This was an unannounced inspection that took place on 1, 2 and 4 May 2018.

Chalkmead Resource Centre 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 home is located in Merstham Village in Surrey.

The home 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 and associated Regulations about how the service is run.

At the last inspection in January 2017 we looked at the five key questions. The rating for safe, effective, caring and responsive was good with well-led requires improvement. The overall rating was good. We asked the provider to take action to make improvements regarding the registered manager ensuring that all person-centred records followed best practice guidance and the provider reviewed their incident and accident analysis in line with best practice guidance. Both recommendations were followed up and found to be met.

People told us that the home provided a pleasant, friendly and relaxed atmosphere that was created by the staff and they were satisfied with the care and support they received. They also thought there were enough staff who met people’s needs in a kind and thoughtful way.

The home’s recording, auditing and quality assurance systems were comprehensive and kept up to date. They consistently monitored and assessed the quality of the service provided and information was regularly reviewed and recorded in a clear and easy to understand way.

People had access to community based health professionals when required, staff discussed their health needs with them and they were provided with balanced diets that also met their likes, dislikes and preferences and protected them from nutrition and hydration associated risks.

People told us good quality meals were provided and there was a good variety of choices. Staff supported people to eat their meals and drink as required whilst enabling them to eat at their own pace and enjoy the experience.

The home was a safe environment for people to live and staff to work in. It was clean, well-furnished and maintained.

Staff knew the people they supported and were appropriately skilled and trained to meet people’s needs. They also understood their responsibility to treat people equally and respect their diversity and human rights. They treated everyone equally and fairly whilst recognizing and respecting people’s differences.

Staff thought the registered manager and organisation provided good support and there were opportunities for career advancement.

People said they found the registered manager and staff were approachable, responded to them and encouraged feedback from them.

Chalkmead Resource centre is a residential service which provides care and accommodation for up to 50 older people some who have physical needs and some people who are living with dementia. People have varied communication needs and abilities. The service is set over two floors, and is divided into different living units; each unit has their own lounge and dining area. On the day of our inspection there were 47 people living in the service

The inspection took place on the 15 November and was unannounced.

A registered manager was 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 said that the home was well-led and that management was good. Although the registered manager had started to take action to drive improvements at the home, the management of records still required improvements.

Formal systems were not being used consistently to support people to express their views and to be involved in making decisions about their care and support. There had been no residents or relatives meetings since the manager had been in post.

People said that they were happy with the care and attention they received. However there were inconsistencies with up to date information in care plans. Other people had assessments and care plans that were personalised and reflected their individual needs.

The registered manager had completed some audits of the service such as people’s weight and activities but not for other aspects of the service and as a result actions were not always implemented to improve the quality of service they received. The registered manager acknowledged further work was required in this area and explained that since being in post she had prioritised areas such as ensuring staffing levels were maintained. We have made a recommendation about this in our report.

People said that there were enough staff on duty to meet their needs and to provide assistance at the times they wanted. Staff recruitment processes were robust and helped ensure the provider only employed suitable staff to care for people.

People said that they were treated with kindness and respect. In the main people were treated with dignity and respect and their privacy was promoted.

People said that they were happy with choice of activities available to them. The home employed dedicated activity staff and an activity programme was in place.

People received their medicines when they needed them and medicines were managed safely. There were systems in place to ensure that medicines had been stored, administered, and reviewed appropriately. Risks to people’s safety were assessed and actions taken to reduce reoccurrence where possible.

People said that they would speak to staff if they were worried or unhappy about anything. Staff had received safeguarding training and were aware of their responsibilities in relation to safeguarding.

People said that the food at the home was good. Staff assisted people when required and offered encouragement and support. People were provided with a choice of freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. Specialist diets to meet medical, religious, or cultural needs were provided where necessary

Staff were sufficiently skilled and experienced to care and support people to have a good quality of life. A training programme was in place that included courses that were relevant to the needs of people. Staff received support to understand their roles and responsibilities and said that the manager was approachable.

Chalkmead Resource Centre was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). These safeguards prot

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plans.

We spoke with several people who used the service during our visit and they told us they were generally happy living in the home. They said the staff were kind and caring and that some were nicer than others. A person who had recently been admitted said "I can relax now as I am well cared for", another person told us "I love the company and can choose what I want to do".

The home was busy and people were looking forward to Christmas. The activity coordinator was arranging a carol service with the local school, and Christmas parties were also being planned.

We spoke with relatives and visitors who all spoke highly of the home. One relative told us "I visit every day and I am always made very welcome". Another visitor told us "I am so much more at ease since my family member moved here as he is well cared for and happy".

We noted that people were not always protected from abuse because an incident of poor practice was not raised as a safeguarding referral to the local authority.

We found the provider had effective systems in place to monitor and regularly assess the quality of service that people received.

We found a lack of leadership in the home regarding effective use of resources and allocation of staff.

People expressed their views and were involved in making decisions about the home.

We were told that staff were kind and caring and treated people with dignity and respect. Some people told us that there were always enough staff on duty to help them with personal care. Some people told us that that often had to wait for care in the morning as there were insufficient staff to help them when they liked.

We had good feedback regarding the food and people were seen to enjoy their lunch in nice surroundings.

The home was clean and well decorated and people were able to personalise their rooms according to incivil choice.

Quality assurance was monitored and any suggestions or comments were acted upon.

People were very positive in their feedback of the home. Some people told us that they were kept informed about their care and treatment. They told us that there is plenty to do, and it was their choice if they wanted to join in the daily activities provided. One person told us that they were able to have visitors in the privacy of their own room and also enjoyed going out with family. Another told us that they enjoyed the dog that visits the home daily. We were told that staff are kind and caring and treat people with respect. There was good comments about the meals provided and someone told us that the food was tasty and home cooked.

We undertook an unannounced inspection at Chalkmead Resource Centre on 4 and 7 November 2014.

Chalkmead Resource Centre provides accommodation and support for older people some of whom may be living with dementia. The service can provide accommodation for up to fifty people. At the time of our inspection there were forty six people using the service.

The service is a purpose built care home located on the outskirts of Merstham Village. Accommodation is arranged in five individual units over two floors. Each unit has its own lounge, dining area and kitchenette. There is a lift provided for people to access the first floor, and a large well maintained garden for recreation.

The service has 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 service was not always safe because people did not always receive their medication safely. We saw on two occasions where tablets were administered and signed as taken by the member of staff who was undertaking the medicine administration, when they were left unattended and not take. This meant that people did not get their medicine at the time intended or another person could have taken these tablets which could have caused them harm.

Staff were trained in safeguarding awareness. They knew how to recognise signs of abuse and how to raise an alert.

There were safe recruitment procedures in place. The provider had systems in place to ensure all security checks were in place before staff started work. Staff were not able to work in service until all checks were obtained.

People lived in an environment that was generally clean and well maintained. We found areas of the home that had a strong smell of urine. When we brought this to the attention of the manager and made arrangements were immediately made to have the carpets cleaned to remove the odour.

We found all staff had undertaken induction training on commencement of employment. One staff member said “I had a senior staff shadow me for two weeks when I started”. Another staff member said “I did a lot of training on the computer”. We saw the staff training arrangements in place and the training that had been booked for 2015.

The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people lacked the mental capacity to make decisions the service was guided by the principles of the Mental Capacity Act 2005 Code of Practice. We saw the staff had undertaken training regarding this.

The service was caring and we saw staff treated people with kindness and respect. People told us staff were kind and sensitive to their needs. “They will do anything for you” and “Poor girls they are rushed off their feet”. A relative told us “Some staff are more understanding of Mother’s needs than others”.

We saw that staff were very busy and did not always have the time to attend to people immediately. There was a tool in place to assess staffing levels requires on each unit. This did not accurately reflect the actual number of staff available to ensure effective care. For example we saw two staff attending to someone’s manual handling using a hoist when another person who required assistance got up unattended and was at risk of falling until we intervened to help.

People generally received effective care and spoke highly of their care and treatment. “They take good care of me here” and we were told they could see the doctor or the nurse when required.

The manager carried out monthly audits of all aspects of the service to monitor its progress. Some audits included medicine management, care plan reviews, risk assessments evaluation, housekeeping audits and catering feedback. The manager was monitoring the high level of falls in the service on a weekly basis with the help of the senior management team and other health care professionals to reduce the frequency.