This inspection took place on the 09 May 2017 and was unannounced, which meant no one at the service knew we would be visiting.

The service is registered to provide care for up to eight people with learning disabilities and/or autistic spectrum and people who misuse drugs and alcohol. At the time of our inspection there were six people living there.

Chamwood has single bedrooms with en-suite accommodation. It is located in the Grimesthorpe area of Sheffield with good access to public services and amenities. Accommodation is on two floors. The home has two communal lounges and a kitchen/dining room. There is car parking to the side of the property.

The service had a registered manager at the time of 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 2008 and associated Regulations about how the service is run.

Our last inspection at Chamwood took place in April 2016. At that inspection we found two breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found evidence on this inspection to show improvements had been made to meet the requirements of regulation and the provider was compliant in both these areas.

We spoke with four people living at Chamwood. Their comments about Chamwood were positive. We saw people freely approach staff and have conversations and interactions with them.

Staff understood their role and what was expected of them. They were happy in their work, motivated and confident in the way the service was managed.

Staff had a good understanding of the procedures for the safe administration of medicines and had completed formal training in this.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

People had access to a range of health care professionals to help maintain their health. A varied and nutritious diet was provided to people that took into account dietary needs and preferences so that health was promoted and choices could be respected.

People felt able to tell staff if there was something they were not happy with.

People living at the home, said they could speak with staff if they had any worries or concerns and they would be listened to.

We saw people participated in a range of daily activities both in and outside of the home which were meaningful and promoted independence.

There were systems in place to monitor and improve the quality of the service provided. Checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and/ or their relatives had been asked their opinion via questionnaires. The results of these had been audited to identify any areas for improvement.

This inspection took place on the 19 April 2016 and was unannounced, which meant no-one at the service knew we would be visiting.

The service is registered to provide care for up to eight people with learning disabilities and/or autistic spectrum and people who misuse drugs and alcohol. At the time of our inspection there were five people living there. Chamwood has single bedrooms with en-suite accommodation. It is located in the Grimesthorpe area of Sheffield with good access to public services and amenities. Accommodation is on two floors. The home has two communal lounges and a kitchen/dining room. There is car parking to the side of the property.

The service had a registered manager at the time of 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 2008 and associated Regulations about how the service is run.

At the last inspection which was completed in November 2014, we found the provider to be non-compliant with four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These were regulations 12 ;Safe care and treatment, 9; Person centred care,15; Premises and equipment, and 17, Good governance.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. During this inspection we checked that the service had had followed their action plan and to confirm they now met all of the legal requirements.

During this inspection we found some areas of the service were not safe. Access to the garden was cordoned off due to unsafe steps which meant people had limited access to the garden.

We found staffing levels were sufficient to meet peoples needs found gaps and inconsistencies in the recruitment process.Recruitment records checked did not include all the relevant information and documents as required by the regulations. This meant procedures had not been adhered to so that people’s safety was promoted.

People told us they like living at Chamwood, one person said, “I trust them (staff) and I know I can ask for anything ” and another person told us, “I like it here, I just don’t like the area .”

Systems and processes were in place for the safe administration of medicines, but some improvements were needed surrounding the storage of medication so that people were kept safe.

The care records we looked at included risk assessments. Those seen identified any risks associated with people’s care and had been developed to help minimise and monitor the risks. For example, one care record we looked at contained good guidance for staff regarding a person’s mental health, so staff could respond appropriately.

Staff we spoke with had a clear understanding of safeguarding people and they were confident management would act appropriately to safeguard people from abuse.

Staff told us the training they completed provided them with the skills and knowledge they needed to do their jobs. We saw that supervisions and appraisals were not always provided in line with the provider’s policy. The meant that not all staff were receiving all the support required to carry out their jobs.

Staff had an understanding of the Mental Capacity Act and the need for people to consent to their care and treatment. The registered manager understood Deprivation of Liberty Safeguards (DoLS)

There were systems in place to monitor and improve the quality of the service provided. However, appraisals and recruitment processes were not always completed in line with policy and the quality assurance had not identified this.

The provider had made some progress since our last inspection to improve the service for people living at Chamwood. These changes were very recent and needed to be sustained.

We carried out an unannounced inspection of Chamwood on 21 November 2014. An unannounced inspection is when we enter and inspect the service without giving prior notice to the provider, people who use the service or the staff.

Chamwood is an eight bedded home that provides accommodation for people who require personal care. It has single bedrooms with en-suite accommodation. It is located in the Grimesthorpe area of Sheffield with good access to public services and amenities. Accommodation is on two floors. The home has two communal lounges and a kitchen/dining room. There is car parking to the side of the service.

There has not been a registered manager at the service since 2011. There was an acting manager who has been in charge of the service for the past 18 months. They told us that they had applied to CQC to become 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. The present acting manager covered two services. The provider had not made appropriate arrangements for sufficient cover of the day to day management of the service, which had resulted in the acting manager being unable to fulfil the full range of their duties and responsibilities satisfactorily.

During our inspection we saw insufficient action had been taken to maintain the building and the surrounding grounds belonging to the service. We saw that there was outstanding maintenance work with no written plans for completion. The service did not have a maintenance programme with timescales for action to show how and when the work was going to be completed. This meant there was no identification of the work which needed to be completed by the provider. You can see what action we told the provider to take at the back of the full version of the report.

We were informed by the acting manager that the fire risk assessment had been updated and all staff including the people who lived at the service were involved in the weekly fire drills.

We observed that the management of medication by staff was carried out in a safe manner. Staff were trained in the protection of vulnerable adults and there were systems in place to protect people from any abuse, bullying or harassment.

People commented that staff understood their needs and knew who they should go to seek additional help if they needed. One person said, “Staff give us the best support they can. I trust them”. They said there was plenty of staff and they were happy with the support.

Staff on duty said they had been supervised and supported by the acting manager and the deputy. They were very positive about the arrangements for training and development in place.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict them. DoLS is part of this legislation and in place so that where someone is deprived of their liberty they are not subjected to excessive restrictions. We found staff were knowledgeable about protecting the rights of people and making sure people gave consent to care. The staff members we spoke with had attended training in MCA and DoLS and demonstrated a good understanding of the legislation and how this impacted on their role.

We looked at the food and nutrition arrangements at the service. From the care files we noted people’s likes and dislikes had been identified and each person had an eating and drinking plan to meet their needs.

Three people told us they were involved in decisions about their wellbeing. They explained that staff gave them information in the way they understood and gave them time to digest and think about it. One person said, “They don’t get fed up when I ask them over again”. The deputy manager said that all the people at the service had a named next of kin and the acting manager told us they had access to an advocacy service if people needed assistance when making decisions.

We found people had contributed to their initial assessment and planning of their care. The documents identified people’s views about their strengths, levels of independence, their health status and aspirations. There was a lack of evidence of people being involved in care programme approach (CPA) meetings. CPA improves the delivery of service to people with mental illness and minimises the risk of them losing contact with mental health services. This meant there was a lack of evidence that people were in receipt of care that was specific to their mental health needs.

We found people had not been offered appropriate opportunities, encouragement and support to promote their autonomy, independence and community involvement through activities. There was an assumption by staff that people spend the day how they choose and they were there to help with people’s decisions. This had resulted in people spending their day without any structure, no routine or any organised opportunities for activities. We found the care plans on activities or working and playing needed revision as there was a lack of information about people’s activities or interactions and the daily notes did not capture how people spent the day.

People said they knew how to make a complaint and they had been given information on who they should complain to. People had access to written information about making a complaint. We found people knew how to share their experiences or raise a concern or complaint.

We saw some reports from the provider visits. They were not informative and did not have comments on action needed or the progress on the actions required. The system did not demonstrate that the provider continued to monitor the quality of service provided. This is due to the lack of evidence that assessment of quality and identification and management of risks had taken place during the provider monitoring. The acting manager told us that they did not have a system in place to supervise and check the home manager’s performance by the registered provider. This meant the manager was left to carry out their duties without any oversight by the provider.

You can see what action we have told the provider to take at the back of the full version of the report.

On the day of our inspection visit to Chamwood Court we spoke with three people using the service, three members of staff including the manager and we looked at four sets of care planning documentation.

People told us that they were well looked after by staff and they received good care at Chamwood Court. A comment from a person using the service included “Things have gotten much better here for us now we have a new manager.”

People told us that they all felt safe living there and would know what to do if they felt unsafe. One comment included “Yes I feel safe, I’d tell staff if I didn’t.”

People confirmed that they were happy with the way that they received their medication and that they were given on time.

We found that there was an effective system in place for monitoring complaints, feedback, carrying out audit and learning from incidents and accidents.

We found that people’s care plans and care records reflected their needs and were appropriately stored.

On the day of the visit to Chamwood we spoke with three people living there and four members of staff.

People who lived at Chamwood told us that they were treated with respect and they were happy with the support they had received. People’s comments included “Very nice, everything good about it. Nothing could make it better, it’s nice.”

People told us that they were well looked after by staff. We found that people experienced care, treatment and support that met their needs and protected their rights. However care and treatment was not planned in a way that ensured people’s safety and welfare.

The people living at Chamwood told us that they felt safe living there and would know what to do if they felt unsafe. We found that people who use the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to prevent abuse from happening.

We found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We spoke with staff about how they were supported to undertake their roles. Comments included “I feel supported by the manager and the deputy”. We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We found that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive.