The service consists of two separate buildings. Chelston Park can accommodate up to 36 people. 31 bedrooms are for single occupancy of which five can be used as double rooms if people chose to share. Chelston Park provides accommodation with nursing and residential care to older people. Chelston Gardens is a purpose built home which is divided into four distinct units over two floors. Chelston Gardens provides accommodation with nursing care for up to 50 older people who are living with dementia. There are very large and well maintained grounds with ample parking. When we visited there were 79 people using the service.

At the last inspection, the service was rated Good.

At this inspection we found the service had improved to outstanding.

Why the service is rated outstanding

People benefitted from a provider and strong management team who were committed to ensuring they received the best possible care. There were very effective systems in place to continually monitor the service provided and there was a strong emphasis on researching and implementing best practice. People were supported by a highly motivated and very well supported staff team. Staff felt valued and morale was very good. The people who used the service, their representatives and professionals involved with the service spoke very highly of the standards of care provided and of the commitment of the management team.

People remained safe at the home. One person said “Oh yes; I feel very safe here. It’s very nice.” Another person told us “I feel safe, secure and well looked after.” A visitor told us “I have no concerns at all. I go to bed at night knowing that my [relative] is safe, warm and well cared for.” Another visitor said “I can walk away from here and not have to worry about a thing.”

People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. Staff knew how to protect people from the risk of harm and abuse. Risks to people were reduced because there were systems in place to identify and manage risks such as reducing the risk of falls, assisting people to mobilise and reducing risks to people who were at high risk of malnutrition and pressure damage to their skin.

People continued to receive effective care. People benefitted from a staff team who had the skills. knowledge and training to meet their needs. One person told us “I think the staff here are marvellous. They know what they are doing. A relative said “The staff are amazing. I know they get excellent training here.” 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 support this practice. One person told us “Staff never tell me what to do. They ask me what I want to do.” Another person said “I can do as I please.” People’s health care needs were monitored and met.

The home continued to provide an outstandingly caring service to people. People were supported by a staff team who were happy in their work and who were committed to ensuring people received the best possible care. People and their relatives spoke highly of the staff team. One person told us “The staff are lovely. Very kind indeed.” One relative told us “They are marvellous. [Name of person] is my world and they know that. They are so kind and attentive. I am blessed [name of person] is cared for here.” Another relative said “The staff are all wonderful and they really do care. I honestly can’t think of anything they could do better.” A member of staff said “This is the best place I have ever worked. Really. I think our residents get a very high standard of care and we all really care about them and their families.”

The home continued to provide a responsive service. The registered managers ensured the home could meet people’s needs and aspirations before they moved there. A relative told us “[Name of one of the registered managers] came to meet [name of perso

Two adult social care inspectors carried out this inspection. We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five 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?

Staff ensured people received safe and effective care which was in accordance with people’s individual needs. However people’s care plans were not always reflective of people’s assessed needs. This could place people at risk of receiving unsafe or inappropriate care if they were cared for by staff who did not know them well.

Care plans included a range of individual risk assessments and agreed actions for managing these risks. These included reducing the risk of falls, skin damage and malnutrition.

The people we spoke with told us they felt safe at the home and they commented on the kindness of the staff. Comments included “I feel very safe here” and “I have no concerns at all. If I did, I would tell someone.” A visitor told us “I have never seen anything but kindness. The staff treat people so well.”

The provider had a range of policies and procedures in place to protect the people who lived in the home. The staff we spoke with had a good understanding about how to report any concerns.

Visitors were only able to access the home when they were let in by staff and all visitors were required to sign a visitor’s book when they arrived and left the home. This helped to provide a safe environment for people who used the service.

People were cared for in a clean, hygienic environment. The systems in place to reduce the risk and spread of infection were effective. We saw that all areas of the home were clean and there were no offensive odours.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager had followed appropriate procedures where concerns about some people’s safety had been identified and certain restrictions were needed to reduce risks to these people.

Is the service effective?

The service was effective. People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well.

Staff knew how to ensure that people’s rights were respected. They demonstrated a very good understanding of how to support people to make decisions. They knew the procedures to follow where an individual lacked the capacity to consent to their care and treatment. Procedures were in place which meant that decisions about the care and support people received would be made in their best interests.

People enjoyed a range of activities which included in- house activities, trips out and visiting entertainers. . The people we spoke with told us they enjoyed the activities. Comments included “It’s very good. There is always something or other going on. I especially enjoy the music sessions” and “I do enjoy the trips out. We went to the garden centre recently.”

People said they were provided with a choice of meals and drinks; they liked the food served in the home. People were able to choose where to eat their meals. Some people used adapted cutlery to enable them to eat independently. Where people require help to eat their meal they were well supported by a member of staff.

Is the service caring?

People told us staff were kind and caring. We observed staff interacted and supported people in a gentle and professional manner. People appeared comfortable with the staff who supported them.

The people we spoke with were complimentary about the care they received and of the staff who supported them. Comments included “I am very happy here. The staff are nice and everything I do is my choice.” We met with three visitors. They were positive about the care and support their relatives received. They made the following comments “It’s lovely here. I don’t know how they do it. I visit regularly and my X is certainly well cared for” and “the carers really do care. You can see it in their eyes. I am very pleased with the care.”

Is the service responsive?

People received care that was responsive to their individual needs. People’s health care needs had been monitored and appropriately responded to. Information about people’s health needs and contact with health and social care professionals had been recorded. We were informed that the service received good support from health care professionals and there were no problems obtaining their input for people when required.

Staff had a very good knowledge of people’s healthcare needs and were able to tell us about how they monitored and treated individual needs.

One person told us “I saw the doctor recently because I had a pain. I told the nurse and she arranged for the doctor to see me the same day.” Another person told us “If I needed a doctor; all I have to do is tell the nurse and they will make the arrangements.”

The care records we read showed that staff responded promptly to any concerns about people’s health or well-being. We also saw they implemented recommendations made by health care professionals. For example, one person had been seen by a speech and language therapist (SLT) after they had experienced difficulties in swallowing and had lost weight. We saw the SLT team had recommended a diet which should be ‘mashed’ to a certain consistency. We observed this person being assisted with their lunch and saw they had been provided with a meal in accordance with the recommendations made.

We saw people had access to a call bell so they could summon staff assistance when needed. During our visit we observed staff responded promptly for any requests for assistance. People told us staff did not keep them waiting too long when they used their call bell. Comments included “I sometimes need to use my bell at night. The staff are very good and come quite quickly” and “If I ring my bell, the staff are there.”

Is the service well led?

There was a registered manager in post. A registered manager is a person who has been registered by the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

There were systems in place which monitored and improved the quality of the service provided. Regular internal audits had been carried out which monitored the health and safety of people. Internal audits included checks on the home's fire systems, environment, care planning, reducing the risk of falls and the management of people's medicines.

The provider may find it useful to note that the current systems for auditing people’s care plans did not identify that staff had not always created a care plan to reflect changes in people’s needs or following recommendations by health care professionals. We discussed our findings with the manager and quality manager at the time of our inspection.

Risks to people were assessed and reviewed. If risks could be reduced then appropriate measures were taken. If any incidents or near misses occurred they were reviewed to see if any lessons could be learnt or trends identified.

The home was accredited to the ‘National Gold Standard Framework.’ This is a comprehensive quality assurance system which enables care homes to provide quality care to people nearing the end of their life. Many cards praised the staff for the care their relatives had received at the end of their life. Relatives had also shared their positive experiences through our on line ‘Share Your Experience’ survey.

Our inspection was unannounced and lasted approximately ten hours. We were accompanied by an expert by experience. We visited both buildings, Chelston Park Nursing and Residential Home and Chelston Gardens Dementia Nursing Home. Altogether there were 79 people living at the service; 29 people in Chelston Park and 50 people in Chelston Gardens . There is a shared registered manager and shared support services such as kitchen, laundry, training, maintenance and quality assurance across the site.

We received information of concern regarding peoples right to choose, their care and welfare and the administration of medicines. We looked at this as part of our visit. We spoke with six people living at Chelston Park Nursing and Residential Home and spent time observing those within Chelston Gardens Dementia Nursing Home. We spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care. We also spoke with twelve nursing and care staff, two housekeepers, the cook, handyman and two activities coordinators. We also spent time with both the quality assurance manager and registered manager . We looked at eleven sets of care records, and focussed on how people’s consent was gained by staff. We also looked at how people’s health and well-being was supported.

We found people’s health and well-being was assessed, and care was provided in a way that suited people's individual needs. We saw that medicines were managed in a safe and effective way, and there was a system in place for dealing with complaints and concerns. We looked at how the provider reduced the risks of infection after we became concerned with some infection control practices. We looked at a selection of records relating to the care people received and to the running of the home. We saw that there were areas within Chelston Park Nursing and Residential Home where care records were not always accurate and up to date.

During our visit we spoke to people living in Chelston Park and Chelston Gardens about the home they lived in and the care they received. We also observed how people were cared for and the way staff interacted with people. In Chelston Park we watched people taking part in various activities through out the day. These included stone painting, singing, ball games, board games and one to one sessions for people who preferred to remain in their room. One person proudly showed us his tomato plants and was helped by a member of staff to water them. People told us that they enjoyed the trips out; they said they could go to the local pub, have a picnic on the Blackdowns or go for a drive through villages they knew or grew up in. One person said,” there’s always plenty to do and always music. It’s not like your own home of course, but we have a lovely garden and they are building a gazebo.” Another person said that they were very happy living at Chelston Park and the staff were all very good. One person said, “I am really happy here, I have all I want.” Whilst another person said, “I am very content, they do everything well and look after me now I can’t do things as well as I could. I used to play tennis and hope I can watch it this afternoon.” Later in the day we saw that person and a friend watching the Wimbledon Tournament on the TV.

One visitor told us, “they are all so caring and you can talk to the manager at any time. The activity lady is absolutely brilliant she keeps them interested. My relative is really well looked after, and they are really good at keeping me informed and up to date about their assessments.”

We observed lunch; it was managed well with two sittings. Staff sat at the table with people and helped them in a dignified and respectful manner. One person said, “Lunch was very good as usual, I had the curry. The only problem is they always put too much on the plate, and I don’t like to think that I am wasting food.”

In Chelston Gardens people told us, “I love it here.” One person said “it’s all very nice here; I like the garden and reading my paper.” Another person said, “I like living here the staff are good company and know what they are doing.” Referring to the activities lady they also said, “She’s always very kind.”

We observed people taking part in activities and enjoying a laugh with staff. There is a pub themed room with a balcony and people have access to an enclosed garden. Lunch time was observed to be a relaxed social occasion with people being helped in a respectful manner. One person did not like anything on the menu and requested ham, egg and chips, staff relayed the request to the kitchen and they were told it would be ready in 20 minutes.

This inspection took place on 15 and 16 July 2015 and was an unannounced inspection.

At the last inspection carried out on 17 September 2014 the service was found to be in breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Care plans did not always reflect the care people received. Following the inspection the provider sent an action plan to the Care Quality Commission (CQC) stating how and when improvements would be made. At this inspection we found that action had been taken to improve the service and meet the compliance action set at the previous inspection.

The service consists of two separate buildings. Chelston Park can accommodate up to 31 people and it provides accommodation with nursing and residential care to older people. Chelston Gardens is a purpose built home which is divided into four distinct units over two floors. Chelston Gardens provides accommodation with nursing care for up to 50 older people who are living with dementia. There are very large and well maintained grounds with ample parking.

There is a registered manager who is responsible for the home. 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 and associated Regulations about how the service is run.

The registered manager had an excellent knowledge about the needs and preferences of the people who lived at the home. They had a clear vision for the home and they made sure this was understood and followed by the staff team. They were committed to ensuring people received the best possible care.

Staff morale was very good. The atmosphere in both parts of the home was relaxed, cheerful and welcoming and staff communicated with people in a very kind and respectful manner. Without exception all the people and visitors we spoke with were very complimentary about the care they received and of the staff who supported them. One person said “I am so happy here. The staff are so kind and they are always so happy. I would recommend this home to anyone.” A visitor told us “The staff here have really got to know my [relative] well. Nothing is too much trouble.”

People told us they felt safe living at the home. One person told us “I feel very safe indeed and I am very well cared for.” A visitor told us “I can leave here knowing my [relative] is happy and safe which is such a comfort to me.” There were policies and procedures in place to minimise risks to people and to help keep them safe. These were understood and followed by the staff team.

There were enough staff to help keep people safe and meet their needs. One person who lived at the home told us “They [the staff] always have time for you. There certainly seem to be plenty of staff about.” Another person said “Last night I accidently pressed my call bell and the staff were there straight away to make sure I was all right.” The service made sure staff were appropriately trained and supported.

People were provided with opportunities for social stimulation and trips out. Designated activity staff were employed and activities were tailored to meet the needs and preferences of the people who lived at the home.

People received effective care and support which was adjusted to meet their changing needs. People had access to appropriate healthcare professionals to make sure they received effective treatment when required. There were systems in place to make sure people received their medicines when they needed them.

People had their nutritional needs assessed and food was provided in accordance with people’s needs and preferences.

There were effective quality assurance systems in place to monitor care and plan on-going improvements. There were audits and checks in place to monitor safety and quality of care.