About the service: The Chace Rest Home is a residential care home providing personal care and accommodation for up to 41 people, some of whom have dementia. There were 39 people living at the service at the time of our 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's experience of using this service:

¿ The provider’s systems and procedures in place to manage the risks associated with the storing of items which were of a potential hazard to people and from cross infections needed to be strengthened.

¿ Staff were knowledgeable about safeguarding and able to raise concerns.

¿ Personalised risk assessments for some people needed to be in place so staff had all the guidance required to promote people’s safety and consistency in care.

¿ People told us they felt safe living at the home. They told us the staff team were kind and caring and they treated them in a considerate and respectful way.

¿ People were supported by staff at the times they needed care without unnecessary delay and systems were in place to recruit staff safely.

¿ People were supported to take their medicines to meet their health needs.

¿ Staff were supported through on-going supervision and they accessed training relevant to people's needs, to ensure these could be met.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ People’s needs and wishes were assessed before they moved into the home with their preferences forming part of this so people’s needs could be met and they would not be discriminated.

¿ People were encouraged and supported to make choices about what they ate and drank.

¿ The provider had taken some measures to create a dementia-friendly environment, and had plans in place to further adapt the home to people’s needs.

¿ Staff and management worked with a range of health and social care professionals to ensure people’s needs were monitored and met.

¿ Staff recognised the need to promote people’s equality and value their diversity.

¿ People had the opportunity to participate in activities for fun and interest, and the registered manager gave assurances they would continue to develop personalised activities to meet each person’s needs.

¿ People who lived at the home and relatives knew they could speak with the registered manager if they had any complaints and concerns to raise.

¿ The provider and management team had quality assurance systems and processes in place to monitor the quality and safety of people’s care. However, daily quality checks needed to be strengthened to identify staff practice concerns and drive improvements. After the inspection we received actions the management team and provider had taken which included some of the concerns identified during the inspection.

¿ People who lived at the home, relatives and staff found the registered manager was approachable and willing to listen.

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

Rating at last inspection: At the last inspection, on 9 November 2017, the service was rated Requires Improvement (report published 22 February 2018). At this inspection the rating has remained Requires Improvement.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

This inspection took place on 9, 10, 13 November 2017 and was unannounced.

The Chase Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Chace Rest Home provides accommodation and personal care for a maximum of 41 older people. On the day of our inspection there were 34 people living at the home, some people living at the home were living with a Dementia.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 inspection in September 2016 we found the provider was good overall, however we found the provider had not ensured people received consistent quality care.

At this inspection we found areas where improvements had been made, however these had not been fully completed or sustained. We also found other areas where improvement was needed. This is the third time the service has been rated requires improvement.

The management team had improved how staff were allocated, and people told us staff met their needs in a timely way. However, on-going monitoring to identify where staff practice needed improving was not consistently completed. People continued to receive an inconsistent experience of the quality of care they received.

Improvements to bathrooms to reduce the risk of infection had been identified but not completed. The provider had included these in their planned improvements.

We found shortfalls in systems which failed to identify when Deprivation of Liberty Safeguards had expired and best interest decisions had not been completed. The registered manager and the provider had not ensured there was a system in place to monitor this.

Where people needed support with making some decisions, information was not always recorded effectively and staff did not consistently understand what this meant to their practice. Reviews on people’s best interests decisions were not always completed in line with legislation.

The provider had failed to ensure their web site displayed their performance ratings in line with current legislation.

People told us they felt safe because staff knew them well and were available when they needed them. Staff understood how to recognise potential abuse and where they needed to report any concerns to. People had risks to their wellbeing identified and staff knew how manage the risks to people’s safety. People told us there were sufficient numbers of staff to meet their needs.

The provider used safe systems to recruit new staff. People’s medicines were stored securely and administered as prescribed. Staff had been trained and observed to ensure safe practice when administering medicines. Staff followed infection control guidelines, and the provider had plans in place to update bathrooms to ensure they remained free of infection.

People had their needs assessed to ensure the service could support them effectively. People’s rights and preferences were taken into consideration when their care was planned. The service used information technology to support people’s needs and maintain their independence as much as possible. Staff received regular updates to ensure they were able to meet people’s needs.

People told us they enjoyed the food and were offered healthy choices. We saw people were offered visual prompts to support their decisions about their meal choices. Staff adapted how they communicated with people to ensure they understood the choices they were offered. People were asked for their permission before they were supported, and th

The Chace Rest Home provides accommodation and personal care for a maximum of 41 older people. On the day of our inspection there were 38 people living at the home.

The inspection took place on the 6 and 7 September 2016 and was unannounced.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 carried out an unannounced comprehensive inspection of this service on 19 and 22 February 2016 when we found that they were in breach of the law because they were not managing medication safely. The provider wrote to us to say what they would do to make the necessary improvements. At this inspection we saw that the actions required had been completed and the regulations were now met. However we saw that further improvements were needed in the safe storage of medicines to ensure people had their medicines safely. For example, keys for medicine cupboards needed to be accessed by staff responsible for administering medicines. Also temperatures needed to be monitored to ensure medicines were kept within manufacturer’s guidelines.

People said they were happy with the support that staff provided. They told us staff were caring and helped them stay independent. People told us they were able to maintain important relationships with family and friends. We saw people had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. People we spoke with said there were regular delays in when they received their meals, and we saw one meal time where delays occurred in people getting their meal. Medicines were administered in a safe way; however we found there were improvements needed in how medicines were stored. People told us they had access to health professionals as soon as they were needed.

Three relatives we spoke with said they felt included in planning the support their relative received and were always kept up to date with any concerns. People living at the home were able to see their friends and relatives as they wanted. People and their relatives knew how to raise complaints and felt confident to do so when they needed to. The registered manager had arrangements in place to ensure people were listened to and action would be taken if required.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks and were able to respond to people’s needs. Staff had up to date knowledge and training to support people. We saw staff treated people with dignity and respect whilst supporting their needs. They knew people well and took people’s preferences into account and respected them.

Staff had the knowledge and training to support people. Staff were aware of the need to ensure people agreed to the support they received. They listened to people’s choices and supported them when needed with decisions.

The registered manager and staff had a culture of focussing on people as individuals. People who lived at the home and staff were encouraged to be involved in regular meetings to share their views about the quality of the service.

The provider and registered manager had systems in place to monitor how the service was provided. However further improvements were needed with the monitoring of the safety of the environment, storing medicines and supporting people with consistent quality care. Newly implemented processes needed to be embedded to sustain and continue the progress with delivering quality care.

This inspection took place on 19 and 22 February 2016 and was unannounced.

The provider of The Chace Rest Home is registered to provide accommodation and personal care for up to 41 people. At the time of the inspection there were 40 people lived at the home.

There was a registered manager in post, who was on duty during our 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 did not have their medicines administered and stored in a safe way. The staff practice did not follow the procedures written by the provider and these increased the risk of cross infection. This is a breach of the regulations because the registered person had not ensured the safe management of medicines.

There were some arrangements in place to assess, monitor and improve the quality of the care but these were not always effective. This is because the checking systems had not identified some areas that required improvement actions to be taken. We saw staff did not always follow the risk assessments advice when helping people putting them at potential risk.

People were kept safe from potential abuse and harm by staff who understood how to identify the various types of abuse and knew who to report any concerns to. Staff were trained and supported to meet the needs of people who lived at the home. Checks had been completed on new staff to make sure they were suitable to work at the home.

People enjoyed the food they received and but food and drinks were not consistently monitored to ensure they stayed healthy. When people needed it they had access to a range of healthcare professionals to make sure they remained healthy and well.

People were not always treated as individuals, as staff didn’t always know people’s needs and their individual preferences. Most interactions between people and staff were task orientated.

People knew how to complain and felt able to discuss concerns with the registered manager. The registered manager was visible in the home so people felt able to approach them to discuss their concerns.

You can see what action we have asked the provider to take at the back of this report.

The inspection was carried out by one inspector. At the time of our inspection there were 36 people who were using the service. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with four people who used the service, two relatives and a person’s friend who was visiting. We also spoke with two relatives by telephone. We spoke with four staff who were supporting people and looked at records. This evidence helped us answer the five questions detailed below.

Is the service safe?

People told us they felt safe. We observed a relaxed atmosphere and positive relationships between the people who used the service and care staff. There were risk management plans in place and health and safety arrangements for most people. The premises were well maintained and hygienic so they remained safe for people’s use. Staff had received training for their respective roles to promote their competency for delivering safe care and support for people who used the service.

Staff did not have the documentary evidence of the moving and handling assessments carried out by a professional but in their absence staff did not carry assessments themselves. Staff had not developed a care plan for a long term health condition because they were unaware the person had the condition. A recent admission with a history of falls did not have a risk assessment in place to protect them from unnecessary accidents and injuries. We found unsafe staff practices to ensure that people received their medicines as prescribed by the doctor. At times staffing numbers were not adequate to deliver people’s care safely or when they wanted it and needed it.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to people’s safety.

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Most people's health and care needs had been assessed and with the exception of the latest admission, care plans were in place. Care plans were regularly reviewed but not necessarily at the time when people’s needs had changed. We found that other health needs had been assessed regularly such as, nutrition, skin care and most people’s mobility. Health care professionals helped staff by caring for people’s specialist needs. It was clear from what we saw and from speaking with staff that they did not fully understand people’s care and support needs because they had not been fully informed. The people we spoke with all said they received the standard of care that matched their needs. Care staff encouraged and supported people in leading interesting and enriched lifestyles.

Is the service caring?

People were supported by attentive care staff who encouraged them to be as independent as possible. We saw that care workers showed patience when supporting people. The people we spoke with were positive about the way they were cared for and supported. A person told us: "They (staff) look after me." A relative said: “It’s (care) very good. They are very proactive and take a lot of time and trouble.” We observed people asking staff to do things for them. Staff responded to the requests as soon as possible and carried them out efficiently. We observed staff encouraging people and making arrangements for them to attend the activity that had been arranged for them. We saw that staff respected people’s decision if they did not want to take part in the activity. Staff spent one to one time with people stimulating them by reading magazines with them. People were treated with dignity and respect by staff.

Is the service responsive?

The home had a people carrier and the activities organiser took people to places they liked to visit, such as garden centres. We found when staff identified concerns about people’s health they contacted the appropriate professional and asked for their help. The service worked well with other agencies and services to make sure people received care in a joined up way. People and their relatives knew how to make a complaint if they were unhappy. We saw from the complaints that had been received the manager dealt with them in a timely way. Letters of response had been sent to the complainants with explanations and where necessary apologises.

Is the service well led?

Records showed us that improvements had been made when they were identified through the maintenance process. Staff told us they were clear about their roles and responsibilities and the ethos of the service. This helped to ensure that people received a good quality service at all times. There were clear lines of responsibility and staff knew who they could seek guidance from if they were unsure about something. Staff told us they were able to actively contribute during staff meetings so that they may lead to improvements in the service.

The manager told us people who used the service, their relatives and visiting professionals had completed annual surveys. The manager told us the surveys had been analysed and a report developed by the provider but it was not available in the home for people and staff to refer to. Therefore, we were unable to evidence it as part of the inspection process. The manager had failed to regularly check that essential documents had been developed. For example, moving and handling assessments and a care plan for a long term health condition. The manager had not checked that staff had made recordings in the kitchen cleaning schedule to confirm the work had been completed. The manager told us they carried out regular checks regarding staff practices for administration of medicines. We found concerns about the way medicines were administered. The home was registered with The Care Quality Commission (CQC) to accommodate 34 people but we there were 36 people living in the home.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to management of the service.

We inspected The Chace and spoke with four of the people who lived at the home and with five of the staff on duty. We spoke with the registered manager and the admin manager. We spent some time in communal areas and observed the interaction between staff and people who used the service.

We looked at care records for three people and other supporting documents for the service. Consent had been obtained from people before care and treatment had been provided. Alternative arrangements had been made to support people who were unable to consent to their treatment or support. Staff told us they: “Always ask people if they want me to give them care before I give it”.

People’s needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us they were aware of each person’s needs and how to give care and support to meet those needs. People told us staff were: “Very good here” and that they were: “Very happy with the staff who worked at the home”.

We saw that staff were kind and caring in their approach to people who lived in the home. Recruitment procedures were in place that made sure suitable staff were provided to care for people.

A complaints procedure had been made available to people and their relatives should they wish to make a complaint. We saw comments from relatives: “Thank you for the excellent care and support you give to X (person's name)”.

We visited The Chace in July 2011 and issued compliance actions for out of date information contained in care records and medication management. We carried out this inspection on 22 August 2012 to check whether compliance had been achieved as part of a routine inspection.

We used a number of different methods to help us understand the experiences of people who lived at The Chace. We saw how care was given to people who lived at the home and found that people were relaxed and at ease with staff and within their home environment. We saw that staff interacted with people who lived at The Chace in a friendly, courteous and respectful manner.

We found that people were treated with respect and their dignity and choices had been considered by staff. We saw that people were given choices which supported and helped them to make their own decisions. When staff spent time with people it was meaningful, personal and offered appropriate encouragement for people to manage their own needs.

People told us that staff “always call me X (persons name) which I like” and “I have my breakfast when I want it” and “I go to bed when I want”. People told us that there were things to do. Relatives told us that they were always made to feel welcome at the home and were involved in the care and support of their relative. They told us they were “more than happy to approach the staff about anything”.

People who lived at The Chace were given the opportunity to express their views about the service they received. This was because people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

Most of the people who told us about their care at The Chace or about the care their family member had, were very happy. People who lived there whom we met during our visit and had brief conversations with, looked well groomed, alert and aware of their surroundings. We noticed that people had been helped to look their best, for example people had clean and styled hair and clean clothes. Many of the women at the home had jewellery on that matched their outfits and some wore makeup and had manicured nails. One visitor commented on how good the carers were at making sure her mother always had perfume on – something she had always enjoyed.

We had information from eight relatives, six of whom had very positive views. The other two expressed a different view and did not feel happy that care was always reliable. One of these people gave their views anonymously and the other did not wish to be identified; we were therefore unable to make detailed checks ourselves to find out about the care of the people concerned. We had been able to check with the local authority about one person’s care; they had told us they do not have significant concerns.

We met one person who lives at the home and her daughter. They were both happy with everything at The Chase. The daughter told us “I am happy because Mum is”. We also met a visitor whose family member was very unwell and unable to have a conversation with us themselves. Their relative told us that staff let her know what was happening and that she felt welcome when she visited.

We received emails from four families after our visit to the home. One person had some concerns about the building and the amount of activities available but other than that people were very positive about the care and quality of relationships with staff at the home. The following comment captures this well –

“When I raise issues with the care home, I feel that they are dealt with kindly and intelligently. My mother's health needs have been attended to promptly, so far as I am aware. I believe that efforts have been made to encourage my mother to participate in activities in the home, and that her wish for privacy is respected.”

During our visit we observed staff working with people in a caring and respectful way. Staff went about their work calmly and we did not see them rushing anyone. We also saw people being given good support from staff during lunchtime and being helped to choose what they wanted to eat.

People’s medication was stored in lockable cupboards in their rooms so that staff could support them with taking their medication individually rather than during a more impersonal medication ‘round’.

People told us they felt safe and one man commented that people at the home need not be concerned about the abuse that had been in the news, telling us, “No-one here needs to worry, nothing awful like that would happen – it’s a lovely place.”

We inspected The Chace Rest Home on 19 and 20 May 2015. The inspection was unannounced. The provider is registered to provide accommodation and personal care for up to 41 people. At the time of the inspection 37 people lived at the home.

There was a registered manager in place although on holiday at the time of our 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.

At the last inspection in July 2014. We found that the provider was not meeting the Health and Social Care Act 2008 in relation to the care and welfare of people who used the service, the management of medicines, staffing and assessing and monitoring the quality of service provision and records. Following our inspection in July 2014 the registered manager sent us an action plan telling us the actions they had taken or proposed to take to comply with the regulations.

We found that improvements had taken place however regarding the management of medicines and quality assurance systems these were not consistent. We found that people’s medicines were not always managed safely and that quality checks and management were not identifying these shortfalls in order to make further improvements to the service provided to people.

People were able to make choices about their day to day care and staff were seen to support them to make decisions in their best interest. It was identified that some people would be unable to leave the home without close supervision but applications had not been made to the local authority for this to be assessed to ensure that people were not unlawfully restricted.

People who lived at the home told us that they felt safe. We saw sufficient staff to be on duty and that staff were available to meet people’s needs. Staff were aware of their responsibilities to keep people safe and were aware of the actions they would need to take if they had concerns about people’s safety.

People told us that they liked the staff. Staff were provided with training to ensure that they had the skills and knowledge to care for people effectively. People were supported to eat and drink enough to keep them healthy.

People’s health care needs were assessed and care was delivered to meet these needs. People had access to health care professionals to maintain a healthy wellbeing.

People’s privacy and dignity was respected and staff were seen to be kind and caring towards people living at the home. People and relatives felt that staff were approachable and listened to them. People told us that there were things to do during the day and that these included regular weekly outings. Staff were seen to support people to maintain hobbies and interests that were important to them.

The provider and the registered manager had systems in place to obtain the views of people who lived at the home as well as members of staff. Regular checks to monitor the quality of the care people received and where improvements were needed were in place. Further improvement was found to be necessary to ensure shortfalls were identified.