Chargrove Lawn 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. Chargrove Lawn provides accommodation and personal care. The care home accommodates 26 people in one adapted building. At the time of the inspection 22 people were living there.

Chargrove Lawn has recently been refurbished and provides spacious communal areas including a lounge/dining room, two additional smaller lounges, a sun lounge and accessible gardens. People’s rooms are individualised and have en suite facilities. They also have access to shared toilets, showers and bathrooms.

This inspection took place on 9 and 10 January 2018. At the last comprehensive inspection in October 2015 the service was rated as Good overall.

At this inspection we found the service remained Good.

There was a registered manager in place who was also registered to manage another of the provider’s residential care homes. 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 benefited from an improvement agenda for the home which included not only a refurbishment of the environment but also focussing on their wellbeing and offering a more personalised service. An increased range of activities had been offered to people including trips out and meeting with people from other homes owned by the provider. People were supported to develop friendships. People’s preferences and lifestyle choices were explored with them and respected.

People’s health and wellbeing were promoted. They had access to a range of health care professionals and their changing needs were responded to in a timely fashion to keep them healthy and well. Any risks had been identified and strategies were in place to minimise these, keeping people safe. Staff understood how to identify and report suspected abuse and relatives and people said they felt safe care was provided. 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. Deprivation of liberty safeguards were applied for where people were restricted of their liberty.

People were supported by staff who had been through a recruitment process which verified their competency and aptitude for the roles they were to perform. Staff had access to training to equip them with the skills to support people. They were supported to develop in their roles with individual meetings, annual appraisals and staff meetings. People had developed positive relationships with staff and were treated kindly and with dignity and respect.

People’s views were sought as part of the quality assurance process to drive through improvements. People, relatives and staff were able to give feedback by a variety of means. Meetings and forums were held, as well as making good use of information technology. A range of quality assurance audits were completed by staff, the registered manager and the provider to monitor and evaluate the quality of service provided.

The registered manager was open and accessible to people, their relatives and staff. Complaints were investigated and responded to with action being taken in response to any lessons learnt. Actions were taken to drive through improvements in response to accidents, incidents and complaints. The management team worked closely with a range of organisations and agencies to keep up to date with current best practice and to improve people’s experience of their care and support.

Chargrove Lawn provides accommodation for up to 26 older people. At the time of the inspection there were 21 people living there, of whom 13 were living with dementia. People had bedrooms with en suite facilities, some included shower rooms or baths. People also had access to shared bathrooms as well as living and dining areas. The grounds around the home were accessible to everyone. Areas of the home had recently been refurbished and there were plans to continue to upgrade other areas.

There was no 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. A manager had been appointed and they were going through our registration process.

We carried out an unannounced comprehensive inspection of this service on 20 October 2015. A breach of legal requirements was found. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm they now met legal requirements in relation to a breach of regulation 18. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chargrove Lawn on our website at www.cqc.org.uk”

At the comprehensive inspection of this service on 20 October 2015 a breach of legal requirements was found. After this comprehensive inspection, we asked the provider to take action to:

• ensure staff had access to the training, supervision and appraisals they needed to enable them to carry out their duties.

At this inspection we found action had been taken to address this. A new system had been put in place by the provider to manage the training needs of staff. This meant each month the manager would be reminded of any refresher training which was due. Staff confirmed their training was kept up to date. Staff had individual meetings with managers every two months and an annual appraisal. They were also observed doing such tasks as personal care, moving and handling and medicines administration. Staff said they felt supported in their roles and communication within the home was good.

The provider had displayed the rating for this service on their website and in the home.

Concerns were raised with us about how a person had been supported after an accident. It was alleged that they did not have timely access to health care professionals. We spoke with people to check on their well-being but their feedback did not relate to the standards looked at.

We spoke with two senior staff. We also spoke with other health and social care professionals who had looked into the concerns raised. We found that there was a delay in accessing emergency treatment for one person. At the time of the incident they had not experienced any pain. Staff continued to monitor their well-being until it became clear that they needed medical attention due to pain and bruising. This was not however the experience of all people living in the home. Other people had been appropriately referred to health care professionals for advice and treatment in a timely fashion.

We found that the provider had arrangements in place to deal with forseeable emergencies. An investigation was held into this incident to assess how they could learn from this event. The provider was reviewing their response to emergency situations to ensure close working with other services.

Our inspection of April 2013 found that the dignity, privacy and independence of people was not being maintained. We also found that the service was not working co-operatively with other health professionals to ensure that the appropriate health and social care support was provided. Appropriate standards of cleanliness, hygiene and environmental standards were not being maintained. We also had concerns that staffing levels during the night might impact on people's well-being.

At this inspection we found that people were being treated respectfully and sensitively. We observed people interacting positively with staff. People had more opportunities to take part in activities. We were told, "people are doing more, activities are put on and families are involved".

Improvements were noted in the way in which the service worked and co-operated with social and health professionals.

New systems had been put in place to ensure that the cleanliness of the home was being maintained. Feedback from people and visitors included,"I can't put it into words, it's so clean and the carpets are cleaner" and "they are keeping it clean".

The premises and grounds were being adequately maintained. Plans were in place for ongoing refurbishment of the property. A visitor told us, "the conservatory looks beautiful".

There were sufficient staff working overnight to safeguard the health, safety and welfare of people. One person told us "staff are friendly and have time for a chat".

We spoke with six people and spent time observing people in the lounges and dining room. People were treated respectfully and sensitively. The atmosphere was light hearted and people appeared calm and happy. People were offered choices about how to spend their time, with whom and where. People were offered choices about drinks and what to eat.

We talked with people about their care. One person said they had discussed their care needs with a member of staff. Staff told us they had started to spend time with people individually to talk about how they would like to be supported and cared for. We looked at people's nutritional needs. Concerns had been raised with us that people were at risk of dehydration and malnutrition. New systems had been put in place to make sure people's nutritional needs were being comprehensively recorded and responded to. Fortified diets and food supplements were provided where needed.

Arrangements in place for handling medicines did not always protect people. We found this outcome was not being met.

We found that quality assurance processes were in place although audits were not being monitored and action plans were not always being developed to make sure improvements were happening. We found this standard was not being met.

There were inconsistencies in the way in which records were being reviewed, updated and maintained. Potentially this could impact on the health and wellbeing of people. We found this standard was not being met.

People told us they liked living in the home. They said staff were friendly and helped them with their care. One person said there were not many activities but they really enjoyed music and movement. People told us they had newspapers delivered each day. One person said the food was good and they had plenty of choice.

We observed staff supporting people respectfully and sensitively. People received visitors either in their rooms or in the communal areas. A visitor told us they were made to feel welcome and could visit whenever they wished. They said they really appreciated the care provided and they had no concerns about the home.

People told us, "I couldn't fault anything", "it's great", and "I have no regrets moving here". They also said, "it's lovely here", "I am very lucky" and "I couldn't wish for better". People also said the home was clean and beautiful. They all commented on the lovely gardens.

One person said, "I look forward to music and movement". Several people said they looked forward to the hairdresser coming. Not everyone knew about the activity programme. Some people told us they didn't wish to join in with the activities. Other people said they would like to go out occasionally.

People told us if they had any concerns or worries they would talk to staff, the manager or their relatives. One person said any issues were listened to and immediately resolved.

People said, "staff look after me well", "staff are friendly", "all of them (staff) are great" and "staff are very good." People told us how staff responded to their needs in a timely fashion during the day and night. One person said, "I don't have to wait long for their help. They are marvellous." People told us that staff work really hard.

This inspection took place on 20 and 22 October 2015 and was unannounced. Chargrove Lawn provides accommodation for up to 26 people. At the time of our inspection there were 21 people living there. Four people had recently moved into the home from another home owned by the provider which had closed and some staff had moved with them.

There were eight people living with dementia in the home. People had bedrooms with en suite facilities, some included shower rooms or baths. They also had access to shared bathrooms as well as living and dining areas. The grounds around the home were accessible to everyone.

Chargrove Lawn had 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.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff training had fallen behind schedule and according to the provider’s training records, key areas such as fire, medicines, moving and handling and first aid needed to be updated. Schedules for annual appraisals and individual support meetings had also not been maintained. There were plans in place to address these issues.

People received care which reflected their personal preferences and lifestyles, past and present. Staff had a good understanding of people’s needs and how they wished to be supported. People and those important to them were involved in discussing their care needs and relatives said they were kept up to date with changes in people’s needs. People’s health and well-being was closely monitored and when needed referrals were made to social and health care professionals for their advice and input. If people needed additional equipment to keep them safe this was provided. People were encouraged to maintain a healthy diet. They had a choice of meals and alternatives could be provided if needed. Snacks and drinks were available throughout the day. If people had particular dietary requirements these were catered for.

People’s relatives or friends were welcome to visit them and private facilities were available if needed. People had the opportunity to take part in a range of activities both inside the home and outside. External entertainers were engaged to deliver music, Jazz and folk singing and day trips included a boat trip. For people who did not wish to take part in group activities, more individualised activities were arranged such as shopping.

People and staff were confident any concerns would be listened to and the appropriate action taken by management in response. Staff had a good understanding of safeguarding and when to raise concerns. People were kept as safe as possible through the systems and processes which were in place. A thorough recruitment process made sure all the checks needed before staff started work were completed. Staff had requested training in dementia and understanding people’s behaviour, which had been provided. Staff said this had really helped them to reflect about how people were feeling and how best to support them.

People’s experience of Chargrove Lawn was monitored through quality assurance audits, their feedback, accidents and incidents and complaints. Improvements were evident in response to these systems. A relative commented, “Mum has been here for a long time and year on year I have seen the home get better”. This was verified by a health care professional who said the improvement in the home “was quite marked”.