The inspection took place on 5 and 6 December 2018 and was unannounced on the first day and announced on the second day.

Crabwall Hall 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.

Crabwall Hall is a two-storey care home in the village of Mollington which is 2 miles from Chester city centre. Accommodation consists of 43 single bedrooms all of which have ensuite facilities. At the time of our inspection there were 39 people living at the home.

The home had a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection the home was rated good. At this inspection we found the home remained good. The home is rated good as it met all the requirements of the fundamental standards.

Safe and robust recruitment procedures were in place and sufficient staff are employed to meet people’s assessed needs. All staff had completed an induction and had undertaken training to meet the requirements of their role. Staff had regular supervision and attended staff meetings.

The registered provider had safeguarding policies and procedures in place that staff fully understood. Staff had received training and were able to describe what abuse may look like and actions they would take if they had any concerns.

People’s needs were assessed before they moved into the home and this information was used to develop person specific risk assessments and care plans. These documents were reviewed regularly and updated when changes occurred. People were offered choice and their independence was promoted where possible.

People’s needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment stage and care planning development.

Medicines were ordered, stored, administered and disposed of in accordance with best practice guidelines. Staff that administered medicines had all received training and had their competency regularly assessed. The registered provider had medicines policies and procedures in place that offered up-to-date guidance to staff. Medicine administration records (MARs) were fully completed and regularly audited for accuracy.

People were supported by staff with their food and drink needs. When people had been identified as having specific assessed dietary needs staff had guidance available to them to support this. People spoke positively about the food and drink at the home.

We observed people being treated with dignity and respect. Positive interactions between people and staff were observed throughout our visit. Staff were caring and demonstrated kindness to the people they supported.

Activities were available for people to participate in if they chose to and they told us they enjoyed these.

Governance systems were in place and included regular audits of key areas across the home. The information from the audits was analysed to identify areas for development and improvement and these areas were actioned in a timely manner. Accidents and incidents were analysed to identify trends and patterns within the home. Health and safety checks, equipment testing and servicing and fire checks were regularly undertaken.

The Care Quality Commission as required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we find. We saw that the registered provider had guidance available for staff in relation to the MCA. Staff had undertaken basic training and demonstrated an understanding of this. The registered provider had made appropriate

This was an unannounced inspection carried out on the 18 February 2016.

Crabwall Hall is a two-storey care home situated in the village of Mollington, approximately 2 miles from Chester city centre. People are accommodated on both floors and access between floors is via the lift or the stairs. Accommodation consists of 43 single bedrooms all of which have en-suite facilities. There are two large lounges and a lounge/dining room on the ground floor and a library/study on the first floor. There is also a hair salon. At the time of our visit there were 39 people living at the service.

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.

We last inspected the service in January 2014 and the registered provider met all the regulations we reviewed.

Staff understood what was meant by abuse and they were aware of the different types of abuse. Staff knew the process for reporting any concerns they had and for ensuring people were protected from abuse. Family members told us that they felt reassured by staff and that their loved ones were safe living at the service.

Staff morale was very good and there was a happy and relaxed atmosphere throughout the service. Staff treated people with kindness and respect and they were caring in their approach. Staff were aware of the importance to respect people’s privacy and dignity and to encourage people to maintain their independence. Family members and visitors had no concerns about the care their relatives received. They said they had always been made to feel welcome when visiting.

People’s needs were assessed and planned for and staff had personalised information about how best to meet people’s needs. People’s wishes, preferences and beliefs were reflected in their care plans. Care plans were person centred and detailed people’s needs. They were reviewed on a regular basis with the person or other important people such as family members. Staff worked well with external health and social care professionals to make sure people received the care and support they needed. People were referred onto the appropriate service when concerns about their health or wellbeing were noted.

The registered provider ensured that robust recruitment processes were followed. There was sufficient qualified, skilled and experienced staff to meet people’s needs.

Staff received support through supervision and team meetings with the management team. This enabled them to discuss any matters, such as their work, training needs or areas of development. All new staff completed an in depth induction programme which consisted of e- learning, face to face training and mentoring with an experienced colleague. There was a continued programme of planned training which ensured that staff gained the skills and knowledge relevant to their work and to meet the needs of the people who used the service.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager and staff had a good knowledge and understanding of the Mental Capacity Act 2005 and of their role and responsibility linked to this. Staff understood the key principles of the MCA 2005.

Medication was well managed at the service. People received their medication as prescribed and staff had completed competency training in the administration and management of medication. Medication administration records (MARs) were appropriately signed and coded for people’s prescribed medication.

The service was managed by a person described as friendly and approachable. Systems were in place to monitor the quality of the service and to seek p

We looked at four care plans, all of which contained a range of risk assessments, for example, falls, mobility, nutrition and communication. All care plans and risk assessments were reviewed on a monthly basis. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Staff were witnessed as being kind and promoting people's independence. We spoke to seven people who used this service and two relatives. We asked them about the care staff; some of the comments made were that they were “excellent”, “very obliging” and “very kind”.

All seven people we spoke to said the food was “excellent”.

Staff told us how they disposed of medication, which was to have one staff and the pharmacist sign and count medication, store it separately and return it to pharmacy. All medication was stored in a locked trolley, which was secured to the wall. We saw and were told the keys were kept with the senior care assistant at all times.

When speaking to staff all five said they needed one extra carer in the morning. We were told by staff that people using the service were not sometimes able to get up until 11 o’clock in the morning when they had requested to get up at 9 o’clock. We were told this was a regular occurrence. Staff told us this was because the dependency level of people using the service had increased significantly in the past three months. Despite the comments made by the staff it was evidenced in a dependency assessment that the home had the required levels of staffing.

We found that people’s privacy, dignity and independence were respected. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One person who uses the service said, "I wouldn't be living here if I wasn't happy. The staff are excellent. The food is very good. It's very well run. "

People experienced care, treatment and support that met their needs and protected their rights. Everyone we spoke with liked living there. One person who uses the service said, "The care is very good. The staff are helpful. No one has any complaints."

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Staff received appropriate professional development and were able, from time to time, to obtain further relevant qualifications. One member of staff said, "The training is really good. I do feel supported."

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. One family member said, "The care is excellent. They always keep us informed. They certainly respect her. The staff are incredibly friendly and cheerful. I would recommend it to anyone"

We spoke with six people who were living in the home. All said they had been asked what their needs were before admission and the registered manager had discussed with them the care the home could provide. They told us staff always consulted them about their individual needs and involved them in decisions about their care and treatment.

They also told us there was a wide range of activities they could participate in. One person said “There’s something on every day except Sunday and it’s up to you whether you join in or not”. Another said “You get entertainment in the afternoons, there are various things to keep us busy”.

People said they could do as they pleased and that there were no restrictions. One person told us they regularly went out with family and friends.

All the people we spoke with said they received the help they needed. Comments included "I've been here for many years and have never had

any complaints about the care. It couldn’t be any better”; "I like it here very much, it’s a good place to be”; “I’m lucky to be here”; “It’s brilliant”.

People we spoke with told us that they felt safe and well cared for in the home. We asked them if they would know how to raise a concern about something that was worrying them. They expressed confidence that if

they had a problem they would be able to discuss it with the registered manager and that it would be taken seriously.

All the people we spoke with said the staff treated them well and that there were enough staff to support them to fulfil their needs. Comments included "staff on the whole are very good, they come straight away when you call for them"; “the staff are kind and really take an interest in you”; “the girls are very good, always smiling and never a cross word from any of them”; “the carers are much better than another home I was in, they have much more time for you".

People said they were kept informed and consulted about things going on in the home and that they were sometimes asked to complete customer satisfaction surveys, but said they didn’t receive any feedback on the surveys.

The local authority told us they had carried out a review in October 2011 and had no concerns about the care provided. They said it was a well managed home with plenty of planned activities.