We inspected this service on 6 December 2016 and it was unannounced, we returned announced on 7 December 2016.

At the last inspection 25 August 2015 we told the provider that improvements were needed in the management of medicines, risk assessments, recruitment procedures, providing people with a balanced diet, ensuring referrals for health care services were followed up, ensuring that MCA and DoLS legislation was adhered to, that audits were carried out and that a registered manager was in post. This inspection looked at whether the provider had made improvements.

Chataway Care Home provides residential care for up to 14 people. There were 14 people living at the service at the time of the inspection. The accommodation was provided over two floors and there was access to the upper floor via a stair lift. There was a small accessible garden that people could use.

It is a requirement that the home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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. At the time of our inspection the manager had submitted their application to become the registered manager.

People told us that they felt safe. Staff were aware of how to keep people safe knew how to report actual or suspicions of abuse. However they had not received regular training to support their understanding.

The registered manager had investigated accidents and incidents to look at ways to prevent them from reoccurring. Improvements to risk assessments identified what risks people were vulnerable. There were plans in place that were available to staff to support people to keep safe during emergencies.

People received their medicines as prescribed by their doctor, though the reasons people refused medicines were not always consistently recorded. Protocols for medicines prescribed to be taken as and when required where not in place.

People’s needs had been assessed prior to them moving into the service and plans of care had been developed from these. Staff were deployed appropriately to keep people safe. Recruitment of new staff was robust and the manager had carried out checks on prospective staff before they started work.

People were being supported by staff that knew about their roles and responsibilities. Staff training was limited but they received on-going support from the manager.

The manager was aware of their responsibility to notify us of any successful DoLS application. Staff had an understanding of the Mental Capacity Act (2005) and understood how to obtain people’s consent before they offered care and support. Staff knew how to support people to make decisions for themselves. Where people may have lacked the capacity to make their own decisions, the provider had followed the requirements of the Act.

Improvements had been made in ensuring referrals to healthcare services were followed. People using the service had access to the required healthcare services, were supported to maintain good health and received ongoing healthcare support.

Improvements had been made in providing people with nutritionally balanced diet People were provided with a choice of meal at each mealtime. Staff understood the need monitor people’s food and fluid intake where a risk was identified.

We observed people using the service being treated in a caring and considerate manner. They were involved in making choices about their care and support and when they made their choices, these were respected by the staff team.

People said that they were sometimes bored and would like the opportunity for more activities, particularly in the evenings.

People’s preferences were detailed in their care plans and we found things that were important for people to be in place. For example,

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with two people who used the service and their relatives. The two people who used the service told us that they liked living at the home and that they were well care for. One person told us, "I'm happy here, it's so comfortable." Both told us that they liked their bedrooms. We spoke at greater length with their relatives. One relative told us, "The carers are first class, the care is very good." A relative of another person who used the service told us, "I'm supremely confident that my mother's care needs are being met. I can see that she is comfortable here and she tells me that she is." That relative described care workers as being "attentive and courteous." Their partner added, "There is a culture of caring at the home. The manager explains things and keeps us informed."

We saw staff supporting people courteously and discretely throughout our inspection. People clearly enjoyed their meals. We heard people telling care care workers how much they had enjoyed their lunch, one saying "it was lovely, it was my favourite."

The home was undergoing a gradual refurbishment. The manager assured us that people would be involved in the choice of colours and furnishing.

We spoke to three people who used the service. One person told us that he had seen his care plan and had been involved in reviews of the plan. He added, "I don't get bored, I do crosswords." Another person told us, "Sitting in a chair watching television is a good day."

A third person, who shared a bedroom that accommodated another person told us, "I'm well looked after. I like to stay in my room. I don't mind that I share a room. It's home from home."

We carried out our inspection on 25 August 2015 unannounced and returned, announced on the 26 August 2015

Chataway Care Home is registered to provide residential accommodation for up to 14 people who require personal and nursing care. There were 12 people using the service at the time of our inspection.

The service does not have 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. There was a new manager on the day of our inspection. We spoke with the provider who told us that they would support the new manager in applying to become the registered manager following our inspection. We confirmed with the business manager that the process had started.

People we spoke with and relatives were satisfied with the care and support provided. Some people raised concerns about staffing levels but all said that they felt people were safe. People also said that their individual needs and wishes were known and understood.

We found staff were mostly caring, kind and compassionate in their approach. Occassionally they showed their frustration when speaking with people. They understood people’s individual needs.

People we spoke with and relatives told us that they were involved in discussions and decisions about their care and treatment. Additionally, people said they knew how to make a complaint and they would feel confident to do so if required.

Staff received appropriate training and development opportunities to review and develop their practice. Staff recruitment procedures were robust and ensured that appropriate checks were carried out before staff started work.

Concerns were identified that staff did not always have sufficient time to spend with people and develop meaningful relationships.

Staff were aware of how to protect people from avoidable harm and were aware of safeguarding procedures.

People had been asked for their consent to care and treatment and their wishes and decisions respected. The provider adhered to the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2008. However the provider must ensure that the Care Quality Commission is notified of all successful applications for DoLS.

Medicines were safely stored and administered and people received their regular medicines as prescribed. However there was a lack of policy and procedures in place to ensure consistency in the administration variable dosage medicines.

People’s needs were assessed and plans were in place to meet those needs. Risks to people’s health and well-being were identified and plans were in place to manage those risks. Referrals were made to healthcare professionals but were not consistently followed up.

People’s nutritional and dietary requirements had been assessed and monitored but meals were not always nutritionally balanced.

There were no robust systems in place to assess and monitor the quality of the service. There was also no formal system of gathering the views and opinions of people who used the service.