Archived: Le Chalet

Le Chalet is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Le Chalet is a care home registered to provide accommodation with personal care for up to 12 people in one adapted building. 12 people lived at the service when we visited, with one of the people in hospital.

We had previously carried out an unannounced comprehensive inspection of this service in March 2015. At that inspection we rated the service as good overall. The effective, caring, responsive and well led sections were good. The safe section required improvement due to low numbers of staff on duty. We then carried out a further comprehensive inspection in February 2017. Following that inspection the service was rated as requires improvement overall. The caring section was good. The safe, effective, responsive and well led sections required improvement. Five breaches of regulation were found. We found concerns relating to people’s health, care and welfare. There were not sufficient numbers of suitably qualified, skilled and experienced staff on duty at all times to meet people’s needs. The principles of the Mental Capacity Act (2005) had not been followed. The service had not notified the CQC of incidents as required by law. The provider’s quality assurance systems did not effectively assess and monitor the quality of the service.

Following the inspection in February 2017, the provider submitted a service improvement plan (SIP) to CQC. We then met with the provider and newly appointed manager to discuss the SIP and the timescales required to meet their legal requirements. The local authority Quality Assurance Improvement Team (QAIT) supported and worked with the service up to December 2017 to address the breaches of regulation.

The manager was now the registered manager of the service. A registered manager is a person who has registered with the 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.

At this comprehensive inspection, we found the provider and registered manager had made improvements to how the service was run. The breaches of regulation had been met. However, there were still further improvements to be made. This related to:

• The management and leadership of the home and the embedding of quality monitoring systems

• The adaptations, fabric and furnishings of the home to make it an environmentally safe and pleasant place for people to live

People and relatives were happy with the care and support provided at Le Chalet. They spoke positively of the management and staff team. There was a relaxed, homely and happy atmosphere at the home.

There were sufficient and suitable numbers of staff on duty to keep people safe and fully meet their needs. The service had recently had two staff members leave. The registered manager had acted quickly and recruited three new members.

Recruitment checks were safely carried out with updated employment records in place. Staff received regular induction, training and supervision. Some of the staff had been historically reluctant to undertake training in the past but the registered manager had addressed this by introducing new training programmes.

People were protected by staff who had been trained in safeguarding people from abuse. They had undertaken training, knew the right action to take and who to inform if abuse had been suspected.

People’s needs were assessed before they came to live at the service. People had personalised and comprehensive care plans in place. They contained all the information required and detailed people’s preferences, choices and interests. Risk assessments had been carried out in a way to ensure people were restricted as less as possible. People were involved in making decisions about their care. They were referred promptly to health care services when required and received on-going healthcare support.

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 supported this practice. Improvements had been made in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed. Staff knew which people had a Power of Attorney (POA) in place to support the person in decision making. Best interest decisions had been made and involved the relevant parties.

People received their medicines in a safe way and effective systems were in place. The registered manager and staff were committed to ensuring people received end of life care at the service in an individualised way. An activities co-ordinator had been employed. People had a choice of activities and interests to take part in.

Staff were polite and respectful when supporting people. They had built up relationships with the people they supported and knew them and their families well. People’s relatives and friends were able to visit at all times and were complimentary of the service. Regular feedback was sought from residents and their relatives.

The majority of staff felt were motivated and proud of their jobs. They felt they were listened to and had confidence in the registered manager. There had been some unsettlement recently in the staff team but this had been addressed by the provider and registered manager.

People were complimentary of the food and enjoyed the choice of home cooked meals. They were given choices and asked about their favourite meals.

There was a complaints procedure in place and people knew how to make a complaint if necessary.

People, relatives and health and social care professionals were complimentary of the registered manager and their approach. They spoke of them having good communication, together with fostering a friendly and open culture at the service. A quality monitoring system had been put into place which monitored and improved various aspects of the service. This was being further developed to cover all areas of the service.

The physical environment was not consistently decorated or adapted to meet people’s needs. A maintenance and improvement programme was not in place. Therefore, areas of the home which required refurbishment and maintenance were not monitored. There were no specific dates and timescales for actions to be completed by. Some aspects of the service were tired, not fit for purpose and would benefit from continued investment in the premises.

This comprehensive inspection took place on 3, 22 and 23 February 2017. At our last inspection on 12 March 2015 we found a breach of regulation with regards to staffing levels. We asked the provider to take action to meet the legal requirement. We did not receive an action plan. We found this breach of regulation had not been met.

There was no registered manager in place. The last registered manager had left several months before and successfully deregistered with the Care Quality Commission (CQC) in November 2016. A registered manager is a person who has registered with CQC 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 about how the service is run.

The service had a manager in place. They had applied to the CQC to become joint registered manager for both this service and another service owned by the same organisation in Cornwall, approximately 100 miles away. Staff felt supported by the new manager and felt the service had changed for the better. Following the inspection, the nominated individual confirmed the manager would not be continuing in their application to be registered by CQC at Le Chalet. They were actively recruiting for a new full-time manager.

Not all environmental risks to people had been identified and reduced. Hot water from taps was found to be in excess of the temperatures required under the Health and Safety Executive guidance. This put people at unnecessary risk of scalding. Following the inspection, the nominated individual confirmed this had been addressed and resolved.

Whilst there were some audit systems in place to monitor the running of the service, these did not include all of the areas required. The provider visited regularly but had not always checked on the quality of the systems and the running of the service. Following the inspection, the responsible individual confirmed changes in the management of the service.

The CQC had not received the formal notifications from the service. These are for events which affect the running of the service and are required to be sent by law.

There were not always adequate staff available on duty to meet people’s individual needs and choices in a timely way. No dependency tool was used to assess people’s needs and how many care staff were required to be on duty.

Staff did not always initially follow the correct infection control procedures to prevent the unnecessary spread of infection to people. However, these procedures were improved during the inspection.

The manager and staff had some understanding of the Mental Capacity Act 2005 and how it applied to their practice. However, the correct procedure for following the MCA had not always been followed. For those people who required it, applications had been made to the Deprivation of Liberty Safeguards team.

Staff were safely recruited, trained and supervised to do their jobs properly. They worked as a team, some of whom had worked there for several years. They knew how to recognise and report signs of abuse. They knew the correct procedures to report this.

People were very complimentary of the food. There had been recent changes in the kitchen and a new cook employed. They were in the process of developing new menu plans to reflect people’s likes and dislikes. Food was nutritious and home-made as much as possible. Not everyone received the support they needed to eat their food and at the right times.

People felt safe at Le Chalet and were very complimentary of the staff. Lots of positive comments were given which included, “They (staff) are brilliant”, “Staff are lovely”, They (staff) are very helpful and kind … I can’t think of a time they have not been kind … I couldn’t wish for better” and “Staff look after me … it’s very nice here.”

People had an assessment undertaken before they went to live at Le Chalet and each person had a personalised care plan in place with all the information required. Individual risks were identified and reduced as much as possible. People had previously been able to take part in activities but since the activities co-ordinator had left these had been limited. A new co-ordinator was in the process of being employed.

People received their medicines safely and on time. Where necessary, staff sought advice and guidance from health and social care professionals and acted upon it.

People and their relatives knew how to raise any concerns and felt they would be listened to by the manager.

Visitors were welcomed into the home and felt involved in their relative’s care. Relationships between staff and family members had been developed. Relatives were complimentary of the care staff and commented, “It’s like home from home and my (family member) loves it … you couldn’t wish for better care than here”, “The (staff) do look after him … he gets everything he needs” and “My first impression of the home was people were sat outside laughing and joking and looked ‘so happy’.”

The service had an on going programme of continued maintenance and redecoration in place. This addressed all areas of the home and garden.

People’s views were not always taken into account due to a lack of meetings, feedback and quality monitoring.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Health and Social Act (Registration) Regulation 2009.

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

There were 12 people living at the home, one of whom was having respite care. We spoke with 5 people living at Le Chalet. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care. We spoke with five staff members, the registered manager, the provider and two relatives. We looked at four sets of care records, focussing on how people's health and well-being were supported, including people's dietary and medication needs.

We saw people looking relaxed and at ease with staff and each other. People's health and well-being care needs were assessed, and care was provided in a way that suited people's individual needs. Medication was well managed, as were people's nutritional needs. People were offered choices in relation to meals and drinks, and meals were a social event. The manager recognised people's changing health and emotional care needs, and requested additional support where necessary.

We looked at some key documents including care plans, risk assessments, staff training and supervision records. This helped us to make a judgement about how well the home was being run.

We heard positive comments from everyone we spoke with. One person told us, for example ''I have been here two years now. They do look after us well. If they didn't they would get the length of my tongue. They (staff) have to put up with a lot sometimes. They do very well.''

Care was being planned and people were involved in making decisions about their care and treatment and activities of daily living. We saw that people were encouraged to be engaged in various activities and we heard from the manager that the provider had given the staff team some additional hours to take people out and about in the local community and organise planned activities within the home.

Staff had received support and training to do their job and this was being monitored by the provider and manager via team meetings and one to one supervison.

We saw that records were kept secure, were accurate and up to date. There were two entries within daily records for people that were not objective. This has been addressed via additional training and support to staff.