This inspection took place on 10 and 11 September 2018 and was unannounced.

Chalkney House 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 service accommodates 47 people in one adapted building. At the time of our inspection there were 37 people using the service.

There is 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.

Our previous inspection on 3 February 2018 found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the management of medicines and failure to identify and manage risks to people using the service. Infection prevention and control policies were not always followed by staff and cleaning schedules were not being used effectively to keep the premises clean and odour free. We also found that people’s nutrition and hydration needs were not always being properly managed. People’s care plans were not always person centred, completed or reflective of their current needs. Staff lacked guidance on how to respond to people on end of life care to ensure they were pain free and comfortable when they died. People lacking capacity were not consistently supported in line with the requirements of the Mental Capacity Act (MCA) 2005 legislation. Systems to assess and monitor the service were not being used effectively to identify where improvements were needed. Complaints had been investigated however, the outcome and judgements made were not always open and transparent or used to improve the quality of the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when. At this inspection we discussed the action plan with the registered manager and what progress had been made. Improvements had been made to the management of medicines. However, there continued to be failure to identify and manage risks to people using the service. People’s, Personal Emergency Evacuation Plan (PEEP) were not always correct, which meant staff did not always have accurate information to provide the right level of support to keep people safe. Additionally, assessments to mitigate risks to people were not consistently followed by staff, specifically in relation to prevention of falls. Falls resulting in head or facial injuries were not being well managed.

We found ongoing issues with regards to cleanliness and unpleasant odours in the service. Although there was sufficient staff on duty to meet people’s needs and keep them safe, we found the contracted hours for domestic staff were not sufficient to keep the premises clean. The systems in place to monitor the quality of the service, were largely a tick box process and were not effectively used to identify where improvements were needed. For example, these had failed to identify the lack of cleanliness and poor quality of bedding we continued to find. The quality of bedding had been raised at our previous inspection and whilst immediate action had been taken to purchase more, there was no regular checks taking place to ensure bedding was fit for purpose.

Record keeping had improved. The provider had introduced an electronic care recording system which provided good details about the food and drink people received to ensure their nutrition and hydration needs were being met. A ‘Resident of the week’ initiative had been implemented and was helping to improve care plans and ensured people received person centred care that was specific to them. Documentation in re

This inspection took place on 01 and 03 November 2017 and was announced.

Chalkney House 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 service accommodates 47 people in one adapted building. At the time of our inspection there were 37 people using the service.

There is 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.

Before this inspection we received five complaints, three safeguard alerts and two whistleblowing concerns. These all raised concerns about poor care and hygiene, missing medicines, people not receiving sufficient to drink, a lack of understanding around managing people’s end of life care and negative attitudes of staff. At this inspection we found people were receiving appropriate personal care.

Medicines were not being managed consistently and safely. Medicines, including controlled drugs were not always obtained, stored, administered and disposed of appropriately. People prescribed medicines on an 'as required' basis, such as Lorazepam, (used to treat anxiety and produce a calming effect) were being given these medicines on a regular basis. However, a random sampling of people's routine medicines, against their records confirmed they were receiving these as prescribed by their GP.

Although systems were in place to identify and reduce risks to people using the service, these were not always effective. Infection prevention and control policies were in place, but these were not always followed by staff to ensure essential elements of general cleaning were undertaken. Cleaning schedules were in place but were not being used effectively to keep the premises clean and odour free.

People’s nutrition and hydration needs were not always being properly managed. The service was committed to a local authority scheme, known as Prosper aimed at promoting new ways of reducing preventable harm from falls, urinary tract infections and pressure ulcers. Although, individual risks to people’s health due to incontinence, poor skin integrity and dehydration had been assessed, charts to monitor they were receiving adequate hydration and being repositioned regularly were not always completed properly by staff, which increased the risk of people not receiving the care they needed. We recommended that additional training is provided to ensure staff completed records correctly and to reflect the actual care provided. People’s moving and handling risk assessments and care plans indicated the equipment they needed to move, but did not include specific information about the slings to be used to ensure the fit, comfort and safety of the person being hoisted.

The service was providing end of life care to people, however there were no links with the community palliative care team or hospice. The registered manager was not aware of specific guidance with regards to end of life care, such as the National Institute of Clinical Excellence (NICE) quality standard or the Gold Standard Framework (GSF). These provide good practice guidance to ensure people nearing the end of their lives receive the best care. Staff were provided with training to give them the skills and knowledge to meet people’s specific needs, including end of life care, however, staff were not always using their learning to provide appropriate care that ensured people were pain free and comfortable at the time of their death.

People and their relatives were complimentary about the attitude and capability of the staff. Staff were kind and had developed good re

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The inspection took place on the 7 October 2016 and was unannounced. At the last inspection on the 14 September 2015 we rated this service as requires improvement as we identified two breaches in regulations. At this inspection there were no breaches and there were some clear improvements to the service provided.

The service provides accommodation for up to 47 older people some living with dementia. At the time of our inspection there were 39 people using the service. 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.

We found a cohesive service which was well led and managed in the best interests of people using it. Risks to people’s safety were managed through adequate staffing and by staff trained to deliver safe and effective care.

People received their medicines in the way that was intended and people’s health care needs were monitored to enable staff to take necessary actions if needs changed.

Staff recruitment processes were robust and ensured only suitable staff were employed. Once employed, new staff were supported through a thorough induction process. All staff had access to appropriate training, support and the opportunity to undertake further, more advanced training.

People were supported to eat and drink in sufficient quantities to maintain good health and were protected from the risks of malnutrition. Staff promoted people’s well-being through adequate activities and stimulation whilst promoting people’s choice and independence.

Staff had sufficient understanding of legislation relating to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberties Safeguards (DoLS). The MCA ensures that, where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation. People were supported to make decisions and any restriction on people with carried out lawfully.

Staff knew people’s needs well which mitigated risks of them receiving unsafe care but we found records of people’s care needs and initial assessments did not always reflect people’s current needs well.

The manager supported staff and managed a team of happy, cohesive staff who pulled together to provide the best care they could. There were systems in place to help the manager assess the delivery and effectiveness of the care provided and takes steps to address areas where care might have fallen short.

People were consulted about their care needs and the wider needs of the service.

The inspection took place on the 14 September 2015 and was unannounced. We had previously inspected this service on the 11 November 2014 and found it required improvement in three domains. The service has since been re-registered under a new legal entity so is newly registered although there have been no changes to the provider or registered manager.

We found at the last inspection the service had improved from previous inspections and continues to improve.

The service is registered for up to 47 people who require personal care. On the day of our inspection the manager told us there were two vacancies. A number of people had dementia and, or mental health difficulties

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.

During our inspection we found there were enough staff to meet people’s needs but saw that people’s dependency levels could change very quickly and some people required ‘variable support.’ Some people and their relatives felt there were not always enough staff to adequately supervise people, particularly at weekends.

Risks to people’s safety were documented and reduced as far as possible.

Staff received the training they needed to help them recognise where people may be at risk from harm of abuse. Staff knew what actions to take to support people.

Staff recruitment was satisfactory but could be more robust to ensure that people were protected as much as possible from the employment of staff who may be unsuitable to work in the care sector.

Medicines were not always administered safely because we identified a number of errors which could be detrimental to people’s health and well-being.

Staff said they felt well supported through induction, training and monitoring of their performance. Supervisions were frequent and there was a good format in place which had significantly improved since the last inspection.

Staff encouraged people to make their own decisions about their care and welfare but where people were unable to staff acted lawfully to support people.

People were supported to eat and drink enough for their needs but we saw some variation in records so could not be assured everyone was adequately supported. We also felt the dining room experience could be enhanced by staff being more visible in the dining room areas.

People’s health care needs were documented and monitored to ensure people were well cared for. A number of safeguarding’s are still under investigation about potential poor monitoring of people’s well-being but we do not have the outcomes yet.

Staff were caring and supported people appropriately. People were encouraged to be independent but staff recognised when people needed extra support and, or encouragement around their personal care.

People where ever possible were consulted about aspects of their care and given information about the service.

Staff were responsive to people’s needs and there were activities going on to keep people stimulated. This will be improved further by the recruitment of an additional person.

Care records focused on the needs of the individual and were written in a way which reflected people’s individual choices. Although records were comprehensive we found some gaps and felt they could be extended further.

Complaints were recorded and included an investigation to establish the facts. We did not see learning and preventative actions in place as a result.

People and staff told us they were well supported and believed the service to be well managed. Staff support had improved and the manager had worked hard to try and improve the quality of the person’s experiences such as through the reduction of falls. This was still work in progress.

Regular audits of care were being completed and a person responsible for quality assurance had just been employed. Consultation with people using the service could be improved upon to truly reflect everyone’s experience and not just those with families or those who were able to speak out.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.