This was an unannounced inspection which took place on 6 and 13 November 2018. This meant the staff and provider did not know we would be visiting.

We inspected the service to follow up on the breaches and to carry out a comprehensive inspection.

At the last inspection in November 2017 the service was not meeting all of the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regard to regulation 11, need for consent and regulation 17, good governance

At this inspection we found some improvements had been made and the service was no longer in breach of regulation11, but there were continued breaches of regulation 17 as further improvements were required with regard to aspects of people’s care. At this inspection we found three other breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to regulations 18, staffing,9, person-centred care and 10, dignity and respect.

You can see what action we told the provider to take at the back of the full version of the report.

Chichester Court is a care home that provides accommodation and nursing or personal care for a maximum of 50 older people including people who may live with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Chichester Court accommodated 40 people at the time of the inspection.

A registered manager was not in post and an interim manager was managing the service. 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.

People said they felt safe and they could speak to staff as they were approachable. However, we had concerns staffing levels were not sufficient or staff appropriately deployed to ensure people received safe and person-centred care. People said staff were kind and caring. However, we saw staff did not always interact, talk or attend to people in a timely way. Limited activities and entertainment were available to keep people engaged. In some parts of the home there was an emphasis from staff on task-centred care.

Improvements had been made to the environment but further improvements were needed to promote the engagement of people who lived with dementia. We have made a recommendation about the service following best practice for equipping the environment for people who live with dementia. Not all areas of the home were clean for the comfort of people who used the service.

Records did not reflect the care provided by staff. Detailed guidance was not available for staff to minimise or appropriately manage risks to all people. Written information was not available to ensure all people were supported in a person-centred way.

Appropriate training was provided and staff were supervised and supported. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. 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 had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received a varied and balanced diet to meet their nutritional needs.

Communication was effective to ensure staff and relatives were kept up-to-date about any changes in people’s care and support needs and the running o

This was an unannounced inspection which took place on 16 October 2017.

At the last inspection in September 2016 the service was not meeting all of the legal requirements with regard to person centred care. At this inspection we found improvements had been made and the service was no longer in breach of these requirements. However, we considered improvements were required with regard to other aspects of care.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to mental capacity and best interest decision making, record keeping and quality assurance. You can see what action we told the provider to take at the back of the full version of this report.

Chichester Court is registered to provide accommodation for personal or nursing care to a maximum of 52 older people including people who live with dementia or a dementia related condition. The home was separated into two units, the Riverside unit and the Haven unit. Nursing care is provided.

A registered manager was in place. 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.

People said they felt safe and they could speak to staff as they were approachable. We considered that staffing levels needed to be reviewed. We have made a recommendation that staffing levels are kept under review and that staff are appropriately deployed to meet people’s needs in a safe, timely and person centred way.

Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way. However, we have made a recommendation about the management of medicines.

Not all areas of the home were clean and well maintained for the comfort of people who used the service. The home was not designed to promote the orientation and independence of people who lived with dementia. We have made a recommendation that the environment should be designed according to best practice guidelines for people who live with dementia.

Improvements were needed to improve staff understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. 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.

Risk assessments were in place and they accurately identified current risks to people as well as ways for staff to minimise or appropriately manage those risks. Care was provided with kindness and people’s dignity was respected. People's privacy was not always protected.

People had access to health care professionals to make sure they received appropriate care and treatment. People received a varied and balanced diet to meet their nutritional needs. However, we considered improvements were required to people’s dining experience.

The home had a quality assurance programme to check the quality of care provided. However, the systems used to assess the quality of the service had not identified the issues that we found during the inspection with regard to staffing levels, medicines management, people’s dining experience, environmental design, best interest decision making and respecting people’s privacy and record keeping.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support. Appropriate training was provided and staff were supervised and support

This inspection took place on 19 and 21 September 2016. Day one of the inspection was unannounced. The second day of the inspection was announced.

We last inspected Chichester Court on 26, 29 February and 11 March 2016 and found a number of regulatory breaches. Specifically the provider had breached Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care and treatment was not always provided in a safe way. The assessment, planning and delivery of care and treatment did not include arrangements to respond appropriately and in good time to people's needs. There was a failure to do all that was reasonably practicable to mitigate risks as care plans for new admissions had not been completed in a timely manner. Systems and processes had not been fully established and operated to ensure compliance. There was a failure to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users. Measures to reduce or remove risks within a timescale that reflected the level of risk and impact on people using the service were not effective.

Records relating to the care and treatment of people had not been completed with undue delay.

We observed insufficient numbers of staff to meet people’s care and treatment needs at key times of the day. Appropriate action had not been taken to ensure training was in line with the provider's requirements. Staff had not received regular supervision or appraisal to ensure competence was maintained.

Following the inspection the provider submitted an action plan detailing how they would meet the legal requirements. They said they would be compliant by 15 June 2016.

We undertook this inspection to check they now met legal requirements. During this inspection we found that the registered provider had implemented actions and improvements had been made.

Chichester Court provides residential and nursing care for up to 52 people, some of whom are living with dementia. There are two units, one called Riverside which provides care and treatment for people living with dementia and Haven which provides nursing and residential care. At the time of the inspection there were a total of 39 people living at the home.

All of the bedrooms and communal areas are situated at ground level, with two dining rooms and a number of lounge and reception areas that can be utilised by people, visitors and staff at the home.

A registered manager was in post and had been registered with the Commission since July 2014.

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.

Care records and risk assessments for people newly moved into the home had been completed in a timely manner. Audits had been completed within 48 hours of their move to ensure risks had been assessed and mitigated in a timely manner. Pre-admission assessments were detailed, although sections in relation to end of life care, social information and personal preferences and specific equipment required was not always completed.

We observed people’s needs were being met in a timely manner at key times during the day, such as at mealtimes. Relatives and staff confirmed they felt there were enough staff to meet people’s needs.

Improvements had been made to the frequency of supervision meetings for staff and staff said they felt well supported. Staff training had improved although we noted not all staff had attended training in fire safety, moving and handling, safeguarding, mental capacity and equality and diversity.

Improvements still needed to be made to ensure all staff received an annual appraisal.

Some care plans lacked information about people’s preferences about how they wanted to be cared for

This inspection took place on 26 and 29 February 2016 and was unannounced. A further day of inspection took place on 11 March 2016 following the receipt of concerns in relation to care planning documentation for people newly admitted to the home.

We last inspected Chichester Court on 19 and 20 November 2014 and found a breach of legal requirements in relation to meeting people’s nutrition needs

The registered provider had not ensured people were protected from the risks of inadequate, nutrition and dehydration. People were not always supported appropriately with food and drink in a dignified way. During this inspection we found some improvements had been made to manage nutrition and hydration.

Chichester Court provides residential and nursing care for up to 52 people, some of whom are living with dementia. There are two units, one called Riverside which provides care and treatment for people living with dementia where 17 people were living and Haven which provides nursing and residential care where 27 people were living. At the time of the inspection there were a total of 44 people living at the home.

All of the bedrooms and communal areas are situated at ground level, with two dining rooms and a number of lounge and reception areas that can be utilised by people, visitors and staff at the home.

A registered manager was in post and had been registered with the Commission since July 2014.

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 staff dependency tool was used however visitors and staff told us there were not enough staff to meet people’s needs, especially at meal times. Our observations supported this. Several visitors and people living at the service had raised concerns in resident and relatives meetings about the staffing levels and were told the staffing level met the level indicated by the dependency tool.

Risk assessments were in place however care plans were not always completed in a timely manner for people moving into the service. This meant care staff did not have the information they needed to manage the risks and support people appropriately. The registered provider’s governance procedures for ensuring care records were completed in a timely manner for new admissions to the home were not effective.

An electrical installation condition report completed on 20 September 2012 had assessed the installation as unsatisfactory. There was no evidence that this work had been completed in 2012, however in response to our findings the registered manager arranged for the works to be completed and certificates of works were produced.

There were gaps in staff training and staff had not received regular supervisions, i.e. one to one meetings with their manager to discuss their development and competency. Annual appraisals were being completed however 10 were outstanding.

Deprivation of Liberty Safeguards (DoLS) had been applied for, although the manager said there were some outstanding that would be completed as a priority.

Staff meetings and meetings with residents and relatives had been held during 2015 but they were not routine or frequent. We saw that improvements were being made to ensure regular meetings were held.

Staff were knowledgeable about how to report concerns and safeguardings were logged and recorded.

Systems were in place to ensure people who had been assessed as at risk of poor nutrition and hydration were supported to maintain their nutritional needs. This included referrals to speech and language therapy and dietitian services.

Staff treated people with kindness and respect. They spent time with people whenever possible.

Complaints were recorded and logged. The Provider used an iPad feedback point calle

During our previous visit we identified that there were not always enough staff on duty to meet people’s needs.

During this visit we found that there were sufficient numbers of suitably qualified, skilled and experienced staff employed for the purposes of carrying on the regulated activity.

People we spoke with were complimentary about the staff and thought there were always enough staff on duty.

We found that the provider had some arrangements in place to obtain consent from people prior to them being given care and treatment.

We found that people who were using the service were receiving the care and support they needed. During the inspection, the staff on duty were observed speaking to people in a kind and respectful way. We also observed that the people were clean and well groomed. The staff we spoke with could describe how they met the assessed needs of the people they were providing with care. People we spoke with told us that they liked the staff. One person commented, “The staff are good to me”. A relative commented, “I don’t have any complaints”.

We found that the people who were using the service were protected from the risk of infection because appropriate guidance had been followed for example the bathrooms and toilets were clean and hygienic.

We found that the provider supported the care staff to deliver care and treatment safely and to an appropriate standard, to the people who used the service. However, we found that on some occasions there had not been enough staff to meet people’s needs.

We found that the provider had systems in place to check the quality of the service. Records, which the provider is required to keep, to protect the peoples' safety and wellbeing, were being stored securely and could be located promptly when needed. For example, the care records were kept in a secure office.

We spoke to the people who were using the service. One person commented, “It is fine here” and another person commented, “They look after me”. One person told us, that although her relative could not tell her; whenever she visited her, she always seemed comfortable and happy.

We asked some of the people about their care and treatment. Most people we spoke with made positive comments about their care they were being provided with. One person told us “This is much better than the last place I was at, they are nice to me, they are really good” a relative commented, “I have not had any complaints, the manager seems nice”.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The people we spoke with told us they felt safe with their care workers and the care they were provided with. One person commented about their care workers, “I feel safe at this home and I think the world of … who does the activities, I don’t know what I would do without him”.

We spoke we some of the people at the home who all made positive comments about their care. Comments from people who use the service included “The staff ask us what we want for meals”, “Staff are nice”. and “I enjoy the bingo”. People told us that they felt safe at the home. However due to the complex needs of people who were using the service the information we received verbally from some people was limited.

A relative told us that their family member was well cared for at the home and commented “The staff are wonderful”.

We observed care practice throughout the visit and we found that staff were attentive and spoke to people in a friendly manner.

We did not speak directly with people about their medicines.We saw that two people were asleep when we started this inspection and the care workers checked on them regularly and offered them their medicines when they were ready.

When asked about their care at the home people made comments such as “the staff are lovely” and, “it is nice here”.

Staff told us that all of the people have care plans which provide information about how their assessed needs are to be met at the home. Some staff told us that they read the care plans and that they were regularly updated and reviewed. Others told us that they did not have time to read the care plans.

The activity co-ordinator told us that they would like to do more but their hours had just been cut by half.

People who use the service were asked how they feel about living at the home and all of them made positive comments about the service. These comments include “the staff are lovely” and “they are very caring”. They also said “my room is nice”, and “food is nice”.

The inspection took place on 19 and 20 November 2014. This was an unannounced inspection. At the last scheduled inspection carried out on 23 July 2013 we found the provider was not meeting the regulations in relation to staffing. When we followed this up on the 25 February 2014 we found the provider had made improvements to ensure enough staff were available to meet the needs of the people living at the home.

Chichester Court provides residential and nursing care for up to 52 people, some of whom are living with dementia. At the time of our inspection there were 46 people living at the home, with four people on a waiting list to possibly take occupancy of the empty rooms. The home is located near the centre of South Shields and has good access to local shops and transport routes. All of the bedrooms and communal areas are situated at ground level, with two dining rooms and a number of lounge and reception areas that are utilised by people, visitors and staff at the home.

The home had 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.

We found one person did not receive their medicine at the prescribed specific time. We considered improvements were required to ensure people received medicine in line with their prescription. We also saw some prescribed medicine not stored safely. Although the manager addressed these issues immediately.

People did not always receive a good service at meal times, with some people waiting lengthy periods of time for food to be served and exposed to the risk of not receiving adequate nutrition or choice because of the way meal times were organised. Although the manager had made immediate changes, these needed to be monitored to ensure improvements had been made and sustained.

Safeguarding procedures were understood by staff and they knew their duty to report any issues of concern.

People and their relatives told us they felt safe. One person told us, “The staff keep me safe, I have no worries about that.” A relative told us, “People living here are safe, the staff really care about them. No one would ever come to harm here deliberately.”

There were contingency plans and risk assessments in place to help protect people from harm and information was in place to give guidance to emergency services should the need ever arise. Accidents and incidents were reported appropriately and actions taken to reduce any further risk to people living at the home or others.

People told us they felt there was enough staff to look after them. The manager monitored staffing levels to ensure enough trained staff were available to meet people’s needs. The manager had procedures in place to ensure any staff recruited were suitable to work within the home. There was a training programme in place. Staff development was monitored by the manager to ensure they had up to date knowledge and any training needs were met.

Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make decision. The manager had also made four DoLS applications to the local authority.

The home offered a tidy, clean and odour free atmosphere. There were domestic staff who ensured the home was kept that way by adhering to cleaning rotas and daily tasks. Our first impression of the home was one of a warm, welcoming, homely place. The people and relatives we spoke with agreed with our first impression. The conversations were respectful and not hurried. We heard staff taking their time to explain particular things to people.

A good programme of activities were available for people to choose from should they so wish. The home had an activity coordinator who was passionate about providing a full range of different entertainment. Staff had raised nearly £1000 to support this programme.

People and their relatives knew how to complain if they needed to and told us they were confident the manager or staff would listen and solve any concerns they might have had. People had choice to decide what they wanted to do and when.

The registered manager ensured there were quality audits and checks in place to monitor the service delivered within the home. Staff felt well supported and were positive about the culture of the home and said the registered manager was approachable and supportive. People and their relatives told us there were regular meetings at which they could express their views or make suggestions to improve their care. Records were generally up to date.

You can see what action we told the provider to take at the back of the full version of this report.