We undertook an unannounced inspection of Chiswell Residential Home, 193 Watford Road on the 13 September and 25 October 2016 and 14 November 2016.

The service provides accommodation and personal care for up to six people with mental health needs. On the day of our inspection, there were six people using the service.

The home 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.

There were systems in place to keep people safe from harm. Staff had undertaken risk assessments which were regularly reviewed to minimise potential harm to people using the service.

There were appropriate numbers of staff employed to meet people’s needs and provide a safe and effective service. Staff we spoke with were aware of people’s needs, and provided people with person centred care. Staff were well supported to deliver a good service. They felt supported by their colleagues and the management team.

The provider had a robust recruitment process in place which ensured that staff were qualified and suitable to work in the home. This also included checks on agency workers who occasionally. Staff had undertaken appropriate training and had received regular supervision and an annual appraisal, which enabled them to meet people’s needs. Medicines were administered safely by staff who had received training.

Staff cared for people in a friendly and caring manner and knew how to communicate effectively with people. Staff supported people well and spent time with them. We observed staff engaging in meaningful activities with people.

People were supported to make decisions for themselves where possible and they were encouraged to be as independent as possible. Where people were not able to make decisions for themselves, best interest decisions were made on their behalf which involved advocates and other professionals. People’s choices were respected and we saw evidence that people, relatives and/or other professionals were involved in planning the support people required. People were supported to eat and drink well and to access healthcare services when required.

The provider had a system in place to ensure that complaints were recorded and responded to in a timely manner, as well as, an effective system to monitor the quality of the service they provided.

The inspection took place on the 4 February 2016 and was unannounced. Chiswell Residential Home is registered to provide accommodation and personal care for up to six older people with mental health needs. On the day of our inspection there were five people living at the home.

At the last inspection on 15 October 2014, the service was found to not be meeting the standards in relation to safeguarding people from abuse; obtaining consent; supporting staff; record keeping; respecting and involving people who used the service and the quality monitoring of the service. We found that the provider had made significant improvements and was now meeting most of the regulations. However, people had not had their capacity assessed and applications to deprive people of their liberty were not in place. Record keeping still required further development and action plans were in place to help ensure they achieved the required improvements.

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.

People received care that met their needs and staff knew them well. People were involved in planning their care where possible. There was some family contact however this was minimal due to distance so people’s relatives were not routinely involved in people's care and support planning.

Staff had been trained and this was being reviewed and developed as part of the on-going action improvement plan. We found that staff were able to recognise any signs of abuse and knew how to report concerns. There were adequate numbers of staff on duty to meet their needs safely at all times.

People were supported to live as independently as they could. Risks to people`s health, safety and wellbeing were identified and actions were put in place to reduce risks to people when possible. People were encouraged and supported to participate in activities and hobbies; this included some events in the community and shopping trips.

There was a robust recruitment procedure in place to help ensure that staff employed were suitable to work in a care setting. Staff employed at the service had completed an induction when they commenced working at the home and had received some training updates relevant to their roles.

People`s medicines were administered safely and staff had received training. There were systems in place for the safe storage of medicines and we saw that medicine records were completed correctly.

People who used the service felt they were treated in a kind and caring way. Staff respected and promoted people’s privacy and dignity. People were supported to maintain their health and wellbeing.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS)

We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that people living at the service were not always able to make their own decisions. We found that people who had been identified by the provider as not having the ability to conse

Chiswell Residential Home provides accommodation for to up to six people who require support with their personal care needs.

This inspection took place on 15 October 2014 and was unannounced. At our last inspection in October 2013 we found that the service was found to be meeting the required standards. At the time of our inspection there were six people living at Chiswell Residential Home.

The service 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 and associated Regulations about how the service is run.

People were supported by staff who knew them well but did not always have the necessary skills to support them appropriately. We found that staff training was out of date and some staff did not have the training required to deliver the care that people needed. Staff were caring and knew how to protect people’s dignity. We saw kind and caring interaction between staff and the people they cared for.

People were supported to see their GP and other health care professionals. They received regular visits from the community nurse and the community psychiatric nurse (CPN) where necessary. However, we found that people were not supported to go out into, or be involved in, the wider community.

Staff were clear about their roles and felt they were supported by their manager. There were staff and residents meetings held to obtain people’s views and concerns but these were not used to develop the service.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection no applications had been made to the local authority in relation to people who lived at Chiswell House Residential Home.

Staff did not follow requirements of the MCA 2005 regarding people who lacked capacity to make their own decisions. The provider had not made a DoLS application for one person even though we found their liberty had been restricted.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This related to the lack of assessment of peoples capacity and consent to care, the level of training some staff had received and a failure to monitor the quality of the services. We also found the service was in breach of the Health and Social Care (Registration) Regulations 2009. This concerned failures to notify CQC about certain incidents that happened at the service. You can see what action we told the provider to take at the back of the full version of the report.

We inspected Chiswell Residential Home on 17 October 2013. We found the home to be clean and well presented. On our arrival we found some people were seated in the communal living room whilst others had chosen to sit in the back room overlooking the gardens. People we spoke with told us that they 'couldn't manage’ before they came to the home and that it was 'nice' living there. We were told that all the food was made fresh every day and that the food was also 'good' and tasted 'nice'. Staff we spoke with told us that the atmosphere of the home was 'like being at home' and that they were 'always conscious about people’s feelings'. Staff told us that when they cared for people at the service it was 'like caring for your own parents’ and grandparents'.

We found that the home was meeting the standards we had inspected. People were treated with dignity and respect and their consent was obtained by staff before any care was provided. The home was clean and had been well maintained. There was sufficient numbers of staff on duty to meet the needs of people.

During our visit on 15 November 2012, we spoke with all the six people who lived at Chiswell Residential Home. They said that they were happy with the care and support they received and did not have any complaints. One person said “I am well looked after, the staff are good and so is the food”. Another person said that “I am happy living here. They treat us well. They feed us well."

We found that people's privacy and dignity had been respected and that they had been involved in the decisions about their care and support. People had an assessment of needs carried out and the care plans we had reviewed demonstrated that their needs were being met appropriately. We noted that the staff had been provided with relevant training and that they had received regular supervision so that their work had been appraised. There had been an effective system in place to manage and administer medicines so that people received their medication regularly and on time. There had been a quality assurance system to assess, monitor and evaluate the quality of service provided.