About the service: Cheriton Care Home is a residential care home registered to provide care for up to 27 people. It was providing personal care to 20 people aged 65 and over at the time of the inspection. Some people had dementia.

People’s experience of using this service:

• People spoke positively about their care and the staff who supported them. Some people told us they had found it difficult to communicate with staff whose first language was not English.

• People received the healthcare support they needed. A healthcare professional told us the service was “very friendly” and they had no concerns about people’s care.

• People’s needs were recorded in care plans and kept under review. There was information to support people in the way they preferred and to help ensure it was person-centred.

• People enjoyed the food.

• Staff received the training and support they needed to meet care needs and to develop as professional workers.

• There were some areas where care could be improved. We have made recommendations about fire safety, recruitment practice, updating the complaints procedure and the management of diabetes. Further recommendations have been made about the assessment of staff performance before they are confirmed in post, making information widely accessible to people and seeking guidance from the Health and Safety Executive. Another recommendation has been made regarding suitability of the environment for people with dementia.

• We found governance of the service was not effective in identifying areas of practice where the home was not meeting the regulations or where it could improve delivery of care. This included meeting regulatory requirements to notify us of important events and to inform the local authority about allegations of abuse. Audits and checks of medicines practice had not identified a morphine-based medicine was not logged in the appropriate record. Infection control audits had not picked up the issues we observed. A number of health and safety risks had also not been identified. These all had the potential to place people at risk from harm.

Rating at last inspection: The service was rated ‘Good’ at the last inspection on 24 and 26 November 2015. We published our report on 15 January 2016.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement: We found areas of practice where the provider was not meeting the regulations. These were in relation to governance of the service, demonstrating lawful deprivation of people’s liberty, notification of incidents, management of medicines and safeguarding people from abuse.

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will ask the provider to submit an action plan which outlines what they will do to improve the service and by when. We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Inspections will be carried out to enable us to have an overview of the service, we will use information we receive to inform future inspections.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 24 and 26 November 2015 and was unannounced on the first day.

We previously inspected the service in May 2013 when we found the service was meeting the requirements of the regulations in place at that time.

Cheriton Care Home is registered to provide residential personal care for up to 27older people. At the time of our inspection there were 24 people in residence. Cheriton Care Home does not provide nursing care.

Cheriton Care Home is required to 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. The current manager was appointed in May 2015 and began the registration process with the Care Quality Commission (CQC) in June 2015. The process had not been completed at the time of this inspection.

We received very positive feedback about the service from people who lived there. “Very good,” “very caring,” and “I am very well looked after” were some of the comments made. People’s relatives were also complimentary about the quality of the staff and the care their relatives received.

Healthcare professionals told us the home referred people appropriately and staff were responsive to any advice or recommendations they made. They were positive about the standard of care records they saw and felt the home provided a welcome alternative to some larger residential care services.

Staff were provided with the skills and knowledge they needed to recognise and respond to any safeguarding concerns. Risk to people’s health, welfare and safety were appropriately and effectively managed. Risks to individuals were identified and risk assessments were in place which set out the action to be taken to reduce the likelihood of injury or harm to people during the provision of their care. There was a training programme in place for staff to provide and update them with the necessary skills and practical knowledge to meet people’s needs effectively and safely.

People did not consistently benefit from stimulating activities or regular opportunities for interaction with staff and each other. We have made a recommendation about activities and interactions in the report.

Medicines were managed safely and people received their medicines, regularly, on time and as prescribed.

There was a robust staff recruitment process in place. Overall people were satisfied that there were sufficient staff to meet people’s needs. The recent increase in numbers of people receiving care had been challenging for staff, however we were able to confirm staff numbers were to be increased on the staffing rota for the week following our inspection to reflect this.

Care plans were in place which set out people’s needs and how they were to be met. Care plans included details of people’s preferences for how they wanted to be supported. Care plans were reviewed and kept up to date to take account of changes in people’s needs.

The service was being effectively managed. Staff told us they worked together well as a team. A high proportion of staff had worked at Cheriton Care Home for a number of years. This consistency of staff was something people who received care and support, their relatives and visiting health and social care professionals commented on positively.

The provider checked the quality of care at the service through visits, audits and attending staff meetings. They also had a very high profile within the service and provided support to the manager.

People expressed confidence in the staff, and said they felt well-cared for. We spoke with four people. They told us they enjoyed living at Cheriton. One person described the staff as “helpful and approachable”, another said care given was “exceptional.” We heard people enjoyed the activities run by the deputy manager, and that people felt able to sit quietly listening, rather than join in, if that was their preference.

We read care plans and noted these had been regularly updated, and relatives were involved in this process. This showed the planning of care was done in a co-operative manner, ensuring the needs and wishes of the people there were carried out.

Although the kitchen floors and work surfaces were clean, there was a build-up of food spillages on the interior of food storage cupboards. This small area of concern appeared to be a result of a lack of robust checking and auditing of cleaning procedures.

We read staff files and noted the recruitment process was clear and comprehensive with all recommended documentation in place. This meant the provider had an efficient recruitment procedure.

The manager described how he ensured the quality of the service. We read monthly audits, and minutes of meetings held. We saw actions noted had been carried out within a timely manner. We read the complaints policy and examined the complaints log. Where a complaint was made, it was resolved to the person’s satisfaction, indicating commitment to improvement.

On the 30 May 2012 when we visited Cheriton Care Home we spoke with five people who lived there and also with three people who were visiting friends or relatives. Our visit started before 07:30 am and we were able to see and hear people being given the opportunity to get up or not and to choose what they had for breakfast and where they ate it.

One person told us that they sometimes had a cooked breakfast but that today they were just having cereal,toast and a cup of tea as they weren't very hungry. We saw that each person had a choice card set out on an individual tray and when we spoke to the manager about this they confirmed that choices could be varied at any time if a person changed their mind.

When we saw minutes of a residents' meeting held on the 18 April 2012, we saw that requests were made for sandwiches to be available at 8 PM when they usually have a hot drink and we saw evidence that this was now done.

Another resident made a specific request for beans on toast and all residents were asked what different choices for desserts in the evening they would like, again we were able to confirm that action had been taken to address this issue.

One resident had asked that they be left undisturbed when in their room and we saw instructions to staff to take this wish into account.

One friend of a resident we spoke with told us that their friend was 'very well' cared for and that they retained control and choice over most areas of their life.

When we spoke with one person who was a smoker, they told us that they could ask staff for cigarette and we saw this being done. They also told us that they liked going to a day centre and we were able to see them leave on transport provided to take them there later during our visit.

When we spoke with people who live in Cheriton House or to those people responsible for them they told us that they were very well looked after and that the care staff were; 'very kind and helpful'.

During our visit we saw examples of very positive communication and interaction between staff and people living in the home. For example one person was becoming anxious because their television was not working properly and a member of the care staff team immediately went with them to their room and sorted this out. The person concerned came to tell us that their television was now working and was calm and at ease as a result.

We spoke with the relative of one person who lived at Cheriton Care Home who told us that they had 'nothing but good things to say about it' and that their family member was "as happy as she could be" at the home.

Those people we spoke with during our visit about their experience of living in Cheriton Care Home were very positive about their care and the carers. "We all get on very well together" was how one person put it.

All of those people we had conversations with told us that they could talk to the carers, manager or provider if they had any concerns and that they felt confident that those concerns would be addressed. Although they told us that they would raise any issues informally, they also told us that there are more formal meetings where any issues can be raised.