About the service: Chilton Meadows Care Home is a care home providing accommodation, nursing and personal care for up to 120 older people, some of whom may be living with dementia and/or have complex nursing needs. People are accommodated across four houses named Beech House, Munnings House, Gainsborough House and Constable House. At the time of our inspection there were 97 people using the service.

People’s experience of using this service: At this inspection we found a number of improvements had been made. A lot of work had taken place since our last inspection to improve the safety and quality of the service.

Staff recognised any signs of abuse or harm and they reported their concerns in line with correct safeguarding policies and procedures.

Any risks continued to be appropriately assessed and mitigated to ensure people’s safety was considered.

People’s medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

Effective infection control measures were in place to protect people.

Staff received an induction and ongoing training and support to fulfil their role and extend their knowledge.

People enjoyed the food at Chilton Meadows and were supported to maintain a healthy and balanced diet.

People were supported to have maximum choice and control of their lives and were supported in the least restrictive way possible. Staff encouraged people to maintain their independence.

People received support from staff who were kind and treated them with respect.

The leadership, management and governance of the service ensured the delivery of good quality care. The registered manager and management team strived to achieve high standards through continuous improvement. The quality and safety of the service was closely monitored through regular checks and audits.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: The rating at the last inspection was ‘Requires Improvement’. The last report for Chilton Meadows was published on 26 April 2018.

Why we inspected: This was a scheduled inspection based on the previous ratings.

Follow up: We will continue to monitor the service through the information we receive.

Chilton Meadows Care Home provides accommodation, nursing and personal care for up to 120 older people some of whom may be living with dementia and/or have complex nursing needs. People were accommodated across four houses named Beech House, Munnings House, Gainsborough House and Constable House. At the time of our inspection there were 84 people using the service. The service is situated on the periphery of the town of Stowmarket in Suffolk.

Chilton Meadows Residential and Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. This inspection took place on 6 and 13 February 2018 and was unannounced.

The registered manager had already left the service in August 2017 and was working at another location for the provider company. The replacement manager had commenced their role at Chilton Meadows in August 2017 but had not yet registered. They had only just started the process to apply to do so. We have referred to this person as the home manager throughout this report. A registered manager is a person who has registered with CQC 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.

At our last comprehensive inspection in January 2017, we found that improvements were needed to the safe management of medicines. We found improvements were also needed to ensure that all staff received medication training and their competency in this area was assessed. Suitable arrangements were needed to ensure that all staff received regular formal supervision and an annual appraisal of their overall performance. Minor improvements were required to ensure particular decisions which had been made in people's best interests were recorded. Work was required to ensure that people's care plan documentation was accurate and up-to-date and that people had opportunities to lead meaningful lives and to participate in social activities of their choice. We also found that work was required to ensure that appropriate infection control practices, policies and procedures were applied and also that auditing arrangements demonstrated where actions required had been addressed.

We received an action plan from the provider telling us the improvements they were making to meet regulatory requirements. We rated the service ‘Requires Improvement’ overall and in all of the key questions we ask. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chilton Meadows Care Home on our website at www.cqc.org.uk

At this inspection in February 2018, we found that whilst there was progress at the service, there was still further work to be completed. Improvements continued to be needed to the safe management of people’s medicines. Notifications of events and incidents were not always submitted in accordance with statutory regulations. Registered managers and providers are required to submit to CQC statutory notifications in accordance with regulatory requirements however we found a number of serious injuries and potential safeguarding incidents that had occurred at the home which we had not been notified of. We also found whilst risk assessments were in place, improvements were needed to how staff responded to emergency situations such as falls, to ensure they followed the guidance within people’s care plans.

Staff were able to recognise signs of abuse should they occur and knew how to report concerns if they suspected a person was at risk of harm. There was a complaints procedure available in the service for people and relatives to raise concerns.

People received effective care from staff

We carried out an unannounced comprehensive inspection of this service on 4 and 5 May 2016 and found significant breaches with regulatory requirements across all areas of the service. As a result of our concerns the Care Quality Commission took action in response to our findings by placing the service into ‘Special Measures’ and amending the provider’s conditions of registration. This included the provider not being able to admit anyone new to the service.

We asked the provider to send us an action plan which outlined the actions they would take to make the necessary improvements. In response, the provider had shared with us at regular intervals their action plan detailing their progress to meet regulatory requirements and to achieve compliance with the fundamental standards. At this inspection considerable progress had been made to meet regulatory requirements, however some further improvements were still required.

Chilton Meadows Residential and Nursing Home provides care and support to a maximum of 120 older people, some of whom living with dementia and/or had complex nursing needs. People were accommodated across four ‘houses’ called Beech House, Munnings House, Gainsborough House and Constable House. At the time of our visit there were 78 people using the service.

The inspection was unannounced and took place over two days, on the 30 and 31 January 2017.

At the time of the inspection the home did not have a registered manager in post, however a manager was in post and following their appointment had submitted their application to be formally registered with the Care Quality Commission. 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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run. Following the inspection the manager was formally registered with us on 20 March 2017.

Quality assurance checks and audits carried out by the provider and the management team of the service were in place and had been completed at regular intervals in line with the provider’s schedule of completion. The provider and management team of the service were able to demonstrate a better understanding and awareness of the importance of having good quality assurance processes in place. This was a significant improvement and this had resulted in better outcomes for people using the service. Feedback from people using the service, those acting on their behalf and staff were positive and relatives spoke of the improvements made by the provider and management team following our last inspection in May 2016. This referred specifically to better visible management presence within the service and there now being optimism and confidence that the provider and management team were doing their utmost to make the required improvements to the service. Nonetheless, some improvements were still required to ensure that where issues were highlighted as part of the management teams auditing arrangements, information was available to show actions required had been addressed.

All staff spoken with at the time of the inspection described the management team as supportive and approachable. However, suitable arrangements were still needed to ensure that all staff received regular formal supervision and an annual appraisal of their overall performance. Staff told us and records confirmed that a range of training opportunities were available and provided to them, nonetheless staff had not received updated medication training or had their competency reassessed in this area for some considerable time. An assurance was provided by the provider that this would be addressed as a priority.

Staff understood and had a good knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act [2005]. Suitable arrangements had been made to ens

Chilton Meadows Residential and Nursing Home provides care and support to a maximum of 120 older people, some of whom were living with dementia and/or had complex nursing needs. People were accommodated across four ‘houses’ called Beech House, Munning’s House, Gainsborough House and Constable House. At the time of our visit there were 109 people using the service.

The inspection was unannounced and took place over two days, on the 4th and 5th May 2016.

The home had 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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run.

We identified significant shortfalls in the care provided to people across all four houses at the service. This was linked to a lack of oversight from the registered manager and provider.

Relatives and people using the service raised concerns with us about their safety. People were put at the risk of significant harm in the absence of clear records and assessments which reflected all current areas of risk and how these should be managed to protect the person from harm. We observed that staff were not proactive in reducing the risks to people. , The service did not support people to have input from other health professionals such as GP’s or dieticians where this would have been appropriate.

The service was not complying with the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). All staff were unable to demonstrate that people were appropriately supported when they were unable to make choices about their lives. Potential restrictions on people’s freedom and movement were not assessed and formal best interest processes were not followed.

People were not supported to eat and drink sufficient amounts to maintain good hydration and nutrition.

People were not supported to live full, active lives and to engage in meaningful activity within the service. We observed that people were socially isolated and disengaged from their surroundings. People told us there was little to occupy them, that they were bored, and that the activity that was offered by staff was not always appropriate to their needs. This had not been independently identified by the service so no action had been taken by the registered manager to address this.

People’s care plans and assessments were generic and not person centred. Care planning did not include enough information about people’s past lives and experiences for staff to understand them. People and their representatives were not consistently involved in the planning of their care, and their views were not reflected in their care records.

People told us and we observed that there were not enough suitably trained and experienced staff available to meet people’s social, emotional and physical needs. Staff told us they struggled to meet people’s requests for support. Staffing levels were not calculated by the management based on the needs of people using the service and there was no system in place to monitor the effectiveness of the staffing numbers.

People told us staff did not always behave in an appropriate way when supporting them. Staff were not consistently supported to develop their skills within the caring role. There was no system in place to assess staff competency and performance. Supervision of staff was not carried out consistently. Where areas for improvement had been identified, there were no plans in place to support the staff member to improve or to monitor their performance to ensure people received safe and appropriate care.

Staff recruitment was not always conducted in such a way that ensured prospective staff had the skills, background, experience and knowledge for the role.

Systems in place to monitor the quality of the service were ineff

We inspected this service on the 8 April 2015. Chilton Meadows Residential and Nursing Home provides care for up to 120 older people who may be elderly and or have a physical disability. Some people are living with dementia. There were 104 people living in the service when we inspected.

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.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to protecting people by maintaining the service to a clean and hygienic standard and assessing, monitoring and mitigating risks to people. You can see what action we told the provider to take at the back of the full version of this report.

Infection prevention and control measures were not robust because cleanliness and hygiene standards in the service had not been maintained. Systems for assessing and managing people’s safety of people did not effectively mitigate risk.

Delegation and organisation of staff did not ensure people received the care and support they needed consistently and in a timely way. Moving and handling practices were inconsistent and did not assure us that staff received effective training based on best practice to meet people’s needs.

People were provided with their medicines when they needed them and in an appropriate manner. However improvements were needed to ensure consistency in the recording of people’s medicines.

Procedures and processes were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

People were positive about the care they received. The atmosphere in the service was friendly and welcoming. People were supported and encouraged to attend appointments with other healthcare professionals to maintain their health and well-being.

Staff had developed good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner.

People had their care needs provided for in the way they wanted. Where they lacked capacity, appropriate actions had been taken to ensure decisions were made in the person’s best interests. People knew how to make a complaint and said that any concerns were acted on promptly and appropriately.

Staff were knowledgeable about people’s choices, views and preferences and acted on what they said. However this information was not always reflected in people’s care records to ensure best practice was followed. People were encouraged and supported with their hobbies and interests and participated in a variety of personalised meaningful activities.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring and respectful manner.

Processes were in place that encouraged feedback from people who used the service, relatives, and visiting professionals and this was acted on. Systems in place to monitor the quality and safety of the service provided were not robust. Improvements were needed to drive the service forward.

We spoke with five people who used the service, a relative, the manager and three other members of staff as part of this inspection. People who used the service told us that they were happy, felt safe and they received good care. One person said, “The staff are kind and they look after me ever so well.” Another said, “There is always something going on in the afternoon which I enjoy.”

People told us the food was well presented and cooked to a very good standard, with plenty of choice. One person said, “I like the vegetables, always taste nice.”

We found that the service was meeting the personal, emotional and healthcare needs of people who used the service. The environment was clean and well maintained. The care plans were concise and up to date and the service carefully sought the person’s consent at every opportunity. The service had an up to date complaints process and was working with other providers of care to ensure that people needs were being met.

We spoke with nine people who use the service. We observed staff interaction with people and saw that this demonstrated genuine affection, care and concern. Four people told us that staff always treated them with dignity and respect and were mindful of their privacy when conducting personal care.

We examined seven care plans and found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. We found that health risk assessments for moving and handling, falls and prevention of pressure sores were up to date. These then formed the basis of care plans.

A program of refurbishment of the whole site was underway. Relatives told us that they thought the developments were going to be of benefit to people living at the service.

We examined the roster for each of the houses for the week of our inspection and found there were enough qualified, skilled and experienced staff to meet people’s needs. Relatives we spoke with told us that there were enough staff on duty at the service. One person who lived at the service said, "The staff here are very good. They really look after you". Another person said "All the staff are lovely, but I particularly like the men best. They will do anything for you".

We spoke with six people who use this service and they confirmed that their dignity and privacy is respected. One person told us that at night staff enabled them to be independent. “I like my commode just at the right angle next to my bed and a glass of water at hand. I have a call bell if I need staff and they always come quickly if I need them”. Another person told us “staff know how to respect my body and my clothes”.

One person we spoke with told us "The food here is very good. You can’t fault it. They have people who help you socialise. Each week they give you a sheet of what’s on. Today a shoe company visited and I bought these sandals".

Two different relatives who visited most days told us they were very pleased with the care and support given to their relative. "I can’t fault the place. I come every day so I should know".

A relative told us "I’m here most days and I’ve never seen staff being nasty and you know some of these residents can be tiring".

A friend visiting told us "I have no complaints the home is brilliant, but if I did have a concern I would know who to speak with and I’m confident they would resolve it".

The feedback from all residents and visitors spoken with was positive about the staff at Chilton Meadows.

One resident told us "I’m very happy with everything, but it is the staff that make it". Another resident said of the staff "They are all nice people and they make the visitors so welcome".

A relative told us "the carers are all nice, but it feels like there have been a lot of staff changes lately". (This person was referring to Munnings House)

All people we spoke with told us they were happy living at Chilton Meadows. We observed that people were given opportunities and choices throughout the day with several people attending planned regular activities on site. Several people we met were going to the hairdresser for hair appointments. People who live at Chilton Meadows looked smart and well cared for.