Chase Lodge Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified two breaches of regulations. Medicines were not always managed safely. We found errors in recording and missing information. Systems did not always identify or address the shortfalls we found. This meant we could not be assured people were receiving medicines as prescribed or that medicines administration and stock control was monitored. Changes were promptly made to improve. There was no evidence that people were harmed, but this was a breach of regulations relating to safe care and treatment. Staff knew how to keep people safe, however some incidents had not been notified to Care Quality Commission (CQC) as required. This was an oversight and people were not harmed by the omission, but it was a breach of regulations relating to the notification of incidents. Statutory notifications were submitted to CQC following the site visit. At the last inspection, we identified a breach of the regulations due to concerns about the environment. At this inspection we found improvements had been made and the provider was no longer in breach of regulations related to this issue. We saw evidence that the building and equipment were checked to manage risks and changes were made as needed to keep people safe. Effective infection prevention and control measures were in place. People were protected from the risk of harm and abuse. People told us they felt safe living at Chase Lodge and could approach staff with any needs. Staff had training on how to recognise and report harm and abuse. Staff worked with other agencies to keep people safe. Staff worked with people, relatives and other professionals to manage the risks people might face. People were encouraged to be involved in regular reviews of their support needs. It had been difficult to recruit permanent staff, but agency staff were used to ensure safe staffing levels were consistently met. Staff were safely recruited and received relevant supervision and training.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt able to raise concerns and the service responded to feedback they had provided. A person said, “We have been given questionnaires and been asked on numerous occasions to write a letter. I would make complaints to the manager. If it didn’t get sorted I would go to [senior managers]. I’m satisfied.” Relatives also said they were able to give feedback. One relative told us they had staff phone numbers and added, “They’re always so helpful, very helpful. They let me know if there are any problems. I have no reason to raise any issues, when I went there it was all good.”

Staff knew how to raise concerns and record incidents, and this helped keep people safe. However, the management team confirmed during our assessment that there was no system in place for recording and monitoring medicines errors and acknowledged some notifications had not been shared with CQC as required. The management team responded openly and proactively to our feedback about areas for improvement identified during the assessment. The registered manager told us learning from incidents or safeguarding concerns was shared with the team.

Some processes were in place to monitor standards and identify, record and learn from incidents that happened within the home. For example, the registered manager told us learning from incidents, errors or concerns was discussed in team meetings and staff confirmed this. However, we found actions taken and learning were not always documented or reviewed. Changes were made after our visit and we saw lessons were learned, and changes made to ensure safe services continued to be provided.

People told us they were supported to make or attend appointments with health professionals and specialists. This helped to provide a joined-up approach and consistency. One relative told us there had been minor issues when their family member first arrived at the service, but this had been quickly resolved and there were no ongoing concerns. Relatives told us they were able to speak with staff and their views were considered.

We received mixed feedback from staff regarding the sharing of information within the service. Some staff told us sufficient information was shared by managers whilst others told us they did not feel involved, or this needed to improve. Some felt the use of agency staff within the service was a barrier to information being shared. One staff member said, “Agency makes it harder. If something gets said to agency staff, they don’t always feed it back. I try and prompt and ask them.”

People who lived at Chase Lodge had regular contact with services such as GP, mental health specialists and social workers. Professionals were very complimentary about how the service worked with them to ensure people were safe and received the support they needed. Professionals told us staff took prompt and proactive steps when there were concerns or changes to people’s health needs.

The registered manager told us about processes in place to ensure people were safely admitted to the service. This included the completion of a pre-admission assessment and opportunities for people to visit the service before they moved there. We were told the electronic care planning system could generate key information to share with other agencies, for example in the event of hospital admission. Policies were up to date and included information about key local partners.

People told us they felt safe living at the service overall, although 2 people noted the behaviour of another person made them feel vulnerable. People’s relatives felt their family members were safe at the service. People appeared comfortable around staff. People and their relatives told us they were able to speak with staff if they had concerns.

Staff received training about how to recognise and respond to safeguarding concerns. The staff we asked demonstrated an understanding of safeguarding principles and we saw them delivering safe practice. Staff told us they did not have concerns about the safety of people using the service. Staff had not always documented safeguarding concerns or made statutory notifications to CQC. The registered manager took steps after our visit to ensure staff knew what was expected of them. We also asked staff about Deprivation of Liberty Safeguards (DoLS), but some were less confident about this subject. The professionals we contacted expressed no concerns about the service’s response to safeguarding concerns.

We observed staff supporting people in ways that kept them safe from harm or unnecessary risks. At times, this could be challenging because some people could make unwise decisions. We saw staff being proportionate and balancing people’s safety and welfare with their capacity to make decisions.

The provider's safeguarding policies reflected relevant legislation. The management team worked with external agencies and acted in a timely way to make sure people were appropriately safeguarded. The registered manager demonstrated their understanding of safeguarding procedures and told us about a safeguarding concern they had investigated and reported to the local authority. CQC had been notified and appropriate referrals made. However, we found several other incidents which had not been shared with CQC as required. The registered manager told us this had been an oversight. Statutory notifications were submitted to CQC following our visit. The Mental Capacity Act 2005 provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. People’s capacity to make decisions was assessed and recorded. Staff respected the rights of people to make decisions or refuse support.

People and their relatives understood staff had responsibilities to keep people as safe as possible. Although we saw risks were usually assessed, monitored and managed, people could not remember if they had been involved in this process. The people we spoke with did not recall seeing forms or paperwork relating to risk assessment or management. People were encouraged to make day-to-day decisions about how to keep themselves safe. This meant they had control and were not unnecessarily restricted. A professional told us, “I have been involved in numerous meetings around managing risks and have felt the team are fair in their approach and will make positive risk taking decisions. The team will reflect and change the approach if needed.”

The staff team and managers knew people well and demonstrated a positive approach to managing people’s risks which considered people’s capacity. Most staff told us people’s risk assessments contained enough up to date information to support people safely. However, some staff felt some care plans needed more details. Staff said they had time to read risk assessments and care plans since shift arrangements had changed. The registered manager told us people’s risk assessments were reviewed and updated each month on the electronic care planning system.

Our observations raised no concerns about how staff managed risks. We saw staff supporting people in line with safe practice and their individual risk assessments. There were recent changes such as putting lockable medicines storage in bedrooms for people to work towards managing their medicines more independently. There was a holistic approach to ensure the support provided met people’s needs safely and enabled them to do the things that mattered to them.

Risk assessments were in place and were clear and person centred. These were regularly reviewed to ensure they remained up to date. Records overall described risks which might be faced by people, and what staff should do to reduce these risks. During the site visit, we found the needs of some people with more complex health conditions were not always sufficiently detailed in records. For example, the care plans of one person with pressure needs, one person using a walking frame, and another person living with a stoma. These risk assessments needed more information to guide staff. We highlighted this to the management team who responded promptly to update these records.

Most people spoke positively about the environment, its condition and cleanliness. Comments included, “Yes it safe. We have 3 maintenance people, and I would talk to the managers. They listen and get it done” and “Yes the home is clean, and they clean my bedroom and I know I can talk to the nurse.” One person told us their bedroom needed attention due to damp and a poorly fitting window. We raised this with the management team and saw there was already a plan in place to rectify these issues. We were sent photographic evidence of work which had been completed after our visit.

Staff received training to keep people safe in the service, such as fire safety and health and safety awareness. The registered manager told us that maintaining the premises had been an ongoing challenge, however the recent recruitment of additional maintenance staff had meant improvements had been made. This helped staff deliver safe and effective support to people.

Improvements had been made to the environment since our last inspection. An ongoing programme of maintenance and improvement was in place to ensure the building, fixtures and equipment continued to be kept in good working order. Some improvements were still needed, but we saw actions were being taken. During our visit, we noted the evacuation information in an emergency grab bag was missing or out of date. We highlighted this to the registered manager, who took action to rectify this.

Systems were in place to detect and control potential risks in the care environment. This included building safety and equipment checks, management audits and a process for identifying and rectifying issues. We received evidence that necessary checks and safety certificates were in place.

People and their relatives spoke positively of the support they received from staff. However, people also said staffing had been challenging at times. Comments included, “This is a big issue. They are recruiting and it has started to get better. It was very short staffed during Covid” and, “There aren’t enough staff here. The staff that are here work extremely hard to cover the lack of staff. There are too many changes and too many different staff.” People explained that agency staff were used, but often they didn’t know the people who lived at the service or the routines they had. People preferred when permanent staff were working. This was echoed by relatives who told us, “They have some really good members of staff, they do really long hours. It’s hard to recruit, so they do longer shifts. Sometimes I have struggled to find staff. There are a couple of people on, and they are stretched. There are core staff that are dedicated to the job. There are other staff there and I don’t know who they are.”

Staff told us staffing levels had improved in the last 3 months. They felt there were not enough permanent staff and the service had been reliant on agency staff or cover from other services for several months. One staff member said, “We don’t have enough permanent staff, we use a lot of agency.” Another member of staff said, “We did struggle for a long time. Sometimes we do have bodies in the building, but they don’t know people and don’t know the building. We pick up the slack, give them the easier jobs.” Other staff members echoed this view and told us this put extra responsibility on permanent staff and impacted on information sharing and the continuity of care for people. The registered manager confirmed the service had faced ongoing challenges with staffing and recruitment. We were told agency staff did not always meet the standards expected. On occasions, agency staff had been sent home early and concerns raised with their employers. The registered manager told us they tried to use the same agency staff to maintain continuity for people and had recently switched to using an alternative agency to ensure people received safe care that met their individual needs. Staff were positive about working at the service. They told us they felt supported and received regular supervision, appraisal and training. A staff member said, “Yes, If I need anything I can contact managers.” Training records showed staff were up to date with essential training in subjects such as fire, manual handling and safeguarding.

On the day of our visit, we saw there were enough staff to provide people with the support they required. The staffing levels we saw were in line with those deemed safe by the provider. However, 2 of the staff who were working were agency staff, and the other usually worked at a different service. We saw positive interactions, but they did not know people well, and this placed greater demands on the managers. People preferred to receive support from staff they knew well.

Staffing levels were altered as and when people’s needs changed to make sure they received consistently safe support which met their needs. Staff were recruited safely by the provider, and relevant checks were carried out before new staff started working at the service. This included criminal record and employment checks to confirm staff were suitable to care for people. Systems and processes were in place to monitor and ensure training and supervision were up to date and supported best practice.

People and their relatives told us the home was clean and tidy and no concerns were raised. Comments included, “Staff are clean and change PPE (personal protective equipment) regularly and the home is clean” and “It’s always been clean when I visit. I use the bathrooms, they’ve always been clean.”

Staff said the service was kept clean and they had completed infection control training. They had a good awareness of infection prevention and control principles and understood their responsibilities in keeping people safe. This included the effective use of personal protective equipment (PPE) and safe food hygiene procedures.

The service was in an older, adapted building. During our visit, we found it to be clean and communal areas were tidy. We were assured that the provider was protecting people, relatives, staff and visitors from the risk of infection.

Regular audits were carried out to ensure the home remained clean and met hygiene standards. Staff maintained records of daily and deep cleaning which were overseen by the management team. An infection prevention and control policy was in place which reflected relevant national guidance.

People told us they were satisfied with the support they received with medicines. One person was waiting to find out if they would be able to administer their own medicines. People told us, “I am given my medicine always. It’s on time and I check them” and “Staff give me the medicine and they do give them on time. Yes I understand what they are for.” There was regular contact with a GP and psychiatrist to ensure people’s treatment needs were met and the medicines they received were appropriate to their needs.

Staff who gave medicines received training and their competency was checked by the registered manager to ensure their practice was safe. However, some staff had not received training to be able to administer medicines. We were told this was particularly night staff. Changes had been made to ensure regular medicines were given during day shifts, but there was a potential risk for people who might need ‘as required’(PRN) or emergency medication.

We were not assured medicines were managed safely in line with national guidance. We found examples where the stock of medicines held did not match the records kept by the service. We also found gaps in medicines administration records which were not clearly investigated or explained. Some medicines which people had ‘as required’ (PRN) did not have written protocols. This meant there was insufficient guidance for staff to know why, how and when to administer the medicine. There was no record of agency staff initials to enable discrepancies to be followed up. The management team confirmed there was no system in place for recording and monitoring medicines errors. The management team told us an increased use of agency staff this year had contributed to the number of medicines errors. We could not be assured people were receiving their medicines as prescribed or that there was an effective system in place to manage medicines administration and stock. Although audits were carried out, they had not identified all the shortfalls we found during our visit. Following the assessment site visit, the management team responded promptly to audit all aspects of medicines management and identify the actions required to ensure improvements were made.