Chapel View is a care home. People in care homes receive accommodation and 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. Chapel View can accommodate up to 39 people in one adapted building. Accommodation is spread over two floors. On the ground floor there are communal areas including lounges and a dining room.

The inspection took place on 10 January 2019 and was unannounced. On the day of the inspection there were 28 people living in the home.

At the last inspection in October 2017 we rated the service requires improvement overall and in each domain area. We found five breaches of regulation relating to; failure to provide safe care and treatment, good governance, consent, failure to notify CQC of incidents and dignity and respect. Following the last inspection, the provider sent us an action plan to show what they would do to improve the service.

At this inspection we found the service had improved in a number of areas. However, there were further areas that needed further development before the service would consistently be providing good care and support. A new manager had come into post in September 2018 and we found they were committed to continuous improvement of the service and responded positively to addressing the shortfalls we found on this inspection.

A registered manager was not in place. The previous registered manager deregistered in March 2018. 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 new manager told us it was their intention to apply to become the registered manager for the service.

People and relatives provided good feedback about the service. They said that care needs were met, staff were friendly and the service was responsive to their individual needs.

People said they felt safe using the service. Safeguarding procedures were in place and followed to help keep people safe. However, some risks to people’s health and safety were not appropriately assessed and mitigated. Some people were not provided with appropriate food in line with their assessed needs. This demonstrated the service had failed to provide safe care and treatment.

There were enough staff to ensure people received prompt care and support. Staff were visible and keen to attend to people’s individual needs. Robust recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

Staff received a range of training and support in order to undertake their role. People spoke positively about the skills and knowledge of the staff who supported them.

People had access to a choice and variety of food. We found some aspects of the mealtime experience could have been improved to ensure a consistently pleasant mealtime atmosphere.

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.

People’s healthcare needs were assessed and the service worked with a range of professionals to help meet their needs.

Medicines were managed in a safe and appropriate way and people received their medicines as prescribed.

Staff treated people with kindness and compassion. People were listened to and their views used to help shape their care and support.

People’s care needs were assessed. Some care plans required more detail adding to provide evidence their needs had been fully assessed, for example in the provision of end of life care. There was a good range of activities available to people based on their likes and preferences.

We inspected Chapel View Care Home (known to people using the service, their relatives and staff as Chapel View) on 9, 12 and 17 October 2017. The first and second days of inspection were unannounced. This meant the home did not know we were coming.

Chapel View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Chapel View is registered to provide nursing and residential care for up to 39 people. On the first day of inspection 32 people were using the service. None of the people were receiving nursing care and the registered provider was in the process of deregistering the home as a provider of nursing care. The building has two floors. There are communal lounges and a dining area on the ground floor, and shared bathrooms and toilets on both floors. The home has 37 ensuite bedrooms, two of which can be used as double bedrooms.

Chapel View was last inspected in August 2016. At that time we rated the home as ‘Requires Improvement’ overall, as it was deemed to be ‘Requires Improvement’ in the key questions of Safe, Effective and Well-led, and ‘Good’ in the key questions of Caring and Responsive.

The home had a registered manager. A registered manager is a person who has registered with CQC 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.

Most checks on the building, its equipment and utilities had been completed appropriately. However, we identified aspects of the building and facilities which posed a risk to people.

People’s care plans did not always contain sufficient detail to inform staff how to support them safely. Care staff we spoke with could describe the support people required which evidenced this was an issue with record-keeping.

We identified some accidents and incidents which the registered manager was not aware of, because they had not been recorded on accident and incident forms. Records showed the registered manager had oversight of those accidents and incidents which were recorded properly.

Some parts of the home were not clean. In places the home’s décor and fittings were tired, which made them more difficult to keep hygienically clean, although a programme of improvement was underway. We recommended the registered manager update infection control procedures in accordance with nationally recognised good practice.

Sufficient staff were deployed to meet people’s needs.

Most aspects of medicines management were undertaken safely, although the application of people’s topical creams was not always recorded.

Records showed the registered provider and registered manager had not ensured the principles of the Mental Capacity Act 2005 were consistently followed for those people who may lack mental capacity. This was a finding at the last inspection in August 2016.

Most feedback about the food and drinks served at Chapel View was positive. We observed staff focused on tasks at mealtimes and chatted amongst themselves, rather than interacting with people. Food and fluid documentation did not always reflect people’s needs; this was an issue at the last inspection.

Staff received the induction, supervision and training they needed to meet people’s needs.

Records showed people had seen a wide range of healthcare professionals, such as GPs, community nurses and dieticians, in order meet their wider health needs.

Good practice on dementia-friendly environments had been used when updating and improving the building.

People and their relatives told us staff were kind and caring. We observed some positive and caring interactions during this inspection; however, we also had serious concerns about the

This inspection took place on 31 August 2016 and was unannounced.

Chapel View is registered to provide nursing and personal care for up to 39 older people. The home is purpose built and has accommodation and communal areas across two floors. At the time of our inspection there were 35 people using the service. The home was not providing support to anyone with nursing care needs.

The service is required to have a registered manager, and at the time of our inspection there was no registered manager in place. There was a manager in post and their application to the Care Quality Commission (CQC) to become the registered manager was being processed. A registered manager is a person who has registered with the CQC 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.

There had been a planned increase in the number of new people admitted to the home in the month prior to our inspection. Some concerns were raised about the availability of sufficient staffing to meet people’s needs safely. The registered provider had taken action to review and increase staffing levels to reflect the increased numbers of people supported, but rotas for the previous month and feedback we received showed that there were occasions where sufficient staffing had not been promptly deployed to cover gaps in the rota. We have made a recommendation about this in our report.

Cleaning schedules were in place, but we noted a number of areas of the home that required greater attention with cleaning and maintenance, in order to ensure standards of hygiene were consistently maintained. We have made a recommendation about this in our report.

Staff had completed Mental Capacity Act (MCA) training and where people had a condition on their Deprivation of Liberty Safeguards (DoLS) authorisation, we saw that the registered provider was ensuring this condition was met. However, care files lacked information about people’s capacity to consent to their care and demonstrated a lack of staff understanding about who could sign to give consent to decisions if the person lacked capacity. The registered manager was taking action to address this. We have made a recommendation about this in our report.

The registered provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse and staff had received safeguarding training.

The provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. We found that people’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm. Regular maintenance and equipment checks were also completed.

Medication was appropriately stored, administered and recorded on medication administration records. Staff responsible for administration of medication had received training and the registered provider completed medication audits. This showed that there were systems in place to ensure people received their medication safely.

Most people told us they were satisfied with the quality and variety of food available and the home was taking action to increase the variety of food available. People were supported to ensure they got sufficient to eat and drink and their weight was monitored. However, record keeping in relation to food and fluid intake was poor and could not always clearly evidence the action staff had taken in relation to dehydration risk and weight loss. We have made a recommendation about this in our report.

Staff completed an induction and a range of training to help them carry out their roles. Training considered essential by the provider was refreshed annually.

People were supported to maintain good health and access healthcare services. We saw evidence in care files of contact with healthcare