The inspection took place on 19 September 2017 and was unannounced. Mary Chapman Court provides care for up to 34 people. There were 27 people living in the home on the day of our inspection. The home supported people who were over 65 years of age, some of whom were living with dementia. The building offered accommodation over two floors.
On the ground floor were a communal lounge, separate dining room and conservatory, where people could socialise and eat their meals if they wished. On the first floor were an additional two lounge’s and hairdressing area. The service provided transport for access to the community.
It is a condition of the provider's registration that a registered manager is in post at this location. The registered manager had left the service in August 2017. The provider had a nursing home, next door to Mary Chapman Court; the registered manager for that location has submitted an application to register with the Commission. Meaning they intend to have a dual management role supporting both locations. 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 of the Health and Social Care Act 2008 and associated regulations. There was an acting deputy manager in post who was supported by senior staff.
At the last inspection on 14 and 15 June 2016 the service was rated 'Requires Improvement'. The report was’ published in August 2016. At the last inspection we found there was an insufficient number of staff to keep people safe and meet people’s needs. We identified the service had not monitored peoples weight for some time so did not take timely actions to protect people from the risks of unplanned weight loss. The service was not following their procedures in the safe administration of medication. Consequently we found the manager had not completed robust and sufficient audits. Following the inspection the provider sent us a detailed action plan telling us how they would address the concerns we identified. At this inspection we found sufficient improvements in all of these areas. The service had continued to develop and had further strengthened their very caring approach. People received exceptional care that was personalised to them, taking account of their individual needs and wishes.
Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People who were able to said they felt safe at the home.
People’s care records showed risks to their safety were assessed and the action needed to mitigate those risks. These assessments and care plans were reviewed and updated at regular intervals to ensure people's changing needs were met. Accidents and incidents were accurately recorded and were assessed to identify patterns and trends. Records were detailed and referred to actions taken following accidents and incidents.
There were sufficient staff in place to meet people's needs. The manager used a dependency tool to assess staffing levels and to ensure they were based on people's needs, were up to date and reviewed monthly. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.
Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.
Staff received an induction into the service and senior staff checked competencies in a range of areas. Staff had received a range of training and many had achieved or were working towards a National Vocational Qualification (NVQ) or more recently Health and Social Care Diplomas (HSCD). Staff received formal supervision and annual appraisals from their managers.
People were supported by staff who understood and effectively applied the principles of the Mental Capacity Act, 2005 and the Deprivation of Liberty Safeguards. Staff confidently applied the MCA to make sure that people were involved in decisions about their care so that their human and legal rights were protected. People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible.
People had sufficient to eat and drink and were supported by staff to maintain a healthy diet. Observations of meal times showed these to be a positive experience, with people being supported to eat a meal of their choice and where they chose to eat it. Staff engaged in conversation with people and encouraged them throughout the meal, noting who liked to sit with whom. Nutritional assessments were in place and special dietary needs were catered for.
People's health care needs were assessed monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular health checks.
Exceptionally caring relationships had been built between people and staff. Staff working in the home were predominantly caring and compassionate. Staff knew the needs and preferences of the people they cared for and people were given reassurance and encouragement when they needed it. Where people needed support in order to make their own day to day decisions this was provided by staff. Where people had short term memory loss staff were patient in repeating choices each time and explaining what was going on and listening to people's stories. People's rights to privacy, dignity and independence were taken into account by staff in the way they cared for them. People receiving end of life care were treated with outstanding care and compassion.
People looked comfortable and happy moving around the home, some people stopping for rests or a nap, other people enjoyed having a late breakfast, doing a crossword or reading the newspaper. Staff were always visible to interact or sit with people. Staff said it was important they were also involved in ensuring people had something to do or someone to talk with. People were offered a wide range of both group and individual activities that were meaningful to them and which had a positive impact on their lives. Each person's needs were assessed and this included obtaining a background history of people. Care plans and assessments were comprehensive and showed how people's needs were to be met and how staff should support people. Care was individualised to reflect people's preferences.
The home had been decorated and arranged in a way that supported people living with dementia. The service was brightly decorated and stimulating for the people living there. The communal areas of the service were clean and well-furnished with a homely feel. People's rooms were individualised, with personal items such as ornaments, photos and furniture. The outside area was accessible with paths and benches.
Complaints were listened to and managed in line with the provider's policy. Relatives told us that they felt welcomed at the service and people and relatives said that they would be confident to make a complaint or raise any concerns if they needed to.
People and their relatives were involved in developing the service through meetings. People, relatives, healthcare professionals connected to the service and staff were asked for their feedback in annual surveys. All responses were positive from the recent quality assurance questionnaire. Their views were valued and they were able to have meaningful input into the running of the home, such as activities they would like to do, which mattered to them.
Staff felt the manager was supportive and said there was an open door policy. Relatives spoke positively about the care their family members received. There were effective quality assurance processes in place to monitor care and plan on-going improvements. A quality and compliance manager visited the home on a weekly basis supported the manager.