About the service:

The service provides accommodation and personal care for up to 16 older adults and people living with dementia. There were 16 people living in the service on the day of our inspection.

People’s experience of using this service:

• The registered providers approach to safety and governance had deteriorated since the last inspection.

• Systems and processes for accepting new referrals for people receiving intermediary care were not in place which placed people at risk of avoidable harm.

• Risks to people’s health were not being managed.

• Medicines were not being administered safely.

• Governance systems did not identify risks to people.

• People received nutritious and healthy food.

• People were cared for by staff who were kind and compassionate.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement. Report published 26 September 2017.

Why we inspected:

This was a scheduled inspection based on the rating at the last inspection.

Enforcement:

Following the inspection, we took urgent enforcement action to restrict new referrals to the home via the intermediary transitional care service. In addition, we requested an action plan and evidence of improvement in the service. This was requested to help us decide what regulatory action we should take to ensure the safety of the service improves. You can see what action we told the provider to take at the back of the full version of the report.

Follow up:

We will continue to monitor the service and have asked the registered provider to send us a report every month to tell us about the ongoing improvements to safety and governance in the service. The registered provider has complied with this and has been submitting regular reports to the CQC.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider and registered manager following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

We carried out this unannounced inspection on 11 August 2017.

Chevington House can provide accommodation and personal care for 16 older people. There were 14 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. The directors of the company were not available to speak with us during our inspection visit. There was a registered manager in post but she was not present in the service during our inspection 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. In this report when we speak both about the company and the registered manager we refer to them as being, ‘the registered persons’. During most of our inspection visit we were assisted by a member of care staff. The registered persons had arranged for this member of staff to act on their behalf. In our report we refer to this person as being, ‘the representative of the registered persons’.

At our inspection on 13 January 2015 we found that the service was safe, effective, caring and well led. Although we found that people needed to be provided with the opportunity to enjoy more social activities our overall rating of the service was Good.

At the present inspection we found that further improvements still needed to be made to the way in which people were supported to pursue their hobbies and interests. In addition, we found two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. This was because the registered persons had not suitably promoted people’s health and safety by consistently helping them to avoid preventable accidents. In addition, they had not completed robust quality checks to ensure that people consistently received care that met their needs and expectations. You can see what actions we have told the registered persons to take at the end of the full version of this report.

Our other findings at this inspection were as follows. Although there were reliable arrangements to order, dispense and dispose of medicines an improvement was needed to how they were stored. The registered persons had not reliably ensured that there were enough care staff on duty in accordance with their own minimum level. In addition, some of the necessary background checks on new care staff had not been completed in the right way. However, care staff knew how to respond to any concerns that might arise so that people were kept safe from abuse.

Care staff had received training and guidance and they knew how to care for people in the right way. People enjoyed their meals and they were helped to eat and drink enough. Care staff had ensured that people received all of the healthcare they needed.

People were helped to make decisions for themselves. When people lacked mental capacity the registered persons had ensured that decisions were taken in people’s best interests. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had ensured that people only received lawful care.

Care staff were kind and people were treated with compassion and respect. People’s right to privacy was promoted and there were arrangements to help them to access independent lay advocacy services if necessary. Confidential information was kept private.

Suitable steps had not been taken to fully achieve positive outcomes for people who lived with dementia. However, people h

Chevington House provides accommodation for up to 16 people who require nursing or personal care. The service mainly provides support for older people and people who are living with dementia.

There was 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 Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. At the time of our inspection no people had had their freedom restricted.

People who lived in the home were happy with the care they received. They felt safe living in the home and said that staff treated them with kindness and respected their privacy and dignity. People told us there were enough staff to meet their needs.

There were robust arrangements for ordering, storing, administering and disposing of medicines were in place. We found that people were provided with a choice of nutritious meals. When necessary, people were given extra help to make sure that they had enough to eat and drink.

Staff understood people’s needs, wishes and preferences and they had been trained to provide effective and safe care which met people’s individual needs. People had access to a range of healthcare professionals when they required specialist help.

The service did not enable people to carry out person-centred activities on a regular planned basis and did not encourage people to maintain their hobbies and interests.

People and their relatives were able to raise any issues or concerns and action was taken to address them. People had been consulted about the development of the service.

The provider had completed quality checks to make sure that people reliably received the care they needed in a safe setting. There was an open culture that encouraged staff to speak out if they had any concerns.

We spoke with four people who lived at the care home and four of their relatives. We also spoke with a visiting health care professional, the registered manager and two support workers.

People told us they liked living at Chevington house and felt safe there. One person said the care home was "Peaceful" and stated “Thank God I’m here.” One relative told us the staff were “Absolutely marvellous.” Another stated that for their relative Chevington was “Like a big family, it’s their home.”

We saw people were well cared for. People’s view’s, wishes and consent regarding care and support were sought by staff, represented in care plans and evident in the interaction we observed.

We found people were offered and enjoyed a wide range of social and recreational activities. People told us they enjoyed the food provided and relatives commented on positive improvements in people’s health and wellbeing as a result of the care provided.

We saw medication was effectively managed and administered and people’s privacy and personal safety was ensured by staff who understood the importance of confidentiality and adult safeguarding procedures. We found care records were well written and care plans regularly reviewed in conjunction with people who received a service, their families and health and social care professionals.

Since our last visit in August 2012, we found the provider has taken steps to improve cleanliness and infection control procedures in the home.

We spoke with two people who were living at the home and both said they were satisfied with the level of cleanliness. One person told us, "I think the home is very clean. The lady always comes and cleans in my room, she pulls the furniture out to clean. I have no concerns." Another person told us, "We are always asked if we would like our clothes washed, you could change your clothes every day if you wanted to."

We also spoke with a relative who told us, "I think the home is kept nice and clean although the small tables could be wiped down a little more often."

We walked around the home and saw some areas had been re-decorated, for example the bathrooms and ground floor hallway. These areas of the home, particularly the bathrooms looked clean. Risks identified at the previous inspection which were related to the spread of infection had been removed. We saw the bathroom suites and toilets all looked clean.

The provider had employed a new housekeeper and we saw records were being kept of work they had completed. A checklist had been used to ensure that all areas of the home were kept clean and a rota for spring cleaning was in place.

We found that Chevington House provided a homely environment where people were well looked after by the care team. People were involved in making decisions about their care and day to day choices such as what they would like to eat and drink and when they would like their care to be carried out.

During our visit we spoke with some of the people who lived there. We asked people if they were happy with the service provided. One person told us, “I’ve no complaints. The care staff are very nice, they are very good.”

Another person told us, “The staff help me get dressed. They are pretty good. The food is very good and the staff treat me with respect.”

We asked people about the care they had received, one person told us, “I like it here, they look after me well.”

We spoke with a relative who was visiting the home, they told us, “We are happy with the care mum receives, we have no concerns. The staff tell us if mum has any problems, we were involved with the care plan at the start.”

People told us they liked living at the home one person said “I don’t think you would do much better, its not too bad at all.” While another person told us “I couldn’t wish for anything better, I mean that they cater for everything I want.”

One person we spoke with who chose to spend the majority of time in their bed told us that staff “Make sure I’m associated with things and I’m not cut off.” They went on to say “There is good communication, everything fits in with how I like it to be.”

When we asked people they told us they feel safe in the home. One person said “I feel safe here because they have the front door locked, so no one can get in.”

People told us they knew how to raise a complaint if there was something they were not happy with. One person we asked said “I would talk to the manager if I wasn’t happy.”