This inspection took place on 14 and 15 November 2017. It was an unannounced visit to the service.

We previously inspected the service on 31 October, 01 November and 09 November 2016. The service was not meeting all of the requirements of the regulations at that time. We had concerns about fire safety measures and support given to staff. We asked the provider to take action to address this. They sent us an improvement plan which told us about the changes they would make. On this occasion we found improvements had been made to ensure people received safe care that was appropriate to their needs.

Chesham Leys provides nursing care for up to 62 people. Fifty four people were living at the service at the time of our inspection. The service provides nursing care to older people and people with dementia.

The service had a 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.

We received positive feedback about the service. Comments from people included “They’re a wonderful group of staff here,” “I have been living here for two years and I am well cared for” and “The people are brilliant; the standard is high, I can't fault it. The staff and management are excellent.” A community professional’s feedback included “I can say that Chesham Leys have worked really hard to improve standards.”

The service had received many compliments. One included “I would like to take this opportunity to thank everyone at Chesham Leys for all their help in making mum’s time in Chesham as comfortable and welcoming as they did. My personal dealings with yourself and your colleagues were always incredibly easy, nothing was ever a bother and any queries dealt with promptly. I loved the relaxed and openness of the home. More importantly was the carers and nursing staff themselves; they treated mum with care and respect.”

People were kept safe at the service. This included use of thorough recruitment practices before staff were appointed. Staff knew about safeguarding people from abuse and had undertaken training in this area. Medicines were handled safely to make sure people received them in line with the prescriber’s instructions. Equipment had been serviced and was safe to use. The premises were well maintained and fire safety checks were carried out.

People’s needs were assessed before they moved to the service. Care plans documented any support needs people had. These had been kept up to date. People received the medical support they required. We did not have any concerns about how people were cared for at end of life but have made a recommendation for best practice to be followed.

The building was clean and tidy; there were no unpleasant odours. Staff wore disposable protective items when they carried out personal care to prevent the spread of infection. We have made a recommendation for the service to follow best practice with workflow in the laundry to reduce the risk of contamination.

Staff received appropriate support to help them develop as professional workers. This included an induction, training and supervision. Staff meetings were held to discuss practice and share ideas.

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. The service had started to look at ways of making information accessible to people who had communication needs. We have made a recommendation for more work to be done in this area to comply with the Accessible Information Standard.

Activities were provided for people to provide stimulation. The service took part in events held between some of the provider’s other h

This inspection took place on 31 October, 01 November and 09 November 2016. The first day of the inspection was unannounced.

We previously inspected the service on 19 and 22 October 2015. The service was not meeting the requirements of the regulations at that time. We identified areas of concern in relation to records, medicines practice, infection control practice, supporting staff and meeting people’s nutritional needs. We asked the provider to take action to make improvements. They sent us an action plan which told us the changes they would make at the service.

Chesham Leys provides nursing care for up to 62 people. Forty nine people were living at the service at the time of our inspection. The service provides nursing care to older people and people with dementia.

The service did not have a 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 new manager had started at the home shortly before this inspection. They would be submitting an application to become registered.

We received largely positive feedback about the service. Comments from people included “If I had won the lottery and won a million pounds I couldn’t have found better care,” “It’s absolutely wonderful here” and “I have no fear about my mum's personal safety, she is safe here.” Other comments included “The staff seem quite caring” and "The staff are kind and compassionate. They can take a joke and have a good sense of humour. I can't fault their attitude.” Some people commented about continued use of agency staff. For example, a relative said "I have noticed that there has been a drive in recruitment, but a lot of agency and new staff are not equipped to deal with the people here. There is quantity but not quality." Another relative told us "The care is up and down and a bit of a lottery, it depends on who is on and the type of agency staff that are on duty. The permanent agency staff are very good and dependable, the day to day care agency staff appear to be lost."

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. Written risk assessments had been prepared to reduce the likelihood of injury or harm to people during the provision of their care. We found improvement to how people’s medicines were handled. However, we have made a recommendation for staff to sign record sheets to show when they have used creams and other topical preparations.

We found there were sufficient staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. However, we found staff did not always receive appropriate support and training to ensure they kept up to date with their skills and professional development.

Care plans had been written, to document people’s needs and their preferences for how they wished to be supported. These had been kept up to date to reflect changes in people’s needs. People said there had been improvement to the activities provided for them. Staff supported people to attend healthcare appointments to keep healthy and well. Improvement had been made to meeting people’s nutritional needs and assessing the risk of malnutrition. We have made a recommendation about the effective use of fluid monitoring charts.

Improvement had been made to infection control practice. The building was clean and hygienic. The premises complied with gas and electrical safety standards. However, we found fire safety checks had not been carried out in line with the provider’s guidance over the past year. These were being addressed.

The provider regularly checked the qu

This inspection took place on 19 and 22 October 2015. These were unannounced visits to the service and the first inspection since the service was registered in August 2014.

Chesham Leys provides nursing care for up to 62 people. Accommodation is on three floors, with the ground floor providing support to people with dementia.

The service had a registered manager who had been in post for nine weeks at the time of our visit. 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.

Chesham Leys was in a period of transition at the time of our inspection. It had been opened and operated under different management, with concerns about people’s care starting to emerge from early summer 2015. New management arrangements had subsequently been put in place and the provider was working alongside other agencies, such as the local authority and clinical commissioning group, to improve people’s care. Although we could see improvements were being made, there were still a number of areas identified within this report where further work was needed.

There were several staff vacancies at the time of out inspection. Agency nurses and care workers were being used to maintain safe levels of staff. The registered manager was actively recruiting permanent staff and interviews took place before, during and after we had inspected the service.

We received mixed feedback about the attitude of staff who supported people at Chesham Leys. One relative told us their impression was that agency workers “Did not care” about the people they supported. Another relative commented about staff “They’re fantastic” and added they were pleased with the care their family member received. Comments from people who lived at the home included “The carers are nice”, “They look after us, they’re very nice”, “Staff used to be good but not now. The agency staff don’t know my needs” and “Staff are splendid, no problems.”

The environment was bright, spacious and designed to meet the needs of people with disabilities. Appropriate equipment had been provided to help people remain independent. Each bedroom was single occupancy with an en-suite shower and toilet.

We identified areas of concern in relation to records, medicines practice, infection control practice, supporting staff and meeting people’s nutritional needs. These constituted breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.