The home provides accommodation and personal care for up to sixteen adults with learning disabilities who require help with personal care. The accommodation is located in a Victorian house with an annexe with five bedrooms located across a small courtyard. Staff work across both areas. The home is within walking distance of the town centre.

At the last inspection in November 2014, the service was rated good, although the well-led domain was rated as requiring improvement. This was primarily because there was no registered manager in post.

This comprehensive inspection took place on 9 May 2017 and was unannounced. At this inspection we rated all the domains as good and therefore the service remained Good.

The home had a manager who had registered with the Care Quality Commission in March 2015. 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.

There were quality assurance systems to monitor the running of the home. Records showed that where issues were identified these were addressed.

People risks, needs and preferences were assessed when they came to live at the Chantry. Care plans were developed to address these with the involvement of the person. The plans described what staff needed to do in order to support people to be as independent as possible and lead fulfilled lives to their maximum potential. Plans were reviewed regularly and if the person’s requirements altered.

Staff knew people well and showed kindness and compassion when working with them. Staff respected people’s right to privacy and ensured they maintained people’s dignity.

People were encouraged to do activities of their choice both inside and outside the home. Some people attended local clubs which they said they enjoyed doing. People were able to do some activities on a one to one basis. Staff also encouraged people to develop skills related to daily life, such as cooking, cleaning and laundry.

People were provided with a healthy and varied menu to meet their nutritional needs. People said they liked the food and were given choices of what to eat and drink.

Staff had been trained in the requirements of the Mental Capacity Act (2005) and knew the implications of this when providing care for people.

There were sufficient staff on duty to support people with their assessed needs. The registered manager ensured staffing levels were monitored and adapted to support people both in groups and on a one to one basis.

People received care that met their needs from staff who were recruited safely and trained in their role. Staff received regular supervision and appraisals to ensure they had the support they needed including consideration of their personal development. New staff received induction training which met national guidelines. Staff were trained in safeguarding and had a good understanding of how to respond to safeguarding concerns.

Policies and procedures were in place for staff to support people take their medicines safely.

The home was well maintained. People were able to personalise their bedrooms. Friends and family were encouraged to visit without unreasonable restrictions.

This was a follow up inspection to check that improvements required since we last visited in December 2013 had been made. Nine people lived at the home when we visited and we met eight of the nine people during our visit. Some of the people who lived at the Chantry were unable to talk to us to tell us about their experiences of living there so we talked to staff about those people’s needs and observed staff interactions with them.

We spoke with six staff, the manager and the nominated individual and looked at training and supervision records for staff. We spoke with ten health and social care and obtained feedback from them about the home. They included a learning disability community nurse, speech and language therapist, physiotherapist and occupational therapist.

We spoke with three relatives about people's care. They confirmed they were very satisfied with the care provided. One relative we spoke with said, "I have confidence in the staff team”. Another relative told us they had seen “significant improvement” and said, “They have got a new manager and everybody seems positive, it’s calmed down a lot and clients are more of a family”.

Is the service safe?

Improvements in staffing meant people were safer and that staff were better able to support and interact with people. Staff told us they were able to give people more time and support. We saw how staff spent more one to one time with each person doing things that interested them. At night, we saw that staffing levels enable people to have additional support and supervision. Hourly night welfare checks had been introduced for two people to ensure they were safe and were offered assistance promptly. An additional member of staff on duty early each morning meant people who liked to get up early were supported to have their breakfast and have assistance with personal care.

Since our last visit, a number of people had been reviewed by a speech and language therapist. The therapist had undertaken training with staff about how to support people to eat and drink safely. We saw the support offered to the person at lunch time was in accordance with their care plan. Staff we spoke with demonstrated they understood people’s risks and we observed they sat with people during lunch and supervised them. For example, by prompting one person to slow down and reminding another person to chew their food properly and swallow it before having the next mouthful. This meant people’s choking risks were reduced.

Further repairs and improvements had been undertaken since we last visited such as the repair of an uneven slope and the installation of new grab rails. However, further repairs and improvements required. For example, a radiator cover still had not been fitted in the refurbished upstairs shower room, a cracked cistern lid needed to be replaced and loose slates on the top of the boundary wall needed to be fixed. The manager told us they had spoken with the provider and agreed funding and a timescale for all the remaining works, which they said would be completed by the end of June 2014.

Is the service effective?

We saw the range of sensory activities available for people had been expanded. For example, sensory cooking, the use of more communication tools such as photographs, symbols and an iPad for one person. Generally, we found care plans included more detailed information about people’s medical history, medical conditions and what support people needed. People’s needs were assessed and care and treatment was in line with their individual care plan. However, not all care plans developed to address people’s needs were being reviewed, evaluated and updated regularly to monitor if the actions being taken were successful. This made it difficult to track people’ progress over time or see whether the care given was effective.

We followed up concerns raised at our previous visit about ‘My everyday living capacity assessment’ documents in care records. These detailed people’s capacity to make day to day decisions such as about eating and drinking, activities, personal care and about the time people wished to get up and go to bed. At this visit, we found these assessments had not been updated or improved. For example, one person’s assessment contained contradictory information about whether or not a person could give their consent to participate or be included in planned activities. This meant some people’s mental capacity assessments did not take account of the requirements of the Mental Capacity Act 2005.

Is the service caring?

People we spoke with seemed happy most of the time and staff treated people with caring and compassion During the morning, we saw staff having much more interaction with people than we had seen on previous visits. For example, staff spent more time with people and people were given opportunities to take part in individual activities such as drawing and colouring, playing dominoes. In the lounge, two people watched a film with a member of staff and another two people went into town to do some shopping. In the afternoon, most people enjoyed a group art activity with an art therapist. Throughout the day we heard staff prompt people and offer praise and encouragement to them for their achievements.

Is the service responsive to people’s needs?

We saw that people’s care plans had been updated and had much more up to date information particularly about people’s health care needs. We looked at the care of one person who was prone to falls because of their reduced mobility and frailty. Since our last visit, this person had been moved to a larger room much more suited to their mobility needs. We followed up what action had been taken about developing a care plan for a person with diabetes. We found a detailed care plan had been made to inform staff about how to support this person with their diabetes. We saw this included information about a low sugar diet and about the need for regular skin care and observation of their feet to check for circulation problems. We saw that diabetic specific foods had been purchased for this person and there was evidence of daily skin care and regular monitoring for known complications of diabetes, as required by their care plan.

Is the service well led?

A new manager had started a few weeks before our inspection and planned to register with the Care Quality Commission. The manager told us they had re-introduced a key worker system at the Chantry so that each person had a small core of staff who were responsible for ensuring their needs were met and for reviewing their care monthly. We saw that a residents’ meeting had recently been held and that people had contributed their ideas to develop the garden and that these ideas were being incorporated into the plans being made. This demonstrated people’s views were being sought and acted on.

The manager told us how a recent audit of care records had highlighted some poor record keeping. They told us how this had been addressed with those staff and objectives agreed about improvements needed. This demonstrated performance issues were being addressed so that all staff were expected to work to a required standard. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. We looked at the incident reports completed since our last visit. We saw that detailed records of each incident were documented with measures identified to reduce the risks of recurrence. We also saw how incidents were monitored regularly by the provider to identify trends. This demonstrated that the quality of incident reporting had improved and was being used proactively to reduce risks.

This visit was to follow up the improvements we required following our last inspection in May 2012. We spoke with four people and one relative about the home and looked at three people's records. We spoke with eight staff and three visiting health professionals and asked about how people’s care needs were being met. Some of the people we met had limited or no verbal communication skills. We observed staff interactions for those people in communal areas of the home.

One person told us about plans to have a vegetable garden next year and said, “I want to grow carrots and turnips”. Staff told us how sensory stimulation was being used to improve the quality of life for a frail elderly person. We were told they loved their aromatherapy bath and how they had been making and tasting smoothies. A relative told us how a person helped with the shopping and laundry and how they enjoyed taking some responsibility.

People’s care had improved and more person centred documentation had been introduced. We found communication between staff had improved and staffing levels had increased. A new bathroom with disabled access had been installed in The Coach House. Further improvements to the environment were still needed to ensure all areas of the home were safe and accessible. Regular checks on cleanliness, record keeping as well as health and safety were made.

We (The Care Quality Commission) carried out an unannounced inspection on 29 May 2012. This visit was in response to several concerns raised to us directly and via the local authority about the levels of staffing at the home in relation to whether people’s care needs were being met. At the time of our visit, there were 14 people living there. The new provider Diamond Care 2000, took over responsibility for this location on 18 April 2012.

We met nine people who lived at the home and asked them about their experiences. One person told us they liked living at the home but said they sometimes felt bored. Another person told us they thought the food was good and liked to help with the cooking. Some of the people we met had limited or no verbal communication skills. For those people, we observed how staff interacted with them in communal areas of the home, asked staff about their care needs and how they were being met and looked at four sets of care records.

At the time of our visit, the home did not have a registered manager as the previous manager had recently left. However, the provider and a registered manager from another home within the company were providing day to day support and supervision to staff. We spoke to nine staff including the provider, the temporary manager and their deputy as well as care and maintenance staff. We spoke to two healthcare professionals who worked with the home, one of whom visited within the last few weeks.

The day of our visit was hot and sunny, residents and staff were in the garden enjoying the new garden furniture and gazebos, which provided much needed shade. People were involved in various activities such as helping with food preparation and cooking and in the afternoon several people attended a group activity within the local community. We were told about other regular activities people enjoyed which included art and music classes, going to church and local groups.

Several staff had left the home during the first few weeks after Diamond Care 2000 took over the home. The home were using existing staff to work extra hours as well as agency staff to meet people’s care, welfare and safety needs. We were told about work underway to recruit and replace staff. The provider identified the staffing levels at night in the Coach House building were no longer adequate to meet the needs of the people who lived there. The provider said they were hoping to improve staffing arrangements at night in the near future.

We identified that some people’s care records did not identify their current care needs and placed them at risk of not having those needs met. For example, in relation to risk of falling for one person and risk of choking for another person because of swallowing difficulties. We found that some people’s day to day records were not being maintained which meant that information about their care needs were missed. We highlighted those concerns to the provider who has told us about work underway to review all residents care needs and update their care records.

We found poor standards of cleanliness in some areas of the home, particularly in relation to bathrooms. In some areas where paintwork, tiling and floor covering were in a poor state of repair. These poor hygiene standards meant people were at increased risk of infection.

Since Diamond Care 2000 took over running the home in April 2012, they have carried out some essential repairs and redecoration and installed a temporary wheelchair ramp in the Coach House building to improve wheelchair access. Further improvements were needed to bring all areas of the building up to an acceptable standard.

The new provider demonstrated their commitment to improving standards of care and the environment in the home as they had undertaken taken a number of improvements in the first few weeks and outlined further planned improvements.

The Chantry is a residential care home registered to provide accommodation with personal care for up to 16 people with learning disabilities. Several of the people who live there have autism, a disability that affects how a person communicates with, and relates to, other people. Eight people lived at the home when we visited. The inspection took place on the 14 and 21 November 2014 and was unannounced.   

At a previous inspection on the 26 September 2013 we identified serious concerns about the care, safety and welfare of people who lived there and ongoing breaches of regulations. We took enforcement action by issuing four warning notices in relation to people’ s care and welfare, the safety of the premises, staffing and quality monitoring, which required the provider to make urgent improvements.  

Following a further visit on 18 December 2013, we found the provider had not made sufficient improvements and risks for people remained. The Care Quality Commission issued a notice of proposal to remove the location from the provider’s registration. The provider made representation against the notice served and a further monitoring inspection was carried out on 04 April 2014.

At this inspection, the provider had complied with five of the eight regulations but remained in breach of three regulations related to consent, care and welfare and the suitability of premises, although some improvements had been made in each of these areas. In view of the improvements, the representations were upheld and the notice to remove the location from the provider’s registration was withdrawn. 

At this inspection, we found the provider had maintained and made further improvements since our previous inspection and made the required improvements relating to consent, care and welfare and the suitability of premises.     

The Chantry has not had a registered manager since the previous one left in May 2012. A number of managers have been appointed during that period, three in the past 12 months. The current manager had been in post for two months and intends to register. 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’s care had improved and staff were knowledgeable and responsive to individual needs. Staffing levels were sufficient to meet each person’s needs. Staff knew how to recognise signs of abuse, and were confident any concerns reported were taken seriously and investigated. There were detailed risk assessments about each person which identified measures taken to reduce individual risks as much as possible. Recent improvements to staff practice in managing people’s medicines had been made to ensure people received their medicines safely.

Staff knew about each person’s health care needs, recognised changes in their health and sought professional advice appropriately.

Each person’s health needs were individually assessed and care records had detailed information on all health needs and how to meet them.

People were involved in day to day decisions about their care and treatment and staff knew what decisions people could make for themselves and how to support them to do so. Staff were meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs). Where people lacked capacity, relatives, staff and other health and social care professionals were consulted and involved in making decisions in their ‘best interest’. 

Staff knew how to support people when they became upset or frustrated and were appropriately trained to manage any behaviour that challenged the service. Staff used positive behaviour support techniques to de-escalate situations in a safe way, which respected people’s dignity and protected their rights. Improvements in practice had reduced the use of medication used for people to manage these behaviours.

Some improvements had been made in the environment of the home and garden, and more were planned. Regular health and safety checks were undertaken and there was of a programme of maintenance, servicing and repairs.

Staff were kind and compassionate towards people and treated them as individuals and with dignity and respect. Staff had undertaken training on total communication methods and used a variety of ways to support people to express their views. This meant people were communicating and interacting more with staff. 

People were supported to pursue a wide range of activities and hobbies which interested them. Staff supported people to be as independent as possible. Care records contained detailed information about each person and how staff needed to support them.

There was good team work and the manager led by example. There were regular meetings with people to review their care and staff contacted relatives and involved them in decision making. The provider had quality assurance processes in place to monitor people’s care and plan ongoing improvements.