Centre and about the staff supporting them. Staff were kind and caring, treating people as individuals and promoting choice and independence. There was a cheerful, relaxed atmosphere that supported people to develop caring relationships with staff and each other.

People did not have confidence in the management of the service and were not confident that any issues raised would be listened to and dealt with.

Staff morale was poor. Staff did not feel valued or listened to. Staff were not supported by regular supervision and were not confident to raise concerns with the management team. Staff felt supported by their peers and there was good communication between the staff team.

There were sufficient staff to meet people's needs. Where agency staff were required the registered manager ensured consistent agency staff were used. Staff knew people well and used that knowledge to support people in a way that valued them as individuals. The provider had effective recruitment processes in place that ensured staff were suitable to work with vulnerable people.

People's care plans were not always up to date and accurate. Risk assessments were not always complete and where risks were identified there were not always management plans in place to ensure the risk was managed. People received their medicines as prescribed. Medicines were stored safely.

Care plans did not always reflect the principles of the Mental Capacity Act 2005 (MCA). Staff understood the principles of MCA and how to apply them when supporting people. People were given choice and their choices were respected.

There was a programme of activities displayed in the service. We saw people enjoying a musical performance. People were encouraged to participate in activities and we saw staff supporting people to enjoy individual activities.

Snacks and drinks were available throughout the day. People enjoyed the food and were given alternative choices if they did not like the meal on offer.

The provider had systems in place to monitor the service. The registered manager and area operations manager had completed an action plan identifying actions needed to address most of the issues found during this inspection.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.