We inspected Chapel House Care Centre on the 13 and 14 March 2018. Chapel House Care Centre is registered to provide accommodation, nursing and personal care to 41 older people and people living with dementia. Since October 2017, the service also works in association with local clinical commissioners to provide six acute beds and 10 ‘step down beds’ to facilitate the discharge of ‘medically well’ people awaiting care packages or assessment from the local hospital.

At the time of our inspection, 20 people were living permanently at Chapel House Care Centre and 13 people were receiving temporary support as per the agreement with local clinical commissioners. Chapel House Care Centre is located next to Gloucestershire Royal Hospital and close to a range of amenities. The service is split over three floors with communal spaces on each floor. The service has a secure garden which people could enjoy. This was an unannounced inspection.

We previously inspected the home on 26 January and 1 February 2017 and rated the service as “Requires Improvement”, as we identified that improvements were still required in relation to people’s person centred care and the quality assurance systems needed to be embedded further. At this inspection we found these improvements had been embedded and sustained and the service was rated ‘Good’ overall.

There was a manager registered with CQC at the service, however they had very recently left the service. An interim manager was now in place and worked alongside the Operations Manager and Director of Operation who assisted in providing the day to day management and support. The provider was in the process of recruiting a new manager for Chapel House Care Centre, who they would support through the registration process with CQC. 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 were safe living at Chapel House Care Centre. There were enough staff deployed to ensure people’s needs were being met. People received the support they required to meet their health and wellbeing needs. People enjoyed an active life within Chapel House Care Centre.

People who were staying at Chapel House Care Centre for short term respite or those returning to their own homes, were supported to maintain their independence and wellbeing by staff employed by the provider and the local clinical commissioning group.

Care and nursing staff treated people with dignity and ensured they had their nutritional needs met and received their medicines as prescribed. Catering and care staff were aware of and met people’s individual dietary needs. Staff spoke positively about the support and communication they received.

Care staff were caring and were aware of people’s health needs. Care staff treated people with dignity. People and their relatives felt their concerns and views were listened to and acted upon. Relatives told us the management team was responsive and approachable.

The manager and provider had implemented system to monitor and improve the quality of service people received at Chapel House Care Centre. Representatives of the provider were working with healthcare professionals to evaluate the service they provided in association with the clinical commissioning group. The provider was working with healthcare professionals to develop this service and assess the benefit it had on people and healthcare services, including the local hospital.

We inspected Chapel House Care Centre on the 26 January and 1 February 2017. Chapel House Care Centre is a residential and nursing home for up to 41 older people. Many of these people were living with dementia. 15 people were living at the home at the time of our inspection. This was an unannounced inspection.

We last inspected in July 2016 and found that the provider was not meeting a number of the regulations. We found that people did not consistently receive safe care and treatment, because staff had not always administered their medicines as prescribed. Additionally staff did not have access to training and support. People did not have access to person centred care and stimulation which would benefit their wellbeing. The provider did not have effective systems to monitor and improve the quality of service people received. Following our inspection in July 2016, the service entered Special Measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. We imposed a number of positive conditions on the registration of the location following our July 2016 inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At our inspection on 26 January and 1 February 2017, there was a newly appointed registered manager in post who had been in post since September 2016. 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 provider had implemented systems to monitor and improve the quality of service people received. Some of these systems had been used to drive improvements around the management of medicines. However some systems had only recently been implemented and therefore it was difficult to ascertain the impact they had on driving the quality of the service. People, their relatives and staff spoke positively about the improvements made at Chapel House since our last inspection. Relatives told us they felt their views were now being listened to and acted upon.

People and their relatives were generally positive about the home. They felt safe and well looked after. People enjoyed the food they received in the home and had access to food and drink. People and their relatives felt activities had improved; however activities were not always tailored to people’s interests and hobbies. Care staff did not always provide meaningful engagement to people living with dementia.

People’s care and risk assessments had been reviewed and were now reflective of their needs. Care assessments give care staff and nurses clear information in relation to people’s needs. People’s care information was not always stored securely; however the director of operations took immediate action in response to our concerns.

Staff were deployed effectively to ensure people’s basic needs were met and kept safe. All staff had received training to meet people’s healthcare needs. Staff felt supported, however while staff had received supervision (one to one meeting) with the registered manager, they had not received appraisals and no assessments of their competency had been carried out. However this had been identified by the provider and there was a clear plan of action in place.

We found one breach of the Health and Social Care Act 2008 (Regula

We inspected Chapel House Care Centre on the 26 July 2016. Chapel House Care Centre is a residential and nursing home for up to 41 older people. Many of these people were living with dementia. 16 people were living at the home at the time of our inspection. This was an unannounced inspection.

We last inspected in March 2016 and found that the provider was not meeting some of the regulations. We found that people did not consistently receive safe care and treatment, because staff had not always administered their medicines as prescribed. Additionally staff were not always effectively deployed and did not have access to training and support. The provider did not have effective systems to monitor and improve the quality of service people received. Following our inspection in March 2016, we issued a warning notice to the provider requesting they take action to meet the fundamental standards in relation to staffing and good governance by 30 June 2016.

At our inspection on 26 July 2016, there wasn't a registered manager in post. The previous registered manager had left the service prior to this 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.

The provider did not have effective systems to monitor the quality of service people received. Audits were not consistently carried out and when shortfalls in the quality of the service had been identified, appropriate action was not always taken to drive improvements. People and their relative’s views had been sought; however action had not been taken in response to their views. Relatives told us they did not always feel their views had been listened to.

People did not always receive their medicines as prescribed. Staff did not always keep an accurate record of the support they had provided people with their care, treatment and medicines.

People we spoke with were positive about the home. They felt safe and looked after. People enjoyed the food they received in the home and had access to food and drink. People had limited access to one to one activities and external entertainment, and did not always benefit from meaningful engagement from staff.

Staff were deployed effectively to ensure people were kept safe and their basic needs were met. Not all staff had the skills they needed to meet people’s needs, because staff did not have access to training and support they needed to meet the needs of people, such as those living with dementia.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancellin

We inspected Chapel House Care Centre on the 9 and 11 March 2016. Chapel House Care Centre is a residential and nursing home for up to 42 older people. Many of these people were living with dementia. 16 people were living at the home at the time of our inspection, and a further person moved in to the home during the days of the inspection. This was an unannounced inspection.

We last inspected in June 2015 and found that the provider was not always meeting the regulations. We found that people did not always receive safe care and treatment, because staff had not always received the skills and support they needed to care for people safely. At our June 2015 inspection, we found the provider had taken some action and people were receiving safe care and treatment, however not all staff had access to the training and support they needed to ensure they met people’s needs effectively. At our June 2015 we also recommended that the provider seek guidance from a reputable source regarding staffing levels in the home, and dementia training for staff. We found at this inspection these recommendations had not been acted upon.

There was a registered manager in post on the day of our inspection. They registered manager had been in post for approximately three months and had just been registered with the CQC. 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 provider did not have effective systems to monitor the quality of service people received. Audits did not always identify shortfalls in the quality of the service, and when they did, appropriate action was not always taken. People and their relative’s views had been sought, however action had not been taken in response to their views. Relatives told us they did not always feel their views had been listened to.

People did not always receive their medicines as prescribed. Staff did not always keep an accurate record of the support they had provided people with their care, treatment and medicines. Where people required their medicines to be administered covertly, staff did not always have appropriate guidance to support people.

People we spoke with were positive about the home, feeling safe and looked after. People enjoyed the food they received in the home and had access to food and drink. People had access to one to one activities and external entertainment, however were often left for period of time without engagement or support from staff.

Staff were not always deployed effectively to ensure people living with dementia were protected from risks. If accidents occurred, staff may not always be able to respond efficiently. Not all staff had the skills they needed to meet people’s needs, because staff did not have access to training and support. Staff spoke positively about the new manager and the support they had started to provide.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out an unannounced comprehensive inspection of this service on 8 and 11 November 2014 during which breachs of legal requirements were found. After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirements.

We undertook a focused inspection on 17 February 2015 inspection to check that the provider had met one of the legal requirements. This report only covers our findings in relation to the legal requirement: the registered person must take proper steps to ensure that each service user is protected against the risks of receiving care or treatment that is inappropriate or unsafe.

We told the provider they had to meet this requirement by 1 January 2015. This inspection found the provider had not fully met this requirement. However, we also found that some improvements to people’s care had taken place.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chapel House Care Centre on our website at www.cqc.org.uk’

Chapel House Care Centre provides care and support for up to 41 people with physical health needs and people who live with dementia. At the time of this inspection 13 people were living in the home.

The home has a manager who is not yet registered. 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.

People’s welfare and rights were not protected in November 2014 and they were not always receiving the care they required. Equipment was in use without an assessment having been completed for its safe use. People’s rights had not been upheld and equipment which could restrict people’s freedom was in use without people’s consent.

At the focused inspection on 17 February 2015 some improvements had been made since November 2014 to ensure people’s welfare and rights. Assessments for the safe use of equipment had been completed. In some cases alternative measures had been introduced, for example, the bed rails removed from the bed and other safety measures adopted. However, we found an example of equipment in use without an appropriate assessment having been completed. The person’s consent for its use had also not been obtained. This meant there was still potential for people to be harmed from equipment and, restricted through its use without their consent.

Some people had been at risk of developing pressure ulcers and their care had not been planned appropriately to reduce this risk. During this focused inspection we were told people were receiving care to prevent pressure ulcers developing. This included repositioning people to relieve pressure from their skin. We saw relevant care plans in place which guided staff on how frequently this should be done. However, staff were not recording when people received this care, although the home manager confirmed that none of the people using the service had pressure ulcers.

People’s care needs had not always been assessed appropriately. During this focused inspection one area of a person’s health had still not been assessed by an appropriate health care specialist.

People had not been protected against the inappropriate use of medicines because staff had lacked guidance on the use of some prescribed medicines. During this focused inspection this was still the case in relation to one particular medicine. There was no evidence of a protocol to guide staff in relation to when to administer this medicine. This meant people were not fully protected against its potential inappropriate use.

This was a continuing breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The evidence was gathered prior to 1 April 2015 when the Health and Social Care 2008 (Regulated Activities) Regulations 2010 were in force. These breaches now correspond to breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.  

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

This inspection took place on 1and 2 June 2015 and was unannounced.

We carried out an announced comprehensive inspection of this service on 8 and 11 November 2014. Breaches in regulations were found during this inspection. We also issued the provider with an enforcement action against one of the regulations.

We undertook a focused inspection on 17 February to check if they had met the legal requirements relating to the enforcement action. Although some improvements had been made, the enforcement action had not been fully met and was subsequently repeated. The provider was told to meet this by 13 April 2015.

This inspection followed up on all the outstanding legal requirements as well as the repeated enforcement action. Although at the time of the inspection we found there were still not enough staff to meet the needs of those using the service, this was improved straight after our visit. We therefore found the service had met all seven legal requirements as well as the enforcement action.

On 1st April 2015 the Health and Social Care Act 2008 (Regulated Activity) Regulations 2014 came into force. We found one breach of these regulations; the provider had not made sure staff had adequate training to equip them with the skills and knowledge required to meet some people’s needs, predominantly those who lived with dementia. You can see what action we told the provider to take at the back of the full version of the report.

We also made two recommendations which relate to maintaining optimum staffing numbers and sourcing appropriate support to improve the service's ability to achieve better outcomes for those who live with dementia.  

The service predominantly cared for older people who lived with dementia and could accommodate up to 41 people. At the time of the inspection 12 people in total were cared for.

A new manager had started in post four weeks prior to the inspection. They were not yet the registered manager of the service however; they were making arrangements to apply to us. 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 the service had generally improved since the last two inspections. People were safe because risks relating to their health and care had been identified and were appropriately managed. This included the safe use of equipment to meet people’s needs. People were protected from abuse and their human rights were upheld. Environmental risks were managed and any shortfalls were addressed. Accidents and incidents were monitored and actions taken to try to reduce reoccurrences. Improvements in staff recruitment practice ensured people were protected from those who may not be suitable to care for them. Improvements had also been made to how people received their medicines and in how staff received guidance for the use of some specific medicines.

The new manager had identified the needs to improve staff training and was making plans to address this as soon as possible. They had made more immediate arrangements to increase the skill levels in the home soon after our visit. The new manager was meeting with staff so they were clear about their roles and responsibilities. Best practice was being promoted and advice was sought from other professionals when needed. People had access to health and social care professionals in order for their needs to be met. People who required support with their eating and drinking had received this. People who lacked mental capacity were protected against discrimination and poor practice because the service adhered to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). A lack of visual adaptions meant some people found it difficult to make sense of their surroundings.

People were cared for by staff who were kind and well meaning. People were treated with respect, dignity and afforded the privacy they were entitled to most of the time. Some staff were better at giving explanations and guidance to people, in a way that they could understand, than others. People who mattered to those who were receiving care were supported and made to feel welcomed. Some people’s independence was supported better than others.

Improvements had been made to people’s care plans and these now provided staff with better guidance on how to meet people’s individual needs. People’s individual life histories, preferences and wishes had been explored with people’s representatives and recorded. This information was not always used effectively to personalise people’s care.

Opportunities for people to take part in activities were provided but with limited resources. The purpose and benefits of supporting meaningful activities were not fully understood or appreciated by all of the staff. This was demonstrated in the approach taken by some staff during the inspection.

There were opportunities for people to express their concerns or to make a complaint and the new manager told us these would be listened to, taken seriously and investigated.

People lived in a service where improvements to how it was being managed had been in place for four weeks. The actions being taken by the new manager were therefore either in their infancy or not yet underway. The full impact of these improvements could therefore not be fully assessed.

The culture of the home had improved and staff were happier, generally more supported and included in discussions about how the service was going to be run in the future. The new manager practiced an open and transparent style of management and they were communicating their visions and values to the staff and to people’s representatives. People’s representatives were to be included in decisions about how the service moved forward and were being encouraged to give their ideas and feedback. There was support for the new manager from the staff and people’s representatives.

Local arrangements for monitoring the quality of the services and care provided were to be improved by the new manager so they could develop and implement necessary improvement actions. Support was being given to the new manager by their immediate line manager who was working alongside them to make improvements in how the service operated. It was however also up to the provider to support these actions and to ensure the management team had the necessary resources to sustain future improvements.