This inspection took place on 3 and 4 May 2018 and was unannounced.

Chaxhill Hall is a residential care home for 36 older people. People living at the home have a range of needs including dementia. At the time of our inspection visit there were 30 people using the service. At the last inspection on 9 November 2015, the service was rated Good. At this inspection we found the service remained Good.

People benefitted from a service where their needs were put first and their safety maintained. There were enough suitable staff to meet people's needs. Risks to people were managed with the support and guidance of health professionals to ensure people remained safe. Staff worked openly with other agencies to safeguard people from harm. The building and equipment were well maintained and people were protected from risks associated with cross infection. When accidents or incidents occurred, the care people received was reviewed and lessons were learned to prevent a similar incident from occurring in future. We have made a recommendation about reviewing how medicines are managed, in line with best practice.

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 privacy was respected and they were treated with dignity and kindness. People were supported to maintain relationships with others who were important to them. They were supported to access appropriate health care.

People benefitted from a stable and caring staff team who knew them well. Staff took a personalised approach to meeting people's needs. People's preferences were taken into account by staff when providing care and people were offered choices in their day to day lives. People received good end of life care.

People's views about the service they received were sought and these were used to improve the service. People were able to raise complaints and these were responded to promptly and thoroughly. The culture at the home was open and transparent. Staff and managers worked together to provide a personalised service where people felt at home. We have made a recommendation about managers networking with other providers.

Further information is in the detailed findings below.

We inspected Chaxhill Hall on the 9 November 2015. Chaxhill Hall provides residential care for older people over the age of 65; some of the people living at the home were living with dementia. The home offers a service for up to 36 people. At the time of our visit 31 people were using the service. This was an unannounced inspection.

We last inspected in September 2014 and found the provider was meeting all of the requirements of the regulations at that time.

There was a registered manager in post on the day of our 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.

People told us they enjoyed living at the home. People were supported by kind, caring and compassionate care staff, who clearly knew people’s needs. Staff supported people to spend their days as they wished.

People were supported with activities, and enjoyed time spent with care staff and other people. People told us there were things for them to do in the home.

People told us they felt safe in the home, staff had a good understanding of safeguarding and the service took appropriate action to deal with any concerns or allegations of abuse.

People and their relatives spoke positively about the registered manager. They felt the registered manager was approachable, listened to them and asked for their views. People and their relatives felt involved in people’s care.

People were protected from the risks associated with their care. Staff had clear guidance to protect people from risks such as smoking and falling. Care workers took action to help maintain people’s independence.

Where people’s needs changed, care staff ensured their ongoing healthcare needs were maintained. Healthcare professionals told us staff always sought their advice and acted upon guidance.

People’s needs were maintained as the registered manager ensured there were enough staff deployed. People received their medicines as prescribed and the registered manager had systems to ensure medicines were administered safely.

The registered manager had systems to monitor the quality of service people received. People and their relatives told us their complaints were acted on by the management team. Relatives felt staff were approachable.

People’s needs were met by care staff who had access to training, effective supervision and professional development.

People had access to appropriate food and drink and were supported to access external healthcare services. People told us their dietary preferences were respected. The home’s chef and staff had full knowledge on people’s dietary needs and ensured they had access to an appropriate diet.

Staff had good knowledge of the Mental Capacity Act and Deprivation of Liberty Safeguards. People who were being deprived of their liberty were being cared for in the least restrictive way. However, where people had given consent around their care, this had not always been documented.

Thirty people lived in the care home at the time of our inspection. There were four care staff working on the day shift, and two care staff working on the night shift. During the day, the staff were supported by the manager, the assistant manager, an activity organiser, a maintenance staff, a laundry assistant, two domestic staff and a chef.

We were given a tour of the home. We spoke with nine people who lived in the home. We spoke with two family members. We spoke with the manager, the assistant manager and six members of staff. We read the care records for four people who lived in the care home. We inspected the polices and procedures, the complaints procedure and we read the report from a quality monitoring visit from the local authority. We spent time observing staff interactions with the people they were supporting.

A single inspector carried out the inspection. The focus of the inspection was to answer five questions: Is the service safe, effective, caring, responsive and well-led?

We found the service was safe.

Staff told us they had received training about safeguarding vulnerable people. They told us they would report any concerns they had immediately, to a senior member of staff, or to the manager. Policies and procedures were available for staff to follow, and local authority contact details, with telephone numbers were available.

We saw that people were cared for by staff who received appropriate support and training. One member of staff told us, "I think we are well supported and encouraged to do further training. I completed my Level three and four in Health and Social Care".

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager completed mental capacity assessments for all people who lived in the home. There were some people who lived in the home who had best interest decisions made on their behalf, with involvement of family members or health professionals. The reasons for decisions made were clearly documented, and reviewed regularly.

We found the service was effective.

We saw involvement from external health professionals, such as social workers, district nurses and occupational therapists.

We observed that people appeared happy and comfortable in their environment.

We found the service was caring.

We saw that staff had a good rapport with the people who lived in the home. We saw warm, friendly and respectful interactions between staff and the people they were supporting. We saw that people were able to choose how they spent their day. Most people chose to spent time in the communal areas, whilst some people chose to spend the day in the privacy of their own bedrooms.

We found the service was responsive.

People had their needs assessed and reviewed on a regular basis. The care records confirmed people's likes and dislikes, and we found that staff were knowledgeable about the likes, dislikes and preferences of the people they were caring for.

We found people were appropriately referred for assessment and treatment by other health professionals when needed.

We found the service was well-led.

There was a registered manager in post who was supported by the staff team and the registered provider.

Quality assurance processes were in place to ensure the service was monitored and actions were taken to improve the care and treatment provided for people.

The care records we checked demonstrated that people’s preferences and views had been taken into account. When people were able to represent themselves they were involved in care planning and reviews. One person said, “I take a lot more decisions myself about what I do now… I feel more like me”.

Risk assessments were in place and were reviewed monthly. This included risks around eating and drinking, falls and pressure area care. When a risk had been identified appropriate measures had been implemented to protect the person.

The home was generally clean and free from odours. People said, “It’s clean enough… they are forever changing your bed” and “I do think it’s clean, it can’t be spotless”.

The people we spoke with thought highly of staff, one said, “They are all very nice, very helpful. I have no concerns. I am amazed that they can cope with so many people”. Another said, “I can’t fault it a great deal. They’re very obliging”.

People were given information and support to make a complaint. Although the provider met this standard the manager identified improvements that would be made in how complaints and comments were addressed by the home.

We spoke with five people who were using the service. When we asked about the care people received we were told “Staff are cheerful and helpful with anything. I couldn’t want more”. Another person said “I let them get on with it ‘cause it’s their job and they know what they’re doing”. We found that people were accepting of poor standards of care which did not always respect their privacy, uphold their rights or meet their needs.

We spoke to four people who use the service.

People described how their medicines were managed and told us they were satisfied with the timing and the administration.

One new person told us they felt "at home" and "the staff do everything they can for me".

We saw how people were treated with dignity and respect, for example the staff knocked on their bedroom door before entering, used their preferred name and helped them with their meals in a quiet and dignified manner. People told us, "it is all ok here", "the meals are very good and we have plenty of drinks", and “I'm ok here".

People told us that staff came when they rang the call bell and that they felt safe in the home as the staff were supportive and kind.

A visitor told us that their friend living in the home thought it was marvellous there.

Two people thought the staff did not have enough time to talk to them.

Most people knew how to raise concerns and had information in their bedrooms about the complaints procedure. People told us they had no concerns.

A relative told us they were very pleased with the care provided.