The Chapel House Nursing Home is registered to provide accommodation with personal care for up to a maximum of 35 older people. There were 29 people living at the home at the time of our inspection, some of whom were living with dementia.

There was a registered manager in post who was present during 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.

At our last inspection on 26 and 27 August 2015 the service was rated as Good. At this inspection we found that the provider had further developed the service and was now Outstanding.

The service was extremely well-led. The provider and the registered manager were very passionate about their work and were committed to providing an excellent service for people and their relatives.

The provider used innovative ideas and demonstrated how they achieved outstanding practice to enhance people’s quality of life. They were proactive in their approach and always looked at ways they could improve the care and support they provided. They were keen to share their knowledge and experience with partner agencies to achieve better dementia care in the wider community and care sector. The introduction of the Namaste Programme had clearly had a positive impact on people’s lives.

The registered manager demonstrated a strong and supportive leadership style and had effective systems in place to monitor the quality and safety of the service. They actively sought and welcomed feedback from people, their relatives and staff alike to drive improvements in the service. Staff were impressed with the quality and variety of training available to them and felt very well supported. There was a real sense of teamwork that made the home an enjoyable place to work. Staff were proud to work at the home and felt valued.

There was an open and inclusive culture at the service. People, their relatives and healthcare professionals were consistently positive about how the home was run. They found the registered manager to be approachable and easy to talk with. Everyone without exception was very impressed with the warm and welcoming atmosphere created by the staff and management.

The provider proactively sought ways of engaging with the local community. They had recently opened a café within the grounds of the home much to the delight of people and their relatives. The provider worked in partnership with other organisations to ensure current practice and to share their experience and knowledge with the wider community.

People received individualised care that was tailored to their needs and preferences. Staff knew people very well and were able to recognise and respond to changes in their needs in a prompt and effective manner. Staff knew about people’s past lives, what was important to them and what they liked doing. They arranged activities that were meaningful and based on people’s past history, interests or hobbies. People’s care plans were detailed and promoted person centred care.

People were cared for by staff who were kind, compassionate and highly motivated. Staff had formed positive working relationships with people and their relatives and contributed to the continuous improvements in their care and support. People and their relatives were actively involved in decisions about their care and felt listened to. Staff consistently respected people’s privacy and dignity. People receiving end of life care, their relatives and people who were important to them were treated with exceptional care and compassion both prior to and following the person’s death,

People continued to receive care and support that protected them from ill treatment and abuse. People were supported safely by staff who were aware of the r

We looked at three care plans and other care records. They all had an assessment of their health and social needs completed. The care plan documentation was up to date and reviewed on a monthly basis.

We spoke with three people who used the service, three relatives, five staff and one visiting professional. People who used the service said: “The staff are very kind”, “The food is good and plentiful” and “The staff are lovely.”

Relatives commented: “The home is clean and odour free”, “I am full of admiration in the home” and “The staff are friendly and nice.” All the people spoken with said they didn’t have any concerns or complaints.

Staff commented: “The training is good”, “All the staff are nice and we help each other out” and “I like working with the people. It is a happy and friendly place here.” All the staff said they got good support from the management team and the registered manager was good and very approachable.

The professional said: “The home is clean”, “The staff are very helpful.” They said they had no issues or concerns with the home.

We looked at staff recruitment and found that robust recruitment procedures were in place.

We observed interactions between the people who used the service and staff and found there was a relaxed and friendly atmosphere between them.

During a tour of the home we found it was clean and odour free. People who used the service and relatives confirmed that the home was clean and odour free.

We found that people were able to express their views and were involved in making decisions about their care and treatment. We spoke with six people who lived at The Chapel House and they confirmed they had been involved in the implementation of their support plans.

People who used the service said "The staff are lovely", "I like living here", "The food is good".

We spoke with three relatives and they commented "The staff are very caring", "My relative enjoys the food here", "The staff are very pleasant" and "The home is always clean". They all confirmed they had no concerns with the home. We also spoke with a local GP who commented "I think the staff here do a difficult job well. The nursing staff are competent and alert to any problems with the people who live at the home."

We looked at three care records and all had an assessment of their health and social needs completed. There were individual care plans and risk assessments in place. There was evidence to show they were evaluated on a regular basis. This meant the service could demonstrate they could meet people's needs and maintain their well being.

We found that the service had systems in place in relation to supervision and training. We spoke with three staff members who commented "The staff team are nice and helpful", "The manager is very good", "I like my job and helping people", "The staff work well as a team" and "We get good training".

During the visit to Chapel House people who live there, visiting relatives and the staff team were spoken with. Many of the people who live here were unable to communicate verbally but looked well cared for and content. The relatives we spoke with were happy with the care and support provided and were confident that the service was meeting their needs.

People living at Chapel House and their relatives confirmed that the staff were very supportive, kind and helpful. Other comments included:

The staff are very kind and helpful

Staff attitudes are good

Staff are aware of fathers needs and care for him well

The staff are very good here

Dad always looks well groomed and clean. When we have needed to use the call bell it is always answered promptly

We are very pleased with the home and the staff are very caring

Staff always speak to you and trained staff are always available if you want to know something in particular.

People are treated as individuals and with respect

The manager is brilliant, she takes on board any issues you have and deals with them

Staff team are lovely. The staff attitude to service users is good and their interactions are very gentle.

The food is beautifully presented and we are very happy with the home.

Staff commented:

I like the environment here and I get on well with the manager and she has an open door policy and is very good.

The staff team is good and there are enough staff on duty to meet the needs of the service users.

The manager is a sensitive and caring person. She finds the right balance and compromises when appropriate.

The staff team and a very good team and work really hard together. The training we get is very interesting.

I get regular supervision.

Other professionals said:

The staff are extremely good and call for assistance when needed.

The manager is good and applies common sense to her practice.

The patients are well presented and I have no concerns or complaints.

The staff are very supportive and respond well to the needs of the clients.

We visited this home on 26th and 27th August 2015 and the inspection was unannounced.

The last inspection was carried out in October 2013 and we found that the registered provider was meeting the regulations we assessed.

The Chapel House is located in the village of Puddington to the north west of Chester. It is surrounded by farmland and countryside. The home provides care for up to 35 older people. The home is a family business with the providers involved in the day to day running of the home. Car parking is available at the front of the building. At the time of our visit there were 30 people living at the home.

There was a registered manager employed to work in the home. 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 and relatives told us they were very happy with the care and support received. Comments included “The staff are lovely”, “The staff are kind” and “I am happy here.”

There was a wide range of person centred activities provided at the home. These were tailored to people’s individual preferences and weekly trips out in the local community were undertaken.

People and their relatives spoke consistently about the caring and compassionate attitude of staff. Staff demonstrated a commitment to providing the best quality of care and people told us staff took time to understand their preferences and needs.

Safeguarding procedures were in place and the registered manager and staff knew what to do if they suspected abuse may have taken place. Policies and procedures were available and staff had undertaken training. The registered manager and the staff team were aware of the procedures to follow if they considered a person may lack capacity to make a decision. They were aware of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and how and when these should be applied. Policies and procedures and the MCA codes of practice were available.

We saw that medication was administered and stored safely. The nursing staff team administered medication and received regular updates to ensure current guidance and practice was followed.

Staff recruitment was robust and checks were undertaken to ensure staff were suitable to work with people who may be deemed vulnerable. Staff received regular supervision and annual appraisals. They also had the opportunity to attend staff meetings.

During observations we saw that people were well cared for and were appropriately dressed for the time of year. There were plenty of staff available during our visit and we saw that at least one member of staff was available in the lounges to assist people as needed. People were regularly engaged in conversations with staff and it was evident that staff had a good knowledge of the topics or activities people liked. For example staff knew peoples family and friends details and had a good knowledge of people’s social history and hobbies. Some staff chatted one to one with people whilst others with reading magazines, looking at photograph albums or helping with a jigsaw. All the actions we observed were positive and people were happy and smiling.

People told us they liked the meals. We saw that people chose where they wanted to have their meal and that staff supported people with their meals as required. The mealtime experience was relaxed and people were given time to enjoy their meal.

We saw the home was clean and that domestic staff were available during the day.

Care plans were well written and were centred on the person’s individual needs. They contained good information about the needs and preferences of the individual and recorded all aspects of healthcare intervention and needs. We saw daily records which showed good details of the person’s well-being on a day to day basis.

A complaints policy and procedure was in place. People confirmed they knew how to make a complaint, if necessary; however they confirmed that they didn’t have any concerns or complaints.

People and relatives said they thought the service was well run and that the registered manager was approachable and proactive in their management of the service. Staff told us they were well supported by the registered manager and that there were good lines of communication within the service.

The registered manager had a range of ways of obtaining the views of people who lived at the home and their relatives. These included questionnaires, speaking to people on a one to one basis and monthly service users meetings. The registered manager also had a range of audits in place to monitor the service. Action plans were produced as required.