About the service: Chesterwood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Chesterwood accommodates five people with an acquired brain injury in one adapted building. There were deliberately no identifying signs to indicate it was a care home. At the time of the inspection, there were five people using the service.

People’s experience of using this service: People told us they were happy living at the home and felt safe. Accidents and incidents were recorded and analysed, and risk assessments were in place. The registered manager understood their responsibilities about safeguarding and staff had been appropriately trained. Arrangements were in place for the safe administration of medicines.

There were enough staff on duty to meet the needs of people. The provider had an effective recruitment and selection procedure in place, and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

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 needs were assessed before they started using the service. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

The provider had a complaints procedure in place and people were aware of how to make a complaint.

An effective quality assurance process was in place. People and staff were regularly consulted about the quality of the service.

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

Rating at last inspection: At the last inspection the service was rated Good (April 2016).

Why we inspected: This was a planned inspection. It was scheduled based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 17 and 22 February 2016 and was unannounced. We last inspected the service in September 2014 and found it was complaint with all the regulations we looked at.

The service is registered to provide care for up to six people with an acquired brain injury. There is 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. The registered manager was away on the first day of our visit and so we returned on a second day to speak with them.

People told us that they felt the service kept them safe. Staff were aware of how to protect people from risk of harm and how to raise concerns when necessary. People had assessments which identified actions staff needed to take to protect people from risks associated with their specific conditions. People were supported to accept their medicines which were appropriately stored and managed. This helped to keep people well.

There were enough staff to keep people safe and to meet their needs. There were recruitment and induction processes in place to ensure new members of staff were suitable to support the people who were living in the home. People were happy with how staff supported them.

Staff told us and records confirmed that they received regular training and supervisions with senior staff to maintain their skills and knowledge. Staff demonstrated skills and knowledge to ensure people were supported effectively and safely.

The registered manager and staff we spoke with were knowledgeable of the requirements of the Mental Capacity Act 2005. Staff sought consent from people before providing support and people were in control of the support they received. People’s rights were protected as they had control over their lives unless action had been taken to legally restrict their liberty. Staff members were not always able to tell us who was legally restricted and they provided mixed reasons for having restrictions in place within the home.

People told us that staff supported them to eat and drink enough to stay well. Staff knew what people liked to eat. People had access to other health care professionals when necessary to maintain their health.

We found that the service was supporting people well, and during our visit we observed people and staff enjoying each other’s company. There was a happy and relaxed atmosphere. We found people were being supported to access activities that they enjoyed and were of interest to them. People had developed positive relationships with the staff who supported them and the service promoted people’s privacy and dignity.

We found that each person’s care had been tailored to their needs and wishes and people felt listened to. The care plans were all individual and reflected the preferences and needs of each person. Processes were in place which supported people to be involved in developing their care plans and expressing how they wanted their care to be delivered.

People did not have any complaints about the support they received. The registered manager and staff provided calm, professional and person centred care for the people who lived in the service. There were systems in place for the registered manager and the provider to check the quality of the service day to day and monitor for any trends in how it was operating over a longer period.

We last inspected this service on 18 September 2013. At that time we found that the registered person had not managed medicines safely and that records relating to peoples care were not adequate. During that inspection we also found that there were not always adequate facilities for people to wash or bathe. We also found that the provider did not have an effective system to regularly assess and monitor the quality of the service. At this inspection we found that these issues had been adequately addressed.

Chesterwood is home to five people with acquired brain injury. There were four people at home on the day of our inspection. We observed people during the day. People had limited verbal communication but could verbally express their choices and preferences. We talked with the manager and looked in detail at the care records of two people. We visited on a weekday and we spoke with two people, three members of staff and one senior manager. Below is a summary of what we found.

The summary describes the records we looked at and what relatives and staff told us.

Is the service safe?

The staff and manager had a good understanding of safeguarding and whistle blowing policies. Staff understood their role in safeguarding the people they supported. We saw people were cared for in an environment that was safe and clean. There were enough staff on duty to meet the needs of people who lived at the home. There were procedures in place to safeguard people from abuse.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that proper policies and procedures were in place. The manager had an understanding of these safeguards which ensured people’s rights and choices were protected.

Risk assessments and health and safety measures were in place to keep people safe. A member of staff told us, “Everything is brilliant here. I love this home.”

Is the service effective?

Care plans specified people’s individual needs, for example, a person’s mobility, or food requirements. One member of staff told us, “The manager is quite supportive. They really helped me, and you can talk to him.” The service worked well with other agencies and services to make sure people received their care safely and effectively.

We saw that people were treated with dignity and care. We saw that people were involved in the running of the home and took an active part in shopping and cooking and cleaning where possible.

Is the service caring?

We saw the staff and manager were patient and gave encouragement when they supported people. All staff were aware of peoples choices, preferences and support needs. We found the care and support was delivered with respect. One person told us, “This is an OK place. It’s quite a nice place. The food is well organised.” A member of staff told us, “I think people are well looked after here, people aren’t withdrawn and they choose what’s in their room and their meals.”

Is the service responsive?

We saw clear and detailed recording that ensured the manager could make timely and informed decisions about a person’s care and support. Records showed that other professionals had been involved in peoples care and support when needed. We saw that information from health professionals was acted upon and integrated into care plans. The home operated a key worker system. The manager told us the aim of the keyworker role was to ensure detailed information was collected for each person and made available to all staff. One member of staff told us, “The managers are helpful and we have a good back up system with the other homes. We get the information we need.”

Is the service well-led?

The manager was aware of their responsibilities in meeting the essential standards of quality and safety. There were systems in place to ensure the quality of the service was regularly assessed and monitored. There was a clear structure of supervision responsibilities within the staff team. Staff had regular training and learning opportunities.

Staff we spoke with told us they thought the manager was approachable and provided good support. We saw that the manager was responding to recent changes in relation to the law and the possibility of depriving a person of their liberty.

People we spoke with about the service offered at Chesterwood were generally very positive. One person living at the home said, "It's nice here." A relative we spoke with said, "My relative is looked after really well, he goes out and about a lot. Staff talk to me and that puts my mind at rest."

We found that each person had a written care plan and they were being supported to access the health services they needed. People told us with pleasure about some of the activities they had requested and been supported with.

We found that the home had systems in place that would reduce the chance of people experiencing abuse. These included new staff being checked before starting work in the home, staff having training, and people's money being stored securely.

Staff working at Chesterwood administered and managed people's medicines. We did not find that all aspects of medicine storage, the recording of medicines given, or the audits of medicines were adequate. We could not confirm all medicines had been given as prescribed.

Chesterwood was an attractive building in a residential street. Most areas of the home were well maintained and clean. However we did not find that bathrooms or sinks in people's bedrooms always had adequate hot water for people to wash and bathe.

There were a number of systems in place to check on safety and quality in the home. However not all of these had been effective in identifying issues or ensuring the changes needed took place.

We met and spoke with three of the four people currently living at Chesterwood. People told us that they liked the home, and the staff who support them. We saw people and staff interacting in a way that was friendly and relaxed throughout the time we were at the home. We spoke with a relative who said, "I am absolutely delighted with the home, everyone always seems very comfortable and happy."

The three people we met had all been supported with their personal care on the day of our visit. We saw people being discreetly prompted to maintain their appearance during the day. Records showed that each person had a plan of care and were supported to attend appointments with the relevant health professionals to stay healthy.

There were systems in place to ensure that staff could recognise and report any possible abuse. Staff we spoke with showed good understanding about what abuse was, and what action they would take if they witnessed it.

We found that enough staff, who had been trained and were experienced in supporting people with a brain injury were available each shift. People we spoke with told us they liked the staff and enjoyed their company.

There were systems in place to check on the quality and safety of the service and people living at Chesterwood and the staff team had opportunities to make suggestions about the running of the home.