We carried out an unannounced comprehensive inspection of Chilton Court on 9 May 2018. This was in response to our previous comprehensive inspection on 16 March 2017, where we rated this service as overall ‘requires improvement’.

During our inspection on 16 March 2017 we found there were two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were needed regarding safe care and treatment and meeting nutritional and hydration needs. The provider submitted an action plan to us about the measures they were taking to address the concerns found at the previous inspection.

At this inspection on 9 May 2018 we found no breaches in regulations, as the necessary improvements had been made and sustained. We were encouraged by the progress made by the management team to address the previous concerns and have rated this service overall ‘good’.

Chilton Court is a residential care home that does not provide nursing. 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. Chilton Court accommodates up to 47 people who require support with their personal care needs, some of whom are living with dementia. There were various forms of accommodation provided such as houses, flats and bedrooms. At the time of this inspection there were 28 people using the service.

A registered manager was 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.

Systems and procedures had been implemented to monitor and improve the quality and safety of the service provided. The registered manager worked closely with the provider’s nominated individual and this had led to the overall quality and safety of the service improving. A nominated individual has the responsibility for supervising the management of the regulated activity, represents the provider and is a point of contact with CQC.

People and their relatives were positive about the approach of the registered manager; saying they were accessible to them and that communication in the service had improved.

People and relatives were complimentary about the care and support provided. Staff consistently respected people’s privacy and dignity and interacted with them in a kind and compassionate manner. They were knowledgeable about people’s choices, views and preferences and acted on what they said.

Staff understood what constituted abuse and what procedure they would follow to report any concerns. Staff also received training in safeguarding.

There were sufficient numbers of staff effectively deployed to meet people’s needs who had been recruited safely. Staff were trained and supported to meet people’s needs. They knew how to minimise risks and provide people with safe care.

Systems were in place to receive, record, store and administer medicines safely. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

Improvements had been made to ensure people’s care records reflected personalised care which were regularly reviewed and amended to meet changing needs.

People received care that was responsive to their needs. They participated in meaningful activities and were supported to pursue their interests. The service listened to people’s experiences, concerns and complaints and took action where needed.

People and/or their representatives, where appropriate, were involved in making decisions about their care and support arrangements. Appropriate referrals were made and acted on where concerns had been identified and people wer

Chilton Court provides accommodation and personal care for up to 47 people, some living with dementia. There were various forms of accommodation provided such as houses, flats and bedrooms.

There were 35 people living in the service when we inspected on 16 March 2017. This was an unannounced inspection.

There was a registered manager 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.

Improvements were needed in the management of medicines, particularly in medicines prescribed for external application and medicines to be administered ‘as required.’ The service’s own auditing system had identified the shortfalls in the records for the application of creams but this was not yet fully addressed.

Improvements were needed in the security of the service. This was in the process of being addressed by the service but not yet actioned.

The quality of information in people’s care records to guide staff in how people’s needs were met varied. Further consideration of how to provide additional and consistent guidance to staff would ensure that people were provided with safe and good quality care at all times.

There were systems in place for staff to receive training, achieve qualifications in their role and to be supported in their work practice. However, improvements were needed in the training of specific needs and subjects relevant to the people using the service.

People’s nutritional needs were assessed. However, improvements were needed in how staff recorded the amounts that each person had to drink and eat each day, where required and how this is monitored to ensure people receive enough to eat and drink. Improvements were needed in the provision of training and knowledge to staff regarding people’s specific dietary needs.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. However, improvements were needed in how people’s capacity and support to make decisions is included in care records to provide guidance for staff. Improvements were needed to provide training to staff in the Mental Capacity Act 2015.

There were systems in place to monitor the service provided. However, this had failed to identify and address all of the issues we had picked up during our inspection.

There was a system in place to manage complaints and these were used to improve the service.

Systems were in place to provide staff to meet the needs of people using the service. Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.

People were provided with the opportunity to participate in activities. People were treated with respect and compassion by the staff working in the service.

Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse.

People were supported to see, when needed, health and social care professionals when required.

This was an unannounced inspection carried out on 15 December 2014.

The service is registered to provide care and support, not nursing for up to 47 older people.

The service has 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.

The people we spoke with who used the service informed us that they felt safe. This was also confirmed by their relatives and friends. Appropriate notifications were made by the service where any potential safeguarding matters had been raised. The staff had received training in the safeguarding of vulnerable adults. From our discussions with them they were clear about their roles and responsibilities and how to report a safeguarding matter.

There were risk assessments in people’s care plans in order to recognise and minimise risk, while supporting people to lead the lifestyle of their choice.

There were sufficient staff on duty to care for people who used the service. Relatives and friends of people who used the service and the staff told us, they found the management and provider approachable and could speak to them if they ever needed to do so or had concerns.

We found that the service had a robust recruitment procedure in place. All the appropriate documentation was checked prior to an appointment being made. This helped to ensure that only people suitable to work with vulnerable adults were employed.

The medication was stored safely, there was a policy and procedure in operation and the service had systems in place to identify medication errors and took appropriate as required to rectify.

People who used the service told us that they knew the staff well. They told us they could express their views to the registered manager or deputy. They also knew the provider and were content with the frequency and actions taken as a result of residents meetings.

The registered manager had received training and they understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which meant they were working with the law to support people who may lack capacity to make their own decisions. The service had a plan in place for all staff to receive training in this subject in 2015.

People had access to healthcare professionals including their own GP, dentists and opticians.

The people we spoke with complimented the choice and quality of the meals provided. People told us they were treated with dignity and respect, which we observed throughout our visit.

People told us they could raise complaints and believed they would be listened to and any matters raised resolved. The also considered the service was well run by experienced managers and staff. They also thought the provider of the service was approachable and kind.

The staff told us that they were supported through training, supervision and an appraisal system. The registered manager informed us that the service was actively recruiting for staff to cover vacancies. They were appreciative of the existing staff to cover the vacancies so that there enough staff on duty to provide care to people who used the service.

There were quality monitoring systems in place to seek the views of people who lived at the service. This information was shared with people who lived at the service and the information was acted upon. Audits were carried out in order that the registered manager and provider could evaluate the service and make improvements.

We spoke with eight people who used the service about their experiences of the service they were provided with. People told us that they were happy living in the service. One person said, “Staff are nice, food is always good, I am well looked after.” Another person said, “The staff treat us well.” Another said, “We are well fed and watered.” One person, who we visited in their bedroom said, "I like this room, I am very happy."

We spoke with two people's relatives who told us that they were happy with the service their relatives were provided with.

We saw that the staff were attentive to people's needs and responded to requests for assistance promptly. They interacted with people in a caring, respectful and friendly manner.

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights. We saw that before people received any care and treatment they were asked for their consent.

Staff personnel records that were seen showed that the provider checked that staff were able to work with vulnerable people before they started work. Staff were trained to meet the needs of the people who used the service.

We looked around the service and saw records which showed that people were cared for in a clean and hygienic environment.

We saw that there was an effective complaints system in place and people's comments and complaints were listened to and acted on.

We met and spoke with nine people who use the service. People we spoke with understood the care choices available to them. They told us that staff always knocked on the door before entering their rooms. All people were complimentary about the staff who worked at this service.

A relative confirmed that their relative received safe and appropriate care that met their needs. Another relative spoke very highly of the activities provided at the service and the outings planned for the coming weeks.

We spoke with people and they told us that if they had any concerns they would go straight to the provider and they felt confident that matters would be resolved. People also felt that the residents meetings were useful as minutes were taken and matters were resolved with action taken on any concerns raised. We were told “We are comprehensively cared for. It is like an umbrella of protection that has allowed us to share many of our responsibilities and worries.”

The 2010 residents’ survey was completed and provides assurance that the provider seeks and takes into account the views of people at the home. The survey also assessed the aspects that were most important to people in order of importance and identified areas of improvement and areas for further development as compared to the outcome of the 2009 survey.

Aspects of people’s experience that were rated highly include the treatment of visitors; the management of the home; safety and security; leisure activities; level of care provided; respect of privacy; tidiness of the home; quantity of food; access to other support (for example doctor, chiropodist).

Aspects that were rated less highly and may identify non-compliance with essential standards were the residents’ guide; the staff’s understanding of people’s needs; the cleanliness of the home; the efficiency of the laundry service; encouragement of independence and freedom; variety of food; overall satisfaction; quality of the food and staffing levels.