Archived: Chelsham Lodge

Updated 9 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 13 March 2018 and was unannounced. The inspection team consisted of two inspectors. We carried out this inspection due to concerns we had received from the local authority Quality Assurance (QA) team. In addition, the service was subject to a safeguarding concern following the death of someone who had lived at the service.

Before the inspection we gathered information about the service. We reviewed records held by CQC which included notifications, complaints and any safeguarding concerns. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing potential areas of concern at the inspection.

As part of our inspection we were unable to speak to people due to their communication needs. Instead we carried out observations of interactions between people and staff to see how people responded. We spoke with the manager, six staff and the area manager as part of inspection. We reviewed the care plans for four people, medicines records and the records of accidents and incidents. Following the inspection we received feedback from two relative’s about their views of the service.

We saw records of quality assurance audits and looked at other paperwork relevant to the running of the service. After the inspection we were provided with information from the manager relating to quality assurance and training and supervision of staff.

The last inspection of this service took place in May 2017 when we rated the service as Requires Improvement.

Updated 9 May 2018

We carried out this unannounced inspection to Chelsham Lodge on 13 March 2018. This inspection was brought forward due to concerns we had received from Surrey County Council’s quality assurance team. Chelsham Lodge is registered to provide accommodation with personal care for up to six people with physical and learning disabilities. At the time of our visit five people lived at the service.

There was no registered manager in post. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager (the manager) had started at the service in November 2017 and they were in the process of registering with CQC.

People were at risk of harm living at Chelsham Lodge. This was because there was a lack of robust medicines management processes and infection control procedures followed by staff. People lived in premises that were not fit for purpose and although staff had identified risks to people staff did not always follow written guidance. Alleged safeguarding concerns had not been escalated by staff and as such not notified to CQC which is a statutory requirement of any registered service. In the event of a fire or evacuation there was insufficient information relating to people available for staff.

Staff did not have access to regular refresher training and although staff had national guidance in place to follow they lacked knowledge in relation to some of this. Staff did not always encourage people to eat healthy and nutritious foods and referrals to health care professionals were not always made in a timely manner.

People were not shown respect or dignity by staff. People’s rooms lacked personalisation and care and we found staff did not always show care or regard to people. We did however see some individual examples of attentive care from staff. Although guidance was in place for people staff were not always aware of it and people were not always being supported to participate in individualised, meaningful activities.

The registered provider had failed to ensure there was a registered manager in post manager for 11 months. This is a statutory requirement for a service registered with CQC.

There was a lack of management oversight at the service and by the registered provider and a lack of robust governance arrangements. Regular audits were not being completed to help ensure people received a good service and those that were carried out had not identified shortfalls. The manager had developed an overarching action plan since joining the service and was working on the culture within the staff team. Staff meetings were held and as such staff felt supported by the manager and told us they felt the service was improving. People were cared for by a sufficient number of staff and good recruitment processes were in place.

Staff were aware of the principals of the Mental Capacity Act. Although people could make a complaint the manager was unable to find all documentation relating to complaints.

During our inspection we found two continued breaches and seven new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The failure to have a registered manager in post was a Section 33 offence of the Health and Social Care Act. We also made three recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report. 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.

The overall rating for this service is ‘Inadequate’ and the service has therefore been placed in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent

enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.