This inspection took place on 18 and 19 September 2018. It was an unannounced visit to the service.

We previously inspected the service in August 2017. The service was not meeting the requirements of the regulations at that time. There were breaches of the regulations in relation to how it investigated and recorded complaints about the service, monitoring of people’s care, recruitment procedures and ensuring staff received appropriate support and training. We asked the provider to submit an action plan which outlined the improvements they would make.

Chilterns Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. The home is registered to provide care for up to 22 older people and people with dementia. Eighteen people were living there at the time of our visit.

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 from people about the staff who supported them. Comments included “All the staff are very nice,” “(The carers) are all very good” and “They’re nice people here.” Relatives’ and visitors’ comments included “They know exactly where (my friend) is when I arrive and what she is doing” and “She’s very well looked after here.”

We saw improvements had been made to recruitment of staff and the support they received. This included staff training and supervision meetings, to discuss individual performance. However, we found the home had not enrolled new workers onto the Care Certificate. The Care Certificate is an identified set of standards that health and social care workers need to demonstrate in their work. We have made a recommendation about this.

There were systems for the safe management of medicines. We observed some areas where staff had not consistently followed good practice when they administered or recorded medicines. These were mentioned to the registered manager, in order for them to take appropriate action.

Risks to people’s safety and welfare had been assessed, to prevent the likelihood of injury or harm. Measures were put in place where risks had been identified. Staff had received training in safe ways of working. This included how to move people safely.

Staff had received training to recognise and respond to safeguarding concerns. Staff told us they would report any concerns they had to managers or external organisations.

People were supported by sufficient numbers of staff. Staff were kind and caring towards people and knew their needs well. Care plans had been written, to record people’s needs and their preferences for how they wished to be supported. These were up to date to reflect changes in people’s needs.

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.

Staff followed good infection control practices, to help prevent the spread of infection. The home had been awarded a ‘Good’ rating by the Food Standards Agency, following their inspection this year.

Nutrition and hydration needs were being met. People were supported with their healthcare needs. Records were kept of any visits by healthcare professionals. The home had not established any links with community services who provided palliative care. We have made a recommendation about this, as a good practice.

The building complied with gas and electrical safety standards. Equipment was serviced to make sure it was in safe working order. Ev

This inspection took place 21 and 22 August 2017. It was an unannounced visit to the service. This was the first inspection since the service registered with the Care Quality Commission under ownership of the current provider.

Chilterns Manor is a care home without nursing for up to 22 older people and people with dementia. Eighteen people were living at the home at the time of our visit.

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 “I think they do their best,” “They are all very nice, we’re like family and always get on together” and “Very friendly and conscientious.” One person told us “The home is lovely and so are the staff members. They take time to make it feel like home for the residents and have really good relationships with both residents and family.” Two of three healthcare professionals we spoke with provided positive feedback about the service. The third shared concerns about moving and handling practice.

People were protected against the risk of abuse. There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. None of the people we spoke with or staff had any concerns about how people were treated.

Risks to people’s safety and welfare had been assessed. Written risk assessments had been prepared to reduce the likelihood of injury or harm to people during the provision of their care. People’s medicines were handled safely and given to them in accordance with their prescriptions. We found some people had recurring falls at the service. There were no records of any preventative action. We have made a recommendation for the service to follow good practice in relation to falls prevention practice.

We found staff had not always been recruited using robust procedures. Some staff had started work before all required checks had been returned. We were unable to see any contingency plans to protect people until these checks had been received at the home. Staff support was inconsistent. Records showed some staff had received a structured induction, regular supervision and an annual appraisal of their performance, but not all. The provider had outlined mandatory training for new staff. In some cases we could not see that this had been fully completed.

The building complied with gas and electrical safety standards. Equipment was serviced to make sure it was in safe working order. Evacuation plans had been written for each person, to help support them safely in the event of an emergency. Regular fire safety checks were carried out including practice drills.

Care plans had been written, to document people’s needs and their preferences for how they wished to be supported. We found some care plans had gaps in information about support needs.

People were supported to take part in a wide range of social activities. Staff supported people to attend healthcare appointments to keep healthy and well.

People told us they would speak with various members of staff or their family if they had any concerns about their care. We found issues people had spoken to staff about had not been recorded anywhere. We were unable to see if any action had been taken in response to these matters.

The registered manager had been working on night shifts for several weeks prior to the inspection. We found there was some lack of awareness by management of what was happening during the day. Whilst the issues did not affect people’s care whilst we were present, there was potential for poor practice to develop. For example, staff handover t