The Chimneys Care Home 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. The Chimneys Care Home is located in the market town of Alford in Lincolnshire. The home provides residential care and support for up to 14 older people.

At our last inspection in May 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

This comprehensive inspection took place on the 5 November and was unannounced. There were 14 people living in the home at the time of this inspection.

At the time of our inspection there was an established registered manager in place who was also one of the registered providers of the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

People continued to receive a safe service. Staff were recruited in a safe way and were provided with training to ensure they had the skills and knowledge to deliver safe care. Staffing levels were sufficient to safely meet the needs of the people living in the home. Medicines were administered and managed safely. The manager implemented processes and systems to manage risk. Accidents and incidents were monitored and where necessary, actions taken to prevent them from reoccurring.

People continued to receive an effective service. Staff were provided with regular training to ensure that they could meet the needs of the people living in the home. This was regularly refreshed and updated. 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 support this practice. Food and drink at the home was good quality and plentiful. The home worked together with a range of health and social care professionals to ensure that people’s health and wellbeing were well maintained.

People continued to receive a responsive service. Systems were in place to ensure that people were involved in planning and reviewing their own care and support needs and they were supported by person centred staff who understood their needs and wishes. Concerns were acted upon before they became complaints. Training was provided to staff to ensure that they could support people with end of life care.

People continued to receive a caring service. The atmosphere in the home was inviting and friendly. Staff demonstrated that they had the right balance between being friendly and professional and treated people with respect and kindness. People living in the home were provided with regular opportunities to express their views which were listened to and acted upon. People’s privacy and dignity was respected and promoted.

People continued to receive a well-led service. The registered manager fostered an inclusive team culture, led by example and was visible to the staff and the people living in the home. The provider and registered manager implemented high standards of quality assurance, governance and audit systems, which were used to ensure that shortfalls were identified and improved.

Further information is in the detailed findings below

The Chimneys Care Home is located in the market town of Alford in Lincolnshire. The home provides residential care and support for up to 14 older people.

We inspected the home on 11 May 2016. The inspection was unannounced. There were 12 people living in the home at the time of this inspection.

At the time of our inspection there was an established registered manager in place who was also one of the registered providers of the home. A registered manager is a person who has registered with the Care Quality Commission (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.

People were safe living in the home and they were cared for by staff in a dignified manner. Their rights to privacy and expressing their views and opinions were respected and supported. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. At the time of this inspection the registered manager had confirmed none of the people living in the home needed to have a DoLS authorisation in place. However, they knew how to make an application for DoLS authorisations at any time if this became necessary.

Staff had received training, which was regularly updated in order to enable staff to provide care in a way which ensured people’s individual and changing needs were met. Staff knew how to manage any identified risks and provided the care needed as described in each person’s care record. The care provided by staff at the home was supported through staff having access to a range of visiting health and social care professionals when people required both routine and more specialist help. Clear arrangements were also in place for ordering, storing, administering and disposing of people’s unused medicines.

There was a warm and welcoming atmosphere in the home and staff worked closely with people and their families to ensure each person was supported to maintain their individual interests and to have a meaningful and enjoyable life. In addition staff provided a varied programme of communal activities for those who wished to participate in them.

People were provided with a good choice of nutritious meals. When necessary, people were given any extra help they needed to make sure that they had enough to eat and drink to keep them healthy.

The registered manager ran the home in an open and inclusive way and encouraged people, their relatives and staff to speak out if they had any concerns. The provider and registered manager listened and took action to resolve any issues or concerns identified. More formal systems were also in place for handling and resolving formal complaints.

The provider and registered manager worked together as a team in order to regularly assess and monitor the quality of all the services provided. This approach ensured that any shortfalls in quality would be quickly identified and actions take to keep developing the services people received.

When we visited The Chimneys there were 14 people living at the home. We spoke with five people and observed how staff provided care and support to people who live in the home. This was because some people either chose not to speak with us or had problems with their memory and could not tell directly us about their experiences of the care they received.

A single inspector carried out this inspection. During the visit we also spoke with the manager and four staff members.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and staff told us.

If you want to see the evidence supporting the summary please read the full report.

Is the service caring?

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Throughout our inspection visit we observed staff were respectful and sensitive in their approach to meeting people’s needs. People told us things like, "All of the staff, day and night are caring. When they check on us at night the staff do it gently so we don’t get worried” and “The care from the staff is very good in my opinion.”

Assessments and care plans included people's likes, dislikes and preferences. Staff encouraged people to make decisions and choices for themselves. We also found the provider ensured people had a choice of suitable and nutritious food and drink in sufficient quantities to meet their individual needs and preferences.

Is the service responsive?

People were involved in an assessment before they moved into the home and when they had moved in. Care plans were developed with people based on the assessment information. This included people's individual choices about how they wanted to be cared for. Assessments and care plans were up to date and regularly reviewed.

Is the service safe?

We saw the provider had made the required improvements to the issues we highlighted during our last inspection of the service on 5 December 2013. Staff followed the services policies and procedures in relation to managing medicines.

People told us that they felt safe living at the home. We saw safeguarding procedures were in place and that staff understood how to safeguard the people they supported.

The manager had policies and procedures in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards although no applications had needed to be submitted. This meant people were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly so it did not put people at unnecessary risk.

Is the service effective?

People’s health and care needs were assessed with them and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical support needs.

People knew how to raise a concern or make a complaint if they were unhappy. One person said, “It’s easy to speak with any of the staff. It feels like my family here and I trust them (staff) to sort out any problems.”

We spoke with the manager who confirmed any concerns raised had been addressed straight away and found responses had been open and timely.

People could therefore be assured that informal concerns were addressed and systems were in place to make sure more formal complaints would be investigated in the right way.

Is the service well led?

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

The service worked well with other agencies and services to make sure people received their care in a joined up way. The manager had a quality assurance system and records seen by us showed that any shortfalls identified were addressed in the right way. As a result the quality of the service was continuingly improving.

We spoke with 10 people who lived at the home as well as staff, the provider/manager and the cook. We also looked at records and observed how staff supported the people living there.

People told us staff always asked for their consent before they undertook any care needs or treatment and their responses were respected.

People also told us they were very happy living in the home; some of them had lived there for a long time. One person told us, ”It’s not like a care home, it’s like a home. Another person said, “I wouldn’t look anywhere else.”

Medicines were stored and disposed of safely and people told us they received their medicines on time. However, staff were not always following the service’s policies and procedures for the documentation and administration of drugs.

There were enough qualified and trained staff to deliver safe and effective care to people.

There were effective systems in place to monitor the quality of service given to people, although they could be more robust, for example including infection control and care records checks. People we spoke with told us they could raise any issues with the provider or manager and felt confident they would be dealt with quickly.

As part of our inspection we spoke with seven people who use the service. They spoke positively about the care and support they received. They told us they liked living in the home and confirmed they were well supported to make choices and decisions about their care. We received comments such as: "You wouldn’t find anywhere better than this, the home is beautiful, I’m very happy here”, "It's very good, I have my own routines “and "It’s a nice, lovely home, good care."

People living in the home, confirmed they felt safe and said they liked the staff. One person told us, "Yes it's very safe and the staff are first class." Another person said, "Very nice group of staff, always very willing and obliging.”

Some people said they were happy with the social activities and stimulation provided at the home while others felt it was an area that could be improved. One person said, ”There’s enough to do, I like to sit and chat with my friends here.” Another person told us, "I enjoy the exercise sessions, we used to have slideshows and music, I really enjoyed those afternoons but we don’t have them anymore.”

We spoke with one visitor during the day. They spoke highly of the staff, facilities and described how their friend had settled at the home. Comments included, “It’s more like a hotel; everyone is very well looked after and happy here.”