About the service: The Chesters Care Home is a residential care home offering accommodation and personal care for up to 29 people. Care is primarily provided to older people many of whom have a dementia. At the time of this inspection 28 people were using the service.

People’s experience of using this service: The provider had safeguarding systems and processes in place. However, we found a number of incidents had not been investigated and the service did not record their decision making and conclusion. The registered manager took immediate action to address this matter during our inspection. This demonstrated a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People told us they were happy living at the Chesters Care Home. People told us staff were kind and caring. People appeared relaxed and comfortable in the company of staff. Staff clearly knew people and their families well. The provider had a complaints process and procedure in place. People we spoke with told us they did not have any complaints.

Medicines were managed safely. People were supported to access health professionals when required. A thorough recruitment process was in place ensuring the service employed staff with the right skills, experience and were suitable to support people.

People took part in a range of meaningful activities and were supported to access the wider community. Staff supported people to maintain relationships important to them.

The service encouraged people and their families to be involved in developing their care plans. Care records were personalised and outlined people’s preferred support. These were reviewed regularly and reflected people’s current needs.

The service recognised the importance of hydration and people were promoted to have fluids and a balanced diet.

The environment had been adapted to support people living with a dementia. Regular health and safety checks were conducted for equipment and the premises. The home was clean and tidy throughout and infection control procedures were followed.

The service had an open and transparent culture. The provider constantly reflected on its performance and used information from a range of sources to drive improvement.

Staff were aware of their roles and responsibilities. A well-established team of experienced staff were in place. Training was up to date and staff told us they received supervisions and appraisals.

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.

Staff supported people to be involved in all aspects of decision making about their care and treatment. People were encouraged to be as independent as possible.

The provider actively offered opportunities for people, relatives and staff to provide feedback about the home. This information was used to improve the service.

Rating at last inspection: At our last inspection we rated this service as Good (report published 08 August 2016).

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

Enforcement: We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safeguarding. Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

The inspection took place on 16 and 20 June 2016 and was unannounced. This means the provider did not know we were coming. We last inspected The Chesters Care Home in September 2014. At that inspection we found the service was meeting the legal requirements in force at the time.

The Chesters Care Home provides accommodation and personal care for up to 29 older people, including people living with dementia. Nursing care is not provided at the home. At the time of our inspection there were 25 people living at the home.

The service had a registered manager. 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.

We found that people’s care was provided in a safe, clean environment that was equipped to meet their needs. Risks to personal safety had been assessed and steps were taken to prevent avoidable harm and abuse. There were robust measures for supporting people to take their prescribed medicines safely.

The home had enough staff and people were provided with safe and consistent care. Staff were supervised and given training relevant to the needs of the people they cared for to support their personal development. Relatives were complimentary about the effectiveness of the care and many told us they had seen improvements in their family member's well-being.

People were supported to access a range of health care services to maintain and improve their health and welfare. Good nutrition and hydration were encouraged and, where necessary, staff gave assistance with eating and drinking. People told us they enjoyed the food and we observed they were offered a varied diet with choices of well-presented, appetising meals.

People and their families were involved in directing the ways their care was provided. The service protected people’s rights when they were unable to give consent to their care and treatment. People and their relatives were happy with the care and had no concerns. Complaints that had been received were properly investigated and resolved.

Staff had a good understanding of people’s needs and treated them as individuals. They were kind and caring in their approach and respected people’s privacy and dignity. People were given the information and support they needed to make choices and decisions about their care.

People had personalised care plans for meeting their needs which described their individual preferences and what was important to them. Care was regularly reviewed and adapted in response to any changes in needs. Stimulating activities, events and opportunities for outings were provided to help people meet their social needs.

The home had an established registered manager who provided leadership to the staff team. There was an open culture and the service worked inclusively with people, their families and staff. Good governance arrangements were in place and the quality of the service was routinely checked to ensure standards were maintained and developed.

We found that action had been taken to improve medicines arrangements and protect people living at the home from the risks associated with medicines.

This inspection was carried out by one inspector. We met with ten people who used the service and observed their experiences of care to support our inspection. We spoke with the owner, five care staff, three relatives and one health care professional. At the time of the inspection the registered manager was on holiday.

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.

Is the service safe?

We found that there were a number of concerns with the medicine procedures and this put people at risk of harm. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to management of medicines.

People told us that they felt safe. One person said, “I feel very safe living here, the staff know me and look after me very well.” Relatives that we spoke to were confident that their relative was being well looked after.

The provider had quality assurance checks in place to ensure that people were cared for in an environment that was clean and hygienic.

At the time of the inspection, there was one person at the home subject to Deprivation of Liberty Safeguards and staff had followed correct procedures.

The home had emergency procedures in place to keep people safe from harm, including harm from epidemics for example.

Is the service effective?

People told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. Staff had received training to meet the needs of the people living at the home.

We saw that people were provided with a suitable choice of food and refreshments at meal times. One person said, "You get plenty and I sometimes ask for more."

Visitors told us that they were able to visit whenever they liked and staff were always helpful.

Is the service caring?

We saw that care workers were patient and gave reassurance when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, “It’s great here, I am very happy and people care about me.” We asked two relatives if they had any concerns about the care provided by the home and they told us that were happy with the care provided. One relative said, “I have been coming here for a long time and have never seen anything of concern, the staff are very caring.”

We observed the owner talked to people who lived at the home in a kind and compassionate way.

Is the service responsive?

People’s needs had been assessed before they moved into the home. One relative told us that the home had helped to arrange an appointment for additional health care needs to be addressed.

One person told us that they attended meetings for people living in the home. They told us that staff listened to them and helped them with anything they had comments or concerns about.

People had access to activities that were important to them like visits to hairdressers for example and were supported to maintain relationships with their friends and relatives.

Is the service well-led?

There was a registered manager at the service.

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Additionally, a robust medication audit was to be implemented immediately after the inspection after concerns were highlighted with the management of medication.

We found that the registered manager and owner were open and responsive to concerns highlighted and wanted to immediately put in place improvement measures within the service.

We observed people were treated with consideration and respect by staff. We spoke to people who lived at the home who told us staff were kind and helpful. One person said," The staff are very kind." We spoke with two relatives who said, "The staff are brilliant." Another person said," The Chesters is a fantastic place." Other comments included there was lots to do in the way of activities and outings.

All people we spoke with said they were respected by staff. Comments included; "My privacy is respected at all times" and "Staff are very polite and helpful."

We saw systems were in place to encourage people to remain involved in decision making in their lives. Where people did not have mental capacity the correct procedures were followed.

We saw there were enough qualified, skilled and experienced staff to meet the needs of people who used the service.

Staff spoken with said it was a good organisation to work for. They enjoyed coming to work and had been working at the home for many years. They said they were well supported to do their job.

We saw the provider had a complaints procedure in place. People were made aware of their right to complain if there was a concern with the service they received.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. We saw the home was bright and well decorated. People enjoyed well-furnished and comfortable surroundings.

We used a number of different methods to help us understand the experiences of people using the service, as some people using the service were not all able to tell us their experiences.

We saw that people were cared for effectively and care was planned for the individual. We saw people were safe and that there were sufficient suitably qualified and experienced staff on duty. We saw the home had an effective complaints procedure in place.

The people staying in the service and the visitors we met during the visit were very positive about the way that the home was managed. Comments included “The foods lovely. I can’t fault the place” and “I like it here everybody is nice to me.”

Most of the people living at the home have dementia and were unable to express their views about the support they received. We saw that they looked well cared for and the staff we spoke with had good understanding of people’s needs. Relatives and a visiting professional gave positive comments about the home and the care provided. They said, “There is attention to detail with personal care”; “We’re very happy with every aspect of the care”; “My brother is totally happy here”; “There is good teamwork”; and, “It’s a nice home, I haven’t experienced any problems”.

Many of the people living at the home had dementia and due to their mental frailty were unable to tell us about their experiences. We observed their care and saw that they were comfortable and staff actively engaged with them. They were offered choices and provided with sensitive support.

Other people living at the home and some relatives gave us their views. Their comments included, “I like living here”; “The staff are very kind and caring”; “They look after us”; and, “We have always been happy with the care”.