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Inspection carried out on 2 July 2019

During a routine inspection

About the service

Chilwell House is residential care home and was registered to provide accommodation for up to 17 people. At the time of our inspection 12 people were using the service.

Chilwell House was compliant with the values underpinned in Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. These values include choice, promotion of independence and inclusion. People had access to local amenities, facilitates and services such as healthcare and were supported to access these regularly.

People’s experience of using this service and what we found

We have found evidence that the provider needs to make improvement. Please see the Well-led section of this full report.

Quality assurance systems were inconsistent. The acting manager had not completed regular audits and quality assurance monitoring.

There was a friendly, relaxed and comfortable atmosphere in the service. Staff were kind, caring and understanding towards the people they supported; they knew them well and we observed many examples of friendly, relaxed and good-natured interactions. People were placed at the centre of the service and were regularly consulted regarding their individual support needs.

Respect, dignity and understanding was at the heart of the provider's culture and values.

People were safe and protected from the risk of avoidable harm. There were detailed risk assessments in place and guidance for staff regarding how to keep people safe.

Systems and processes were in place to safeguard people from abuse. Staff understood the signs of potential abuse and how to respond appropriately.

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

There was sufficient staff deployed to meet people’s identified care and support needs, where it was necessary to use agency cover, the acting manager ensured they were regular workers who knew the people at Chilwell House and were aware of their routines.

Staff received training and had the necessary skills and knowledge to meet people's individual care and support needs effectively. Care planning was personalised, to reflect an individual’s needs and preferences, and helped ensure people were supported effectively and safely, in accordance with their wishes.

Staff knew people's daily routines and what was important to them. People were encouraged and supported to access the local community and engage in activities of their choice.

Medicines were stored, administered and disposed of safely by staff who were trained to do this.

Where accidents or incidents had occurred, lessons were learned to prevent the same thing happening again.

Infection prevention and control measures were in place and the premises were visibly clean in all areas.

Guidelines for staff followed best practice guidance and was used by the acting manager to plan and deliver effective care to people.

There was an open and positive culture within the service where people, staff and relatives felt listened to and confident to raise any issues or concerns.

This service met the characteristics of Good. More information is in the 'Detailed Findings' below.

Rating at last inspection: Last rated Good. Inspection report published on 21 February 2017.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for 'Good' services

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

Inspection carried out on 17 January 2017

During a routine inspection

This inspection visit was unannounced and took place on 17 January 2017. At our previous inspection visit on 27 January 2016 we asked the provider to make improvements in relation to the support when people lacked capacity, notifications and audits to develop the home. The provider sent us an action plan on 15 March 2016 explaining the actions they would take to make improvements. At this inspection, we found some improvements had been made.

The service was registered to provide accommodation for up to 17 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 16 people were using the service.

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.

The provider had not completed audits in relation to accidents and incidents to consider any trends or address any areas of improvement. The care plans had not been reviewed to reflect the overall needs of the person. .

Staff felt supported and they received supervision and the opportunity to expand their roles through a peer support group.

People felt safe and staff understood the importance of reporting any concerns to avoid people coming to any harm. Risk assessments had been completed and further developments had been planned to encompass the identifying of wider risks and any triggers or guidance needed. People received their medicine as required in a safe way and referrals were made to health care professionals when required. .

People using the service had the capacity to make their own decisions. When required some people received the support of an advocate or guardianship to support more complexed decisions. There were sufficient staff to support people’s needs and the provider had increased the staffing to support areas of identified needs and reduce the risks. When staff were recruited checks were completed to ensure they were safe to work with people who used this service. Staff received an induction which provided the training and guidance they needed. Further training was provided to support the staff’s role.

People enjoyed the food and had the opportunity to cook meals for themselves or others. The staff treated people with respect and people told us the staff made time for them when they needed the support. People knew how to raise a complaint and any received had been responded to. People had the opportunity to contribute to the development of the service.

Care plans had been completed with the person to identify their needs. Further developments were being made to make this information more individual and more integral with the person. Activities were established on an individual basis and provided the opportunity to develop life styles and a focus on learning new skills.

We saw that the previous rating was displayed in the reception of the home as required. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

Inspection carried out on 27 January 2016

During a routine inspection

This inspection was unannounced and took place on 27 January 2016. Chilwell House is a recovery and rehabilitation service registered for people with mental health conditions. The service offers accommodation to 17people. There is a main house which can support 14 people with recovery and three self-contained flats within the grounds to support up to 3 people. These flats are used to support people to transition into the community. At the time of our inspection 13 people were using the main house and one person was using the flats.

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.

Some records were not up to date and did not reflect the care required to support the individual to ensure their safety. The provider had not notified us of significant events which related to the service. Where people did not have the capacity to make their own decision; a best interest assessment had not been completed.

People felt supported at the home and the provider ensured the staffing levels were reflective of the needs of the people living in the home. Staff knew people well and were able to respond to people’s needs as they changed. Staff had received training which was appropriate and staff told us they had implemented their learning to enhance the support they provided to people.

People felt safe in the service and staff understood what constituted abuse or poor practice. There were systems and processes in place to protect people from the risk of harm. Medicines were managed safely and in accordance with good practice.

Staff felt supported by the manager and provider. They had regular opportunities to identified areas of further support to develop their skills, or aspect of the environment to enhance the experience for the people or the staff’s wellbeing.

We saw staff discuss things with people and support them in their decision making in their daily living. People were encouraged to cook and prepare a range of food and drink that met their nutritional needs. The service had links with healthcare professionals to maintain people’s health and wellbeing.

Staff were caring in their approach and people felt their privacy and dignity was respected. People felt confident they could raise any concerns with the manager or provider. There were processes in place for people to express their views and opinions about the home.

You can see what action we asked them to take at the back of the full version of the report.

During a check to make sure that the improvements required had been made

Our previous inspection visit in October 2013 found that staff were working long hours to ensure there was always sufficient cover for the community based part of the service.

The action plan and additional evidence we received from the service in March 2014 showed that the service now had a sufficient number of staff available without the need for them to work excessive hours.

Inspection carried out on 29 October 2013

During an inspection to make sure that the improvements required had been made

We received information via our website in October 2013 that suggested the service was not meeting individual needs, that staff training was inadequate and there were insufficient staff available. People we spoke with told us that they liked the staff and that their care was good but felt its reliability could be improved. They told us their individual preferences were taken into account where possible. They told us they liked the staff and said �They are very, very good�. We saw that people were relaxed and had friendly relationships with staff. An external health professional told us they were satisfied with the service and said �The service goes above and beyond what is expected of them�.

We found there had been a period when there were insufficient staff that resulted in staff working excessive hours, giving the potential for unsafe care. We found that staff training was up to date in key areas and that the training was provided by a recognised organisation.

Staff recruitment procedures had improved since our previous visit in May 2013 and all legally required information was now being obtained before people commenced work.

Inspection carried out on 16 May 2013

During a routine inspection

Everyone we spoke with who used the service said they understood their care plan and had agreed to the help provided and an external professional we spoke with confirmed people�s consent was sought and said care and support plans were drawn up with the person and the service.

All the people we spoke with were positive about the service. One person described it as brilliant, another said they were very satisfied and another that they had had no problems since using it. A relative told us they were impressed by how well the service had managed complex needs. Everyone receiving a community service told us the service was reliable and that staff stayed for the amount of time allocated. One person told us �You�re never rushed, they always have time�.

We saw that the premises were clean and tidy and staff were able to describe infection control procedures.

Medication procedures were satisfactory and issues regarding an error that was brought to our attention in 2013 had been addressed.

We saw that Criminal Record Bureau (CRB) checks (now known as Disclosure and Barring Service (DBS) checks) had arrived after people started work and some references were also not up to date. This meant there was the potential for unsuitable people to be working for the service.

We found there were sufficient, suitably trained staff available to provide the support required.