This unannounced inspection took place on 3 and 4 January 2017. During our previous inspection in September 2015 we had a number of concerns related to the safety, the effectiveness and the management of the service. These included inadequate care planning, unsafe recruitment processes, a lack of staff support and a lack of managerial oversight of the service. This resulted in us reporting on several breaches to the Health and Social Care Act 2014. During this inspection we found improvements had taken place in all areas. Some areas of work were on going with future improvements planned. For example in care planning documentation.

Chilton House is a privately owned 18th century manor house situated in the village of Chilton. The home is registered to accommodate 45 older people to receive nursing or residential care. Alongside people who lived in the home permanently, the provider also accommodated people who required rehabilitation and convalescence or respite care. The house is surrounded by well-kept gardens with views over the Vale of Aylesbury. The home has 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.

Information in care plans and risk assessments were up to date and easy to access. We discussed with the registered manager how these could be more detailed and involve input from people. The registered manager had worked hard with staff to improve the layout and content of the care plans. They told us this was still work in progress.

People wore pendant alarms to enable them to summon help from staff. We found these were not working as effectively as they should. The registered manager was aware and was taking steps with the provider and the alarm company to ensure this was rectified as soon as possible.

Medicines were stored, administered and disposed of safely by trained staff. Where people chose to self-administer their medicines this was accommodated by staff.

There were sufficient numbers of staff to meet people’s needs. Staff knew what people’s individual needs were, including their preferences. People spoke positively about their relationship with staff. We observed positive interactions and it was apparent, people enjoyed spending time with staff.

Staff received regular supervision and appraisals. Training for staff was provided and kept up to date. New staff completed an induction and the Care Certificate.

People living in the home had the capacity to make their own decisions about how they were cared for and their preferred lifestyle. Staff were aware of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and how this applied to their role. There were no DoLS in place at the time of our inspection. Mental capacity assessments had been completed for some people for some decisions to ensure people fully understood the decision they were making.

People spoke positively about the food provided in the home. The chef was aware of the dietary preferences and needs of the people living in the home.

People had access to health professionals to ensure they maintained their health. An in house physiotherapy service assisted people with rehabilitation and to maintain mobility.

Staff showed respect for people and preserved their dignity and privacy. People acknowledged this was the case and valued this aspect of their care. Staff were described as “Lovely” “Very caring” “Very attentive.” “Nice and helpful” and “Kind”. People told us they felt listened to by the staff and the registered manager. They had the opportunity to raise comments and ideas about the running of the home in the residents meeting. People told us this was a useful meeting. People knew how to r

We talked with four people who used the service that expressed a high level of satisfaction and who told us that they felt well looked after. People told us that they were treated equally and fairly by staff because staff enabled them to make independent informed choices that enabled them the freedom to do whatever they wished. Two people told us, ‘The staffing numbers in the home are very generous. We spoke with one person who told us, “I love it here! Everybody treats me so well, I am very lucky.”

All of the people we spoke with told us the food was of a very good quality and that there was always a good variety of meal options. We were able to see that there was a consistent variety and choice of nutritious meal options. We spoke with three care staff who told us that they supported people to be as independent as possible and supported them to work towards and achieve personal goals. We looked at four care files that demonstrated the personalised approach in place to support the staff’s comments.

We observed staff treating people with respect and were able to see that there was a good relationship between staff and people who used the service. We observed staff assessing people’s needs and ensuring that care was provided in line with individual care plans. We were able to see that people were comfortable and that there was adequate numbers of staff available to provide the individualised support needed.

The three people whom we spoke with said that they had no concerns with how the home was managing their medicines. They told us they received their medicines at the times prescribed by their GP. Whenever there were changes to their medicines the GP would explain those changes to them.

Seven people we spoke with said that staff enabled them to promote their independence and individuality. People said they were able to choose when to rise and retire and what clothes to wear.

People said that staff respected their privacy and dignity. An example given was staff knocked on their bedroom door and waited for a reply before entering. A second example was staff assisted them with personal care in the privacy of their bedroom.

People described staff as “courteous.” They said staff had been trained to address them by their “formal title.”

The majority of the people whom we spoke with said that family members had chosen the home on their behalf. They could not remember if they had an assessment prior to being admitted into the home. Some people were not sure if they had a care plan.

All the people we spoke with said that they were registered with a general practitioner (GP) who visited the home weekly or as and when required. One person described the GP as “quite good and on the ball”.

People told us that staff made their visitors feel welcome and provided them with refreshments. People said that the home had no restrictions on visiting and family pets were able to visit as well.

People whom we spoke with said that there was a good selection of choices on the food menu. They told us that the food was well presented and cooked to a high standard.

People told us that staff answered the call bell promptly. However, if they did not answer it within a reasonable time they would apologise for the delay.

People said that they felt safe living in the home. They told us that staff always spoke to them in a respectful manner.

People said that they knew whom to speak with if they were not happy with a situation.

Most of the people we spoke with told us that they had no problems with how the home was managing their medication. Two people whom we spoke with said that they were self-administering their medication. This had enabled them to feel they were involved in their care and treatment and to maintain their independence.

All the people we spoke with were confident that staff were appropriately trained to meet their needs.

People told us that they were treated equally and fairly by staff. The staff enabled them to make choices and they were free to do whatever they wished.

Several of the people whom we spoke with said that they had been regularly asked to complete surveys.

The majority of people we spoke with said that they received their medicines at the times prescribed by the general practitioner. However, one person said that sometimes at weekends the staffing levels were patchy and this has resulted in medication not administered on time.

We received a variety of comments from people about staffing levels in the home. Some people said that staff were rushed off their feet. A person using the service said there was a frequent change of night staff. A second person said that at weekends the staffing levels were patchy and this had an impact on their care leaving them to feel isolated

This unannounced inspection took place on 7 and 24 September 2015. Chilton House is a nursing and care home that provides support for people who are elderly and physically frail. The home can provide care for up to 45 people in both shared and single bedroom accommodation. There was no registered manager in place on the day of the inspection, however, a new manager had commenced employment between the first and second day of the inspection.

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 told us they felt safe living in the home, however we found that documents such as risk assessments, treatment plans and care plans were not always completed. This placed people at risk if the care they required was not clearly documented. Recruitment checks on staff were not always recorded. This meant when new staff were employed there was not always records to show the provider had taken the necessary actions to ensure they were safe to work in the home.

A trip hazard such as the steps leading into some people’s rooms had not been identified or highlighted for people. This placed people at risk of falls. We have made a recommendation about keeping the environment safe.

Staff were aware of how to protect people from abuse and knew how to respond to concerns. They were confident they would raise concerns regarding poor practice if they were aware of any. They told us the provider was approachable and there was an open and honest culture in the home, where staff supported each other.

Most staff and people told us there were sufficient numbers of staff to support people with their care. We observed adequate numbers of staff during our inspection.

People were supported to take their medicines safely by trained nurses. People told us they thought staff were knowledgeable and skilled. Training records were not up to date and certificates related to staff training were not all available. Staff supervision records showed staff did not receive supervision and appraisal in line with the provider’s policy. Systems were not in place to ensure staff were supported to carry out their role.

Most people living in the home were able to make choices and decisions for themselves. For people who were unable to do so the Mental Capacity Act 2005 and the code of practice guide staff on the appropriate actions to take including assessing a person’s mental capacity. Staff were not always clear about what the Act meant in regards to their role. One mental capacity assessment had not been completed correctly. We have made a recommendation about staff training on the subject of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were supported with their food and drink and commented that the standard of food was that of a high class restaurant. Where people needed extra support or help, for example by a speech and language therapist this was provided. People’s health and social needs were met by staff who were caring. Health appointments were made to ensure people remained as well as possible. A wide range of activities was available to people including outings and in house entertainment.

We observed staff treating people with dignity and respect. They showed sensitivity when required and people appeared comfortable around them, laughing and joking and having meaningful conversations. The home had a relaxed atmosphere; it was clean and pleasantly decorated. People were encouraged to personalise their own rooms with their own furniture and belongings.

The lack of managerial support meant there had been no oversight of some aspects of the home, for example record keeping. People spoke positively about the provider and the care they received. Checks were carried out to ensure the health and safety of the environment was of a safe standard.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full