This inspection took place on 23 and 24 July 2018. The first day was unannounced, however we informed staff we would be returning for a second day to complete the inspection and announced this in advance.

The Chanters is owned by Larchwood Care Homes (North) Limited and is located in the Atherton area. The Chanters offers accommodation for up to 40 people who require assistance with personal care and support. At the time of the inspection there were 40 people living in the home.

The Chanters is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this 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 2008 and associated Regulations about how the service is run.

At our last inspection in May 2016 the home was rated as 'Good' in four domains and overall, but Requires Improvement in the Effective domain because we had identified a breach of the regulations in relation to the use of the building. At this inspection we found this had been responded to fully by the home and significant improvements had been achieved which included, improving the environment for people living with dementia.

The home had effective systems in place to protect people from the risk of harm and abuse. Staff were knowledgeable about how to recognise and respond to concerns. We could see the home had been thorough in investigating and following up all concerns raised.

Staffing levels were calculated and reviewed regularly based on people's needs. We could see staffing had been amended when required. People living in the home and their relatives told us they felt the home was safe. People had been supported to assess and manage the risks in their daily lives while maintaining as much independence as possible.

Medicines were managed safely, some people had been supported to manage their own medicines.

Staff had been recruited safely, all the necessary checks had been completed to ensure staff were suitable to work with vulnerable people.

The building had been well maintained and there were regular cleaning schedules and infection control checks. We found there was a slight odour on the ground floor which we discussed with the registered manager who will address this. We will review this at our next inspection.

New staff received a comprehensive induction programme and regular training. At the time of our inspection the training records were being transferred to a new system and we could not see the most recent training matrix. We will review this at our next inspection.

The home had applied for Deprivation of Liberty Safeguards (DoLS) authorisations when required and had an effective system for ensuring these were up to date. Staff understood the principles of the Mental Capacity Act 2005 (MCA), the importance of supporting decision making and obtaining consent.

People had been supported to maintain all aspects of their health, they had access to health professionals when needed. The home ensured information about health needs and how to support communication had been transferred effectively when people went to hospital.

The home had considered the impact of the environment for people living with dementia. Using an assessment tool from the Kings Fund, The King's Fund is an independent charity working to improve health and care in England. they had devised an action plan and made changes to the lighting, seating areas, flooring and access to the garden. They had also improved signage around the home and encouraged improved nutrition and access to food and drink at all times.

People living in the home

We carried out an unannounced comprehensive inspection of this service on 10 May 2016. At the last inspection on 28 May 2014, we found the service to be compliant with all regulations we assessed at that time.

The Chanters is a purpose built care home, owned and operated by Larchwood Care Homes (North) Limited. The service is registered with the Care Quality Commission (CQC) to provide personal care and accommodation to a maximum of 40 people. Accommodation is provided over two floors and there is lift access. The home is located near to the town centre of Atherton in Wigan, Greater Manchester. Car Parking facilities are available at the front and large gardens are located at the rear of the property.

During this inspection we found one breach of the Health & Social Care Act (Regulated Activities) Regulations 2014. This was because some aspects of the environment did not take account of national best practice and were not being used for the intended purpose. You can see what action we told the provider to take at the back of the full version of the report

We asked people who used the service if they felt safe and they told us they did. We looked to see how the service sought to protect people from abuse and found there were appropriate safeguarding and whistleblowing policies and procedures in place. All the staff we spoke with demonstrated they had a good understanding of the types of abuse and the procedure to follow if they suspected that a person was at risk of, or was being abused.

We asked staff about whistleblowing. All of the staff we spoke with told us they would not hesitate to use the policy and identified internal reporting protocols. Staff also referred to CQC as an external agency they could contact.

We observed a senior member of staff on a medicines round and found peoples’ medicines were given safely and as prescribed. We found safe systems were in place for ordering, storage and disposal of medicines.

Staff induction was robust and included mandatory training, shadowing and access to appropriate policies and procedures. Further training was on-going and staff were encouraged to access training as part of their on-going development.

We looked at care plans to establish that people were receiving the care and support they needed and if any risks to people’s health and wellbeing were being appropriately managed. We found that the care files were large and contained historical information that was no longer reflective of the person’s needs and this made eliciting the current clinical picture difficult. We spoke with the registered manager about this who informed us that a programme of streamlining the files was underway in conjunction with transferring the documentation to the new provider’s format.

We looked in detail at the care records of people living with complex needs. For example, people at a higher risk due to poor nutrition, falls or pressure care. We found that people’s risks were appropriately assessed and managed and that care plans had been updated to reflect people’s changing needs in a timely way.

People who used the service said the food was good and we saw that there was plenty choice. However, we found that people who used the service who were living with a diagnosis of dementia could have been better supported at mealtimes through the use of a pictorial menu. This would help people living with dementia to better understand the food options being presented to them.

During our inspection visit we asked the registered manager whether or not the service worked to a nationally recognised model of dementia care and we were told they did not. We found that some aspects of the service had been improved to enable people who might be confused to orientate themselves but overall the service was not sufficiently dementia friendly.

We looked at the communal areas of the upper floor and found the décor to be worn in parts and traditional in presentation. Storage space on this floor appeared

The Chanters is registered with the Care Quality Commission to provide personal care and accommodation for up to 40 people, some of whom suffered from dementia and were unable to give us their views. As part of our inspection we spoke with four people who used the service and two visiting relatives. The areas we focussed on included care, infection control, recruitment, service quality and the suitability of the premises.

Our inspection was co-ordinated and carried out by an inspector from the Care Quality Commission who addressed our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We also used a specialist advisor who assisted us on the day of our inspection.

There are two units at the Chanters which consisted of a residential and dementia unit. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and from looking at records.

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

Is the service safe?

People told us they were treated with respect, dignity and felt safe in the presence of staff.

Safeguarding procedures were in place and staff were able to demonstrate how they would safeguard the people they supported. This meant that people were safeguarded from abuse.

There were systems in place to make sure that the management and staff learned from events such as complaints and concerns. We noted accidents and incidents were also monitored closely however action taken to prevent future re-occurrences was not always clearly recorded. We raised this issue with staff during the inspection.

On the day of our inspection we were told there was nobody currently living at the home who was subject to a Deprivation of Liberty Safeguards. We noted staff had received relevant training in relation to Mental Capacity Act (MCA) and Deprivation Liberty Safeguards (DOLS) and also received regular updates in this area.

We undertook a tour of the premises to ensure they were fit for purpose. We noted there was sufficient disabled access and a passenger lift to enable people with mobility problems to access the second floor of the home.

People who used the service, generally felt there were enough staff on shift to care for them appropriately. One person said; “I don’t think you can ever have enough can you. But the staff make the most of what they have got”.

We found staff recruitment practice was safe and thorough. This included ensuring DBS (Disclosure Barring Service) checks were undertaken and a minimum of two references sought before staff commenced employment.

Is the service effective?

Generally, the people we spoke with felt their care requirements were adhered too and that staff provided an effective service to them. One person told us; “I think all the girls are very good at what they do. They get the job done and look after me well”.

People’s health and care needs were assessed with the people who used the service or their representatives. Special dietary mobility and equipment needs had been identified in care plans where required.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible. There were designated ‘quiet areas’ where people could spend time with their loved ones when they visited the home.

Is the service caring?

We observed people were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. We asked people who lived at The Chanter about their opinions of the care they received. Comments included; “Very good” and “I like it here. The staff are nice. They make an effort to spend time with me” and “I would say the care is good. Nothing bad to say really”.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Whilst speaking with people, we noticed they were well presented and appeared well cared for. Two of the people we spoke with told us they were offered the choice of either a bath or shower and could choose what clothes they wanted to wear.

Is the service responsive?

The home employed an activities co-ordinator. The people we spoke to said activities took place most days. There was a display board at the home with an activities schedule which included bingo, dancing, exercise, entertainment, films and reminiscence. We observed an activity taking place on the afternoon of our inspection and people appeared interested and keen to take part.

People we spoke to were aware of the complaint procedure. On the day of our inspection the home had only one complaint on record which had been responded to appropriately. People can therefore be assured complaints would be investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We saw evidence of communication and involvement with health professionals such as dieticians, district nurses and general practitioners.

The service had quality assurance systems in place to monitor the quality of the service provided. This was done with use of audits, surveys and the learning from incidents and complaints. Although accidents and incidents were monitored closely, we could not see any records of where action had been taken to avoid repeat incidents and we raised this with the person in charge.

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

We spoke to people about this service and spent time observing people to gain a balanced overview of what people experienced and how they were cared for. We spoke to people using the service, and relatives of people using the service and three staff members.

We saw that staff knew the needs of people using the service. Care plans were based on a comprehensive assessment of risks and needs and were updated regularly. Care plans were signed by people using the service or, where people lacked the capacity to consent, by a relative or an advocate.

A relative said that they, “have been really pleased with this home.” Another said that care staff were, “really good,” and that the manager was, “lovely and really caring.”

We looked at staffing rotas and saw that staff numbers were consistent and we reviewed the training records for all staff. People said there were always enough staff to care for the service users. We found that all staff received appropriate training to care for people using the service, and that it was updated regularly.

We saw that the home had a complaints policy, which was displayed. No written complaints had been made since the current provider took over the home. Issues or complaints raised verbally were documented and responded to appropriately.

People who we spoke with were complimentary about the care they received at The Chanters. Some of the comments were “Staff are very nice and helpful.” and “Staff are very good.” One person told us “My clothes come back from the laundry lovely and clean and nicely ironed.”

We asked people about the choices that they were given. People told us that they could get up and go to bed when they wanted. One person told us “I go to bed at 9.30pm. That’s when I want to go.” People living in the home told us they were treated with respect. We heard one negative comment from a person who told us that some of the younger carers could be “a bit bossy.”

One relative told us that “They know how to treat people with dementia.” Another relative said “This home is more suitable for my mother rather than her previous care home.”