We carried out an inspection of Chapelfields on the 13th and 18th September 2018. Both visits were unannounced.

Chapelfields 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. Chapelfields is registered to accommodate 70 people. At the time of our visit, 66 people were living there.

Chapelfields provides accommodation and nursing care for people who live with dementia as well as older people with nursing and residential needs.

The last visit to this service was held in August 2016. The service was rated as good on that occasion with no breaches identified.

The service did not have a registered manager. A manager had been in post since June 2018 but had not yet started the process to become 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 2008 and associated Regulations about how the service is run.

We initially noted some deficiencies within the safety of the premises. These included a door which required to be locked left open, the presence of a pest control bait that did not initially have a risk assessment associated with it and the presence of boxes in a person’s en suite area that did not appear to have an accompanying risk assessment. The issue with the door security and pest control bait was addressed during our visit. We discussed the presence of boxes in an en suite area with the manager subsequent to our visit. Other risk assessments relating to the environment and the health of people were in place.

While some work had been started in one living area that catered for people living with dementia, the decoration of the interior of the building was not always presented to assist those living with dementia. We have raised a recommendation about this.

Activities were provided for people who used the service but it was not clear about the frequency of activities received by people who could not leave their bedrooms. We have raised a recommendation about this.

The registered provider had systems in place to report any allegations of abuse and had co-operated with the safeguarding authority at the time of our visit following concerns raised. Staff understood the types of abuse that could occur and knew how to report any concerns. They were aware of agencies they could contact to raise concerns about care standards with the service.

The management of medication was safe. Medication was securely locked and associated records maintained appropriately.

Staffing levels were maintained although a recent period had involved the allocation of agency staff to work shifts within the service. While this use was being addressed by recruitment of new staff, the number of agency staff was decreasing and we did not see a negative impact on the wellbeing of people who used the service.

Recruitment process were robust. Appropriate checks were made on the suitability of people to come at work at Chapelfields.

Accidents were recorded and subject to auditing to identify patterns and trends with a view to prevent their re-occurrence.

Staff received the training they needed to perform their role. They also received regular supervision and a structured induction process for new staff was in place.

The registered provider worked within the principles of the Mental Capacity Act.

The nutritional needs of people were taken into account. Staff were attentive to the needs of people during dinner. Food was prepared in a well-equipped and hygienic kitchen.

The health needs of people were promoted. People were provided access to health professionals so that their health could be positively maintained.

People told u

We carried out an unannounced inspection of Chapelfields on 2nd August 2016. We carried out a further announced visit on the 4th of August 2016. For this second visit, the registered provider was aware that we were visiting.

Chapelfields is a purpose built care home with separate units providing nursing and residential care for 40 frail older people and 30 people who are living with dementia. The home has two storeys and all bedrooms are single rooms with en suite facilities. There are a choice of lounges as well as a communal dining room on the ground floor of the unit for older people. There are lounges and separate dining facilities on both floors of the unit for people living with dementia. At the time of our visit, 65 people were living at Chapelfields.

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. The registered manager was not present during our visit.

Our last visit to the service on the 7th of July 2014 found that the registered provider had complied with all the regulations that we used to assess the service at that time.

People told us that they felt safe living at Chapelfields. Staff demonstrated a good understanding of how to protect vulnerable adults from harm. The premises were well maintained, clean and hygienic. People were further protected by the way the registered provider recruited new staff. People’s health was promoted through the safe management of medication.

The registered provider demonstrated that staff received up to date training on topics which related to the needs of people living at the service.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 and associated safeguards. The registered provider demonstrated that the capacity of individuals was taken into account in their daily lives.

The nutritional needs of people were taken into account. This included the risks faced by people of malnutrition and dehydration. People were offered a choice of meals and regular drinks throughout the day.

People told us that they felt cared for and observations of staff practice confirmed that people were treated in a supportive, patient and respectful manner at all times.

People were able to take part in meaningful activities which included in house activities and trips out to the local community. Activities met the spiritual needs of people.

Care plans were accessible to people, were personal to their health and social needs. Care plans were reviewed and updated as appropriate.

People knew how to make a complaint and any complaints received were investigated in a timely and robust manner.

People told us that they considered the management team to be supportive, approachable and maintained a presence in the service. They stated that the service was well led as a result. The registered provider had a number of ways to measure the quality of the service provided and sought the views of all concerned.

Our inspection team comprised two inspectors. We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found –

Is the service safe?

People said they were treated with dignity and respect and felt safe. There were the right amount of skilled and experienced staff working at the home to safely meet people’s needs.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, although no applications had needed to be submitted recently. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people's rights would be safeguarded as required.

Is the service effective?

People were satisfied with the care provided. Comments included: "It's very good, nice and homely"; "I hope every home's as good as this one"; "It feels like a family".

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Staff had been trained to an appropriate standard to enable them to meet the needs of the people who used the service.

There was a choice of food on offer and people's nutrition and hydration were monitored. People said that they enjoyed the meals and staff knew their likes and dislikes. Comments included "We're offered a choice and they try and accommodate you with whatever you want" and "The food's quite good".

People completed a range of activities in and outside the service regularly. This helped to keep people involved with their local community.

Is the service caring?

People were supported by kind and attentive staff. We saw that nurses and care workers showed patience and gave encouragement when supporting people. People commented: "They're very good"; “They are very helpful and caring”.

Is the service responsive?

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

People using the service, their relatives and staff completed regular satisfaction surveys. Where shortfalls or concerns were raised these were addressed.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system to help make sure the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and received appropriate supervision.

We spoke with five people who were receiving a service and twelve relatives. People told us staff always consulted them about their individual needs and involved them in decisions about their care and treatment. One relative said "I'm very impressed the way they listened to Mum and tailored the care to meet her individual needs".

The people we spoke with said that their needs were met and they were happy with the care provided.

People told us that staff always maintained their dignity when carrying out personal care. One person living at Chapelfields said "It's home from home". One relative said "They always ring me if there are any changes at all in my (relative's) condition". Another relative said how much they appreciated the "little touches" that improved people's dignity, such as making sure the dining tables were nicely set with condiments, flowers and napkins.

Care records gave staff clear instruction on how to meet people's individual needs and showed that people were helped to access other health and social care services when necessary.

We spoke with eight people who were receiving a service and three relatives.

People told us staff always consulted them about their individual needs and involved them in decisions about their care and treatment. They also told us that staff always maintained their dignity when carrying out personal care.

People were aware they could speak to staff and particularly the manager. One person said “If there are any problems my daughter speaks to the staff and things are changed”. Two other people said “If there are any problems I tell the manager”.

The people we spoke with said that their needs were met and they were happy with the care provided. A relative said “They look after my husband very well”. Another relative said his wife was well looked after but when staff had attended to her they didn’t always place things, such as her handkerchief or call bell, back within her reach.

People living in the home told us they were happy with the accommodation, that their needs were able to be met by the number of staff provided and that call bells were answered fairly promptly.

One person said “if I use the buzzer at night they come almost straight away”.

A relative said “the staff are very good”.