Archived: Chelsham Lodge

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.

There was not 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 and associated Regulations about how the service is run. A new manager had just taken over management oversight of the home and had applied to CQC to become registered manager.

We last inspection Chelsham Lodge in March 2015 where we found that staff did not always show people respect. Although this inspection was a routine fully comprehensive inspection we carried out observations to check that the provider had taken action following our last inspection to ensure people were always treated with respect. We found staff were respectful and caring towards people; however people lived in an environment that was in need of refurbishment. Although we were told refurbishment plans were in place, these had been ongoing for some time and in the meantime people lived in premises that were not homely. There were a lack of sensory items for people both inside and outside of the home.

On the whole staff treated people with care and respect; however we observed staff practices were task orientated. Although people had the opportunity to participate in activities both in and outside of the home these lacked creativity and staff had not taken time to consider exploring alternative activities for people. People’s care plans were detailed and comprehensive, however we found some information which would have been useful for staff had not be included.

Staff and the provider undertook quality assurance audits to ensure the care provided was of a standard people should expect. However we found that actions identified from these were not always acted upon.

Staff said they felt supported and we found staff were aware of their responsibilities to safeguard people from abuse. Appropriate checks were carried out to help ensure only suitable staff worked in the home.

Staff had identified and assessed individual risks for people. Accidents and incidents that occurred were recorded and appropriate action taken. Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

Staff supported people to keep healthy by providing nutritious foods. People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health. Staff encouraged people to carry out daily living routines, such as their laundry.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

There were a sufficient number of staff on duty to enable people to either stay indoors or go out to their individual activities. Staff understood people’s individuality and needs and respected people when they wished to have time alone.

Staff received a range of training which included training specific to the needs of people living at Chelsham Lodge. This allowed them to carry out their role in an effective and competent way. Staff met together regularly as a team to discuss all aspects of the home.

If an emergency occurred or the home had to close for a period of time, people’s care would not be interrupted as there were procedures in place.

A complaints procedure was available for any concerns. Relatives were encouraged to give feedback on the care their family member received. People were involved in their care through regular keyworker meetings.

During the inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. We also made one recommendation 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.

The service had reviewed and developed the activities provided to the people who used the service. The service maintains a complete log of all activities and outing that people were engaged in service provided a good degree of flexibility in respect of the activities available to the people who used the service.

People who used the service were protected from the risk of abuse. The service had safeguarding procedures in place which were linked to Surrey County Council safeguarding vulnerable adults from abuse procedures.

The general environment of the service was relatively well maintained. The people who used the service had individual bedrooms which demonstrated their likes and dislikes.

The service had completed a Quality Assurance (QA) questionnaire of family members, medical and social care professionals. The QA demonstrated a very high level of satisfaction with the care and support that was offered to the people who used the service.

The care plans were clear and provided good guidance for staff to follow.

We conducted a random survey of relatives of people who use the service. One person told us that this "was the best service" that their relative had stayed in.

Staff stated that they were trained to work and support with the people who use the service in a way that "ensures dignity and provides respects to the individual we are working".

Care plans were routinely reviewed or updated when peoples needs had changed. The care and treatment is delivered to ensure people's safety and welfare.

Care plans recorded the social and leisure preferences of people using the service, there were no signs of social or leisure activities being available, due to ongoing issues with transport. A review of the day records for a three week period indicated that activities had not happened as per individual schedules. We have set a compliance action upon the provider to address this.

People were protected from the risk of abuse, the provider had taken steps to identify the possibility of abuse and prevent it.

On the day of our inspection there was enough qualified, skilled and experienced staff on duty to meet the needs of the people who use the service.