This inspection was carried out on 12 and 13 September 2018 and was unannounced.

The Chase 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 Chase can accommodate 31 people, and there were 31 people living there at the time of our inspection.

The Chase is a large detached house situated in a residential area of Canterbury, with access to the city centre. There were 29 bedrooms, two being able to offer double occupancy. People's bedrooms were provided over two floors, with a passenger lift in-between. Six of the bedrooms had ensuite facilities whilst the others had shared bathroom facilities over both floors. There were sitting and dining rooms on the ground floor and an enclosed garden to the front and rear.

The service had 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.

The Chase was last inspected in June 2017. At that inspection we rated it as ‘Requires Improvement’ overall.

At this inspection, although people and relatives gave mostly positive feedback about the service, we found significant concerns about the safety of people. Emerging risks were seen in areas where we did not have previous concerns and breaches of regulation were found.

Risks including those associated with medicines, the environment, the spread of infection, and fire had not been assessed and minimised placing people at risk of potential harm. Medicines were not always stored or documented safely.

Recruitment processes were not robust enough to ensure suitable staff were employed to work with vulnerable people. Staffing levels were not always sufficient to meet people’s needs.

Staff understood how to identify abuse and how to escalate concerns. Accidents and incidents had been logged and analysed by the registered manager to try to minimise the risk.

Staff had not received the training or supervision needed to complete their roles effectively. Although some changes had been made to the environment, further planned work had yet to be completed including the replacing of carpets.

The registered manager had assessed people’s needs prior to them receiving a service. People told us they enjoyed the food at the service, and were supported to eat and drink sufficient amounts to maintain a balanced diet. Staff teams worked well with each other and external agencies to provide people with access to healthcare professionals. The principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards were understood and applied in the service.

We observed staff to be busy which impacted on their ability to have meaningful interactions with people. People’s dignity was not always respected, one person asked twice to have a shave and despite us informing staff, the person was not supported to shave.

Although people told us they enjoyed the activities on offer, improvements could be made to the quality of activities on offer for people. With the exception of one care file we reviewed, people’s care plans provided an up to date picture of their support and needs. There had been no complaints since our last inspection. End of life planning had been a focus for staff and the registered manager, and was person centred.

The service was not consistently well-led. Audits were in place but had in some cases had failed to identify issues raised in this inspection, and in other cases the provider had not completed the actions necessary.

The manager had formed good relationships with healthcare professionals who supported im

This inspection took place on 29 and 30 June 2017 and was unannounced. The previous inspection was carried out in January 2016 and concerns relating to the management of medicines, the management of risk, the maintenance of the premises, infection control, staff training, people not being treated with dignity and respect and quality monitoring were identified. At that time we asked the provider to send us an action plan about the changes they would make to improve the service. At this inspection we found that actions had been taken to implement these improvements. However, some areas required further improvements.

The Chase is registered to provide personal care and accommodation for up to 31 people. There were 29 people using the service during our inspection; who were living with a range of health and support needs. Many people were living with different types and stages of dementia. The Chase is a detached house situated in a residential area of Canterbury, with access to the city centre. There were 29 bedrooms, two being able to offer double occupancy. People’s bedrooms were provided over two floors, with a passenger lift in-between. Six of the bedrooms had ensuite facilities whilst the others had shared bathroom facilities over both floors. There were sitting and dining rooms on the ground floor and an enclosed garden to the front and rear.

The service had a registered manager, who was present throughout the inspection. 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.

A number of audits and checks were carried out each month by the registered manager, deputy manager or area manager, but they had not been wholly effective in identifying the shortfalls in food and fluid intake or in driving forward improvements in the environment.

People were offered a choice of nutritious meals and snacks. A picture board was displayed to prompt and remind people about the day’s menu and their meal choices; however during the inspection this was not kept up to date and therefore could confuse rather than assist people.

Staff followed correct and appropriate procedures in the storage and dispensing of medicines. People were supported in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

A robust system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit and appropriate to be working with people. There were sufficient numbers of staff on duty to make sure people were safe and received the care and support that they needed.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to support people in a way that met their needs. Staff continued to receive training and support. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about whistle blowing and were confident they could raise any concerns with the provider or outside agencies if needed.

The care and support needs of each person were different, and each person’s care plan was individual to them. Care plans, risk assessments and guidance were in place to help staff

The inspection took place on 28 and 29 January 2016 and was unannounced. At the previous inspections in July and September 2014, we found there were no breaches of legal requirements.

The Chase provides accommodation with personal care for up to 31 older people living with dementia. There are 27 single and two double rooms at the home. There were 27 people living at the service at the time of inspection. The accommodation is over two floors and bedrooms can be accessed by a passenger lift. There is a communal lounge/dining room and an additional lounge. There was an accessible and secure garden to the front of the home.

The service has a registered manager who was available and supported us during the inspection. 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.

The service was not proactive in making improvements to the environment for the benefit of people who lived and worked at the service. An improvement plan was in place but did not contain any timescales for works to be completed. There were a number of areas where there was an increased risk of an infection spreading, should it occur in the home.

The service specialised in supporting people living with dementia but care staff had only received basic training in this area and had received no training in how to effectively support people with behaviours that may challenge themselves or others. Some staff who were responsible for moving and handling people had not received recent training in this area to ensure they were able to do so safely.

There was a detailed medicines policy in place to guide staff how to administer, record and store medicines safely and appropriately. However, staff did not always follow this guidance. For example, an assessment of a person’s capacity had not been undertaken when a person was being given their medicines without their knowledge and some medicines were stored on occasions at temperatures exceeding the manufacturer’s recommendation.

The home was clean but action had not always been taken to minimise the spread of any infection.

The provider did not take an active role in assessing if the quality assurance processes in place were effective. A number of shortfalls in the service were identified at this inspection.

Accidents and incidents were recorded but an event had highlighted that not all senior staff knew how to act in a timely and appropriate way when such an event occurred.

People had their health needs assessed and monitored and professional advice was sought as appropriate. People were offered a choice at mealtimes, and where appropriate support was provided and people were not rushed.

People, visitors and professionals gave positive feedback about the compassionate and caring nature of the staff team. Staff communicated with people in a kind manner, but there were a number of exceptions to this, where people were not treated with dignity and respect. This included one incident when staff talked about a person as though they were not there and storing equipment in people’s bedrooms.

New staff received an induction which included shadowing new staff. All staff had received training in the Mental Capacity Act 2005. Although staff understanding of the principles varied, staff gained people’s consent before supporting them with any care and treatment. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. DoLS applications had been made for people who lived in the home to ensure that people were not deprived of their liberty unnecessarily.

Staff said there was good communication in the staff team, that they felt well supported and received regular formal supervision with the registere

The inspection was carried out in response to concerns raised to the Care Quality Commission from an anonymous source. During the inspection we looked at the environment, talked to the registered manager and a member of the cleaning staff and looked at records.

The environment although difficult to clean in some areas, was clean on the day of our inspection. Checks were in place to ensure that the home was cleaned to an appropriate standard. Actions had been taken to minimise the spread of any infection, with the exception that not all bins in bathrooms had been provided with lids.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us due to communication difficulties.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with relatives and speaking with staff.

Is the service safe?

People were treated with dignity and respect by the staff. They knew how to communicate with individual people who lived in the home.

Safeguarding procedures were in place and staff understood how to safeguard the people they supported. One relative told us, “My Mum is safe and happy living here. I do not worry when I leave”.

Checks had been carried out for staff before they started work at the home, to ensure that they were suitable for their roles.

Systems were in place to learn from accidents, incidents, complaints, concerns, whistle blowing and investigations. This reduced the risks to people and helped the service to continually improve.

Equipment had been maintained and serviced regularly.

The Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Applications had been submitted, but none were current on the day that we visited the service. Relevant staff had been trained to understand when an application should be made, and how to submit one .

Is the service effective?

We saw from the home’s annual survey for people living in the home and their relatives that most people were positive about the care that was delivered.

People’s health and care needs were assessed with them, and they and/or their relatives were involved in writing their plans of care. This included a clear summary of information about peoples’ likes, dislikes and past histories, so that staff could communicate with people more easily.

Staff had a good understanding of people’s care and support needs and they knew them well.

Is the service caring?

People were supported by kind and attentive staff. For example, we saw staff sitting down beside people and talking with them when supporting them to eat and drink. Staff valued people’s contributions when taking part in activities.

People were able to do things at their own pace and were not rushed. At lunchtime people were able to eat their meals as independently as possible, and in their own time.

People’s preferences and interests were recorded and care and support was provided in accordance with their wishes.

People using the service and their relatives had been involved in the service and completed an annual satisfaction survey. Any shortfalls had been identified and action had been taken to address them. A relative told us, “We filled in questionnaires and things have improved as a result. There have been more activities and music”.

Is the service responsive?

People’s needs had been assessed in detail before they moved into the home.

People had access to activities that were important to them, in the home. An activities coordinator was employed during the week. Relatives said that people also went on trips out.

People had been supported to maintain relationships with their friends and relatives.

Relatives said that they knew how to make a complaint if they were unhappy, but said that they had not needed to. A complaints log was kept which detailed the nature of the complaint and the action that had been taken to resolve it.

Is the service well led?

The home manager had worked at the home for a three years, was registered with the Care Quality Commission and had achieved a national qualification to manage a social care service.

Staff were clear about their roles and responsibilities, felt well supported, and said that there was good communication in the home. All these things helped them to provide the appropriate support for people who lived in the home.

Staff had a good understanding of the whistleblowing policy.

The service had an effective quality assurance system in place which consisted of internal audits and external audits by the provider.

There were twenty eight older people with dementia living at The Chase when we completed our inspection. We met some of the people, the staff, the manager and the provider.

We found that the provider had made changes to improve the service following our last inspection in May 2013.

The provider employed sufficient staff with the necessary skills and experience to meet the needs of the people who use the service. We observed people being supported in the way they wished by staff who knew them well.

The provider had a process in place to assess and monitor the quality of the service people received. We found that people and their relatives were able to share their views of the service and the provider had acted upon these.

During the inspection we found that the service was using close circuit television (CCTV) in some communal areas. The manager was unable to demonstrate that the decision to use this had been made by people with capacity. The provider turned the CCTV off during the inspection.

There were 29 people living at The Chase on the day of our inspection. All the people using the service were living with dementia.

We found that staff knew people well and supported people in the way that they preferred. Staff demonstrated that they were able to support people who became anxious or refused care.

We found that the service followed policies and processes when supporting people with their medicines. This ensured that people were protected.

We saw evidence to demonstrate that people’s records were accurate and maintained in a way which protected their privacy.

The service did not have effective processes in place to gather and act upon information about the quality and safety of the service. This meant that potential risks to people using the service and others had not been managed.

We found that at times there were not enough staff available to meet people’s needs in a timely way. People told us that they were bored at times during the day. Staff told us that on occasions people had to wait for their care.

At the time of the inspection, there were 29 people living at The Chase.

Some of the people living in the home were living with dementia and were unable to tell us about their experiences so we spent time with people and observed interactions between the people and the staff.

The staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported. However, we found that people were not protected from the risks of unsafe or inappropriate care and treatment, because information provided to staff was not always detailed and accurate and there was a lack of care planning and risk management.

We saw that staff listened to people and answered their questions in a way that they could understand. People were reassured by this. We saw that the staff were friendly and people seemed relaxed in the home.

People told us that they were happy with the care they received at the home, one person said "They are very good here, they don’t mind what they do for you".

We saw people receiving their medication and found ordering, storage and disposals processes were in place. However, we found that people were not protected against the risks associated with the unsafe use because medicine administration was not recorded accurately and there was no evidence that the results of testing was acted upon.

People who use services said that the staff treated them with respect and supported them to raise any concerns they had. They said that they received the health and personal care they needed and that they were comfortable in their home.

One person said, 'I get on lovely with the staff because they help us all and they're nice about it. The staff are friendly which makes things relaxed and more homely'.

People said that they were treated with respect and that they received the personal and medical care they needed. Some of them thought there should be more social activities. They were satisfied with their meals. People said that they felt safe and they were confident that complaints would be acted upon. Some of them thought they should have a more active say on improvements to their care and home.