Archived: Cheyne House Nursing

This inspection took place on 4 and 5 January 2017 and was unannounced.

Cheyne House Nursing is registered to provide accommodation and nursing and personal care for up to 26 older people or people living with dementia. There were 15 people living at the service on the day of our inspection.

We carried out an unannounced comprehensive inspection of this service on 2 July 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook a focussed inspection on 30 June 2016 and 1 July 2016 to check that they had followed their plan and to confirm that they now met legal requirements. Breaches of legal requirements were found. Following this inspection we imposed conditions on the registered provider. These conditions meant that the provider was required to take specific actions to improve the service and meet legal requirements.

We undertook a focussed inspection on 23 August 2016 following information received about concerns to check that the provider had taken action with regard to issues raised by ourselves and other agencies who commission care for people living at the service. We also wanted to confirm their progress against conditions of registration which were put in place following the inspection in June and July 2016 met legal requirements. At our inspection on 23 August 2016 we found that the provider continued to be in breach of the regulations and had not made sufficient progress against the conditions of registration we had put in place.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and breaches in Care Quality Commission (Registration) Regulations 2009. The provider had not ensured that people were kept consistently safe from the risk of harm or neglect, that people were provided with person centred care, did not follow safe recruitment practices, there were weaknesses in monitoring the quality of the service and the provider did not display their ratings from their last inspection.

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 did not follow safe and effective recruitment procedures and did not ensure that all safety checks had been made. Fire safety evacuation plans put people and staff at risk of harm in event of a fire. We found that infection control practices had improved and people were now cared for in a clean environment.

Staff did not always have the knowledge and skills to provide people with effective care that met their care needs. Staff had received appropriate training, and understood the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. However, staff did not follow the correct procedure when a person was unable to consent to their care and treatment. People received a balanced and nutritious diet and drinks and snacks were provided between meals.

People were cared for by kind and caring staff. Care plans were not always person-centred and people were not involved in planning their care.

There was poor communication between staff and the registered manager that resulted in people not always receiving appropriate care in a timely manner. Activities provided to people did not reflect their interests and pastimes.

The provider did not ensure that the audits undertaken reflected the care that people received and there was no follow up to check that identified actions had been completed.

The overall rating for this service is inadequate and therefore the service is in special measures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

We undertook this focussed inspection on 23 August 2016 following information received about concerns to check that the provider had taken action with regard to issues raised by ourselves and other agencies who commission care for people living at the service. We also wanted to confirm their progress against conditions of registration which were put in place following the inspection in June and July 2016 now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection; by selecting the 'all reports' link for Cheyne House Nursing on our website at www.cqc.org.uk. In addition we had received information of concern about the standards of care provided at Cheyne House Nursing.

This inspection took place on 23 August 2016 and was unannounced.

Cheyne House Nursing is registered to provide accommodation and nursing and personal care for up to 26 older people or people living with dementia. There were 17 people living at the service on the day of our inspection.

There was not a registered manager in post at the time of our inspection. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our inspection in September 2015 we asked the provider to take action to ensure they notified CQC when a request to lawfully deprive a person of their liberty was granted and operated effective systems and processes to make sure that they assessed and monitored their service. The provider sent us an action plan on 11 March 2016 and told us that these actions would be completed by 30 May 2016. We inspected again on 31 June 2016 and 1 July 2016 and found that the provider had not made all of the required improvements. At this inspection we found that the provider had still not made all the required improvements.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and breaches in Care Quality Commission (Registration) Regulations 2009. The provider had not ensured that people were kept consistently safe from the risk of harm and neglect, did not ensure the proper and safe management of medicines; did not work within the requirements of the Mental Capacity Act 2005, and there were weaknesses in the monitoring of the quality of the service and reporting statutory notification to CQC. You can see what action we told the registered provider to take at the back of the full version of the report.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. At this inspection we found 15 people had a lawful DoLS authorisation in place. The provider had not notified us of these authorisations.

Standards of cleanliness had improved throughout the service. Staff had received training on infection control. However there remained areas which required improvement.

Medicines were not administered safely by staff. Referrals to other healthcare professionals had been made where people required additional support.

There was not always enough staff on duty to care for people’s needs. The registered provider did not support staff to ensure they always had the competencies to meet the health and wellbeing needs of the people who lived at the service.

People were provided with enough to eat and drink. People did not always have a choice at mealtimes.

People had their risk of harm assessed. Systems to monitor the quality of care including record keeping were insufficient to lead to improvements in the care people received.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection; by selecting the 'all reports' link for Cheyne House Nursing on our website at www.cqc.org.uk In addition we had received information of concern about the standards of care provided at Cheyne House Nursing.

This inspection took place on 30 June 2016 and 01 July 2016 and was unannounced.

Cheyne House Nursing is registered to provide accommodation and nursing and personal care for up to 26 older people or people living with dementia. There were 19 people living at the service on the day of our inspection.

There was not a registered manager in post at the time of our inspection. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in September 2015 we asked the provider to take action to ensure they notified CQC when a request to lawfully deprive a person of their liberty was granted and operated effective systems and processes to make sure that they assessed and monitored their service. The provider sent us an action plan on 11 March 2016 and told us that these actions would be completed by 30 May 2016. On this inspection we found that the provider had not made all of the required improvements.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and breaches in Care Quality Commission (Registration) Regulations 2009. The provider had not ensured that people were kept safe from the risk of harm and neglect, did not ensure the proper and safe management of medicines; did not ensure the service was clean and properly maintained; did not work within the requirements of the Mental Capacity Act 2005, and there were weaknesses in the monitoring of the quality of the service and reporting statutory notification to CQC. You can see what action we told the registered provider to take at the back of the full version of the report.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. Five people at the time of our inspection had their freedom unlawfully restricted and two people had a lawful DoLS authorisation in place.

Standards of cleanliness were not always maintained throughout the service and there was a risk of cross contamination from soiled and damaged equipment and poor infection control practices.

Medicines were not always stored and administered safely by staff that had the skills and competencies to do so. Staff did not always refer people to other healthcare professionals and people were at risk of not receiving appropriate care and treatment in a timely manner.

There was not always enough staff on duty to care for people’s needs. The registered provider did not support staff to undertake training to meet the health and wellbeing needs of the people who lived at the service.

People were not always provided with enough to eat and drink. The registered provider did not seek support and advice from appropriate health professionals when a person was a risk of weight loss or had difficulty swallowing.

People did not always have their risk of harm assessed and systems to monitor the quality of care delivered were insufficient to lead to improvements in the care people received.

When we visited this service on 30 May 2014 we found that the service was not compliant because the provider had not ensured that people were always treated with dignity, consideration and respect. We found this had a minor impact on people who used the service.

Following our last inspection we asked the provider for an action plan. The provider sent the action plan to us on 17 July 2014 and told us that they would make improvements by 31 October 2014.

During this inspection we found that the provider had not made the improvements they said they would make in their action plan. Furthermore we identified further areas of concern.

At lunchtime we undertook a short observational framework for inspection (SOFI) in the dining room, one lounge and one person's bedroom. SOFI helps us to understand people's perceptions of the care and treatment they receive when they are unable to tell us themselves. We have used this to find out about the lunchtime experience of people living with dementia.

During this inspection we saw that people were not always treated with dignity, consideration and respect.

At lunchtime we undertook a Short Observational Framework for Inspection (SOFI) in the dining room. SOFI helps us to understand people's perceptions of the care and treatment they receive when they are unable to tell us themselves. We have used this to find out about the lunchtime experience of people living with dementia.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our discussions with people using the service and the staff supporting them. We spoke with four people and one relative. We also looked at six care records.

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

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom.

We saw the service had policies and procedures in relation to safeguarding vulnerable adults and whistle blowing. We spoke with care staff who understood what was meant by abuse and knew how to report their concerns.

Care staff told us they ensured equipment was in good working and reported any faults in order to keep people safe.

Is the service effective?

We found staff attended training courses to meet the individual needs of people in their care such as the care of a person living with dementia.

The registered nurses told us they attended regular meetings. One told us, 'We have regular meetings, but if we have a problem we get together and discuss and resolve the problem.'

Is the service caring?

We found that people were not always treated with dignity and respect. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the dignity, privacy and independence of service users.

We spoke with people who told us they were well cared for. One person told us, 'I'm well looked after, [staff] very nice, would do anything for you.'

Is the service responsive?

We saw when care workers raised concerns about people's health and social care needs, that the provider had contacted appropriate health and social care professionals. The individual care files identified this and a record of actions taken were recorded.

We saw the provider had contingency plans in place in event of an emergency situation.

Is the service well led?

We saw the results of the annual quality questionnaire for people and their families. Most comments were positive such as, 'The care you deliver is second to none' and 'Standards of care are excellent.'

All the staff we spoke with said that the manager was approachable. One staff member said, 'They encourage us, ask for our feedback, what we can do to improve the service.'

During the visit we spoke with the nurse on duty, a care worker, the cook, a housekeeper and the registered manager. We also looked at some of the records held in the service. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people were supported to make decisions about their care. People's individual characteristics were respected and their privacy and dignity were promoted.

We found people had a choice of suitable and nutritious food and people's individual preferences were taken into account.

We found the provider had an effective system to assess the risk and spread of a health care associated infection. People were cared for in an environment that was kept clean and hygienic.

We found the provider had not ensured people's health and welfare needs were met by sufficient numbers of appropriate staff.

People could be confident their personal records were accurate, fit for purpose held securely and remain confidential.

We spoke with four care staff, the cook, the nurse in charge and the registered manager. We also looked at some of the records held in the service including the care files for four people.

We saw that staff asked people who used the service for their agreement and consent over everyday issues. This included things like a staff member asking if they could move someone's walking frame to get by.

People we spoke with who were able to give consent told us staff always asked for their agreement. One person told us, 'I get on very well with the staff, they always ask for my permission. If I say no they abide by it'

The menu did not offer a choice of meal although we did see one person was given an alternative meal. One person told us, 'We don't get a choice often apart from eat it or eat it not!' Another person said, I would love to have a proper Sunday lunch.'

People felt they could say if things were not right for them. One person who used the service told us, 'If it is not right you can say, they do not mind.'