This inspection was carried out over three days on 27 and 28 February 2017 and 1 March 2017. Our visit on 27 February 2017 was unannounced.

At the last inspection on 8, 9 10 and 30 August 2016 we rated the service as ‘Inadequate' which meant the service was placed in ‘special measures.’ At that inspection we identified multiple regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to medication administration, safeguarding service users from abuse and improper treatment, fit and proper person’s employed, safe care and treatment, staffing, person-centred care, dignity and respect and good governance.

Following the inspection the provider sent us information detailing how the identified breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

We saw that significant improvements had been made and all the regulatory reaches identified at the last inspection had been met.

Chester House Care Home is located in Hazel Grove, Stockport and can provide care for up to 14 adults with a range of needs.

Accommodation is provided on three floors, accessible by two stair lifts. There are twelve single bedrooms and two bedrooms that have the capacity to be used as shared rooms. However at the time of this inspection the rooms occupied were all single occupancy. At the time of our inspection there were eleven people living in the home.

No en-suite faculties are available.

The home has a lounge/dining room and a conservatory which is currently used as a smoking area as well as an outside garden to the rear of the property.

Since our last inspection the registered manager had left the service which meant there was no registered manager in post at the time of the 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. The home is currently being managed by the two registered providers who are both registered nurses and an assistant manager who is a qualified doctor.

The assistant manager and one of the registered providers were present during all three days of the inspection and were responsive to our feedback and were committed to further improving the service delivered to people living at Chester House Care Home.

We observed staff giving kind and caring support to people. We saw that people’s privacy and dignity were respected and the atmosphere felt relaxed, friendly and homely. From our observations of staff interactions and conversations with people, we saw staff had good relationships with the people they were caring for.

Medicines were managed safely and people were receiving their medicines in line with the prescriber’s instructions.

From looking at the training record and speaking with staff, we found improvements had been made to ensure staff were properly trained and future training had been planned.

Staff spoken with understood the need to obtain verbal consent from people using the service before a task or care was undertaken and staff were seen to obtain consent prior to providing care or support.

We saw that some refurbishment had been undertaken since the last inspection and was ongoing to improve the environment for the people living at Chester House. The home was clean and we saw staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection.

There were no restrictions in place on people’s movement within the home. On the ground floor the communal areas consisted of a newly refurbished lounge and dining area and a conservatory.

Since the last inspection the service had improved the recruitment processes to ensure only suitable staff were employed and staff were now r

This inspection was carried out over four days on the 8, 9, 10 and 30 August 2016. Our visit on 8 and 30 August 2016 was unannounced.

We last inspected Chester House Care Home on 2 December 2013. At that inspection we found the service was meeting the regulations we assessed.

Chester House Care Home is located in Hazel Grove, Stockport and can provide care for up to 14 adults with a range of needs and requirements.

Accommodation is provided on three floors, accessible by two chair lifts. There are twelve single bedrooms and two bedrooms that have the capacity to be used as shared rooms. However at the time of this inspection the rooms occupied were all single occupancy. No en-suite faculties are available.

The home has a lounge/dining room and a conservatory which is used as a smoking area as well as an outside garden to the rear of the property.

At the time of our inspection 8, 9 and 10 August 2016 there were nine people living in the home. When we inspected on 30 August 2016 there were ten people living in the home.

A Registered Manager was in post although they were not available during the first three days of inspection due to being on four weeks annual leave but were available on the 30 August 2016. 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.

During this inspection we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Some medicines were not managed safely. We found there were not always clear, detailed written directions for the use of medicines to enable staff to apply prescribed creams as intended by their GP. This meant there was a risk prescribed creams may not have been applied when required, which could have resulted in unnecessary discomfort to the person.

We had concerns in relation to staff supervision because staff were not receiving supervision on a regular, ongoing basis and there was no evidence that staff had received an annual appraisal. This meant that staff were not being appropriately guided and supported to fulfil their job role effectively.

Recruitment processes required improvements to ensure only suitable staff were employed to work with vulnerable people.

Some of the routine safety checks had not been undertaken for example checks of window restrictors and nurse call bells. This meant the provider could not be sure people using the service were safe at all times.

We saw that some people’s identified care needs did not have a corresponding plan of care to direct care staff on how to meet the individual care need. This meant there was risk that people could receive unsafe and inappropriate care.

There was not a systematic approach to determine the number of staff and range of skills required to meet the needs of the people who used the service. This meant people might be at risk of receiving unsafe and inappropriate care. We saw and staff told us that as part of their paid care hours they were expected to undertake cleaning, laundry and cooking duties. Staff told us they thought due to this they were sometimes too busy to spend time with the people living at Chester House Care Home.

People were not always supported to access regular, meaningful activities within or outside the home. This meant people were not always encouraged to meet their full potential.

Prior to this inspection it came to the attention of CQC that an allegation of abuse had been made of which the CQC had not been notified. During this inspection it was identified that the registered manager had

We inspected Chester House on this occasion because when we visited the home in May 2013 we found that it did not comply with certain of the regulations which are required when providing care to people.

During the current inspection we spent time talking with the people who lived in the home as well as the registered manager. People told us that the owner of the home was a regular visitor and that they felt they could approach them about matters relating to their care.

We looked at the records which the provider kept both in relation to the quality of service provided and for the administration of medicines. We looked at the arrangements in place for the storage and administration of medicines. We found that Chester House Care Home complied with the requirements relating to both these activities.

When we visited Chester House Care Home we talked to people who used the service who told us that the staff provided “good professional support”. Another person said “its supportive here – they’ve helped me a lot”. A third person said “it’s very well organised here” and a relative told us that they were very satisfied with the care provided to a member of their family.

One of the reasons for this inspection was to check that an Action Plan which had been supplied by the home following an inspection in November 2012 had been implemented. We saw that planned actions in relation to care planning, administration of medicines, and supporting workers were in place.

During this inspection we also saw how people were involved in their care and were able to make choices. However on this occasion we did not see adequate arrangements for the storage of medicines or comprehensive audit systems which would monitor the quality of service provision in the home.

We spoke with one person who uses the services. They were happy with the care they received.

They said “I am involved with the care plans and staff discuss these with me.”

There were positive comments about the staff and the service that was being provided.

The person said “The staff are nice, helpful and supportive.”

The person we spoke with was complimentary about the environment and told us there was always enough food on the plate.

"I can pretty much do as I like, they asked what I wanted" and "they asked what sort of things I like", “I go to bed late so I don’t get up early”, “you can do what you want they don’t have any strict rules”, "its spot on", "I have no qualms", "you can't beat it", “I can get out and about”, “they try to arrange some activities but people are not interested”, "the food is really good", "there is not much I don't like", "food is lovely", "it is good home cooking", "staff are kind and help me if I need help", "the staff are all good if we need anything it is there".