Archived: Chasewood Care Limited

Updated 18 August 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 was planned to check 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.

Chasewood Care Limited is a residential care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 107 older people, in six units, on two floors, some of whom live with dementia. At the time of our inspection, 50 people were living at the home permanently and seven people were living at the home temporarily after a stay in hospital.

This was a comprehensive inspection, prompted in part, because we received information of concern from a whistle-blower and from a healthcare professional about the leadership and governance of the home and because of the history of the service. We brought our scheduled inspection forward to check whether there was any substance to the whistleblowing information; whether the provider had taken the improvement actions they said they would take; and to check how and when they intended to meet the conditions of their registration. We reviewed the information we held about the service and information that was shared with us by the whistle-blower and by the local commissioners of care and healthcare professionals.

Following our inspection in November 2017, the service had been rated as ‘requires improvement’ in well-led and overall. The provider had sent us an action plan setting out how they planned to improve. The provider has been in breach of two conditions of their registration since May 2017. There was not a registered manager in post, and there had not been a registered manager since December 2016. At our inspection in April 2016, the provider was in continued breach of Regulation 17, so we imposed an additional condition on their registration in December 2016. The additional condition requires the provider to send us copies of their audit reports each month. They had not complied with this condition effectively since May 2017.

The inspection visit took place over four days. Three inspectors and an expert by experience visited the service on 17 April 2018. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of dementia care service. This visit was unannounced. We told the provider we would come back on 19 and 20 April 2018. A pharmacy inspector visited the service on 19 April 2018 and two inspectors visited the service on 20 April 2018. One inspector visited the service on 27 April 2018, and this visit was unannounced.

We did not ask the provider to complete a provider information return (PIR) before our inspection, because this was a responsive inspection. The PIR is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During our inspection visit, we spoke with three people who used the service and four relatives about what was like to live at the home. We spoke with a visiting healthcare professional; the provider, a director of the service, the manager and 13 staff, including two deputy managers and seven care staff, the head of kitchen and housekeeping, the kitchen assistant and two domestic staff.

We reviewed five people’s care plans and looked at elements of another five people’s care records. We reviewed ten people’s medicines administration records and other records associated with medicines administration. We reviewed six staff recruitment records and records of the checks the provider and mana

Updated 18 August 2018

The first day of our inspection visit was on 17 April 2108 and was unannounced. We told the provider a pharmacy inspector would carry out an inspection of medicines administration and management on 19 April 2018 and two inspectors would visit again on 20 April 2018. We made a fourth visit to the service on 27 April 2018, to follow up on areas that required clarification.

Chasewood Care Ltd is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home is registered to accommodate 107 older people in six units across two floors of one building. The care home provides the service for older people, who may live with dementia. Fifty seven people lived at the home at the time of our inspection visit.

We previously found the provider was in breach of the Regulations in safe and well-led and rated the service requires improvement overall. We asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions of safe and well-led, to at least good. The provider sent us their action plan in February 2018 and we looked at their action plan as part of this inspection. We found the provider had not taken the actions they said they would take to improve the service, in line with their action plan. The provider had not made the improvements in the quality of the service required to meet the Regulations and continued to be in breach of the same Regulations and in breach of other Regulations and of the conditions of their registration.

The provider had not sent us the copies of their audit reports by the 28 of each month, as required by the additional condition of registration we imposed in December 2016.

There was not a registered manager in post. The previous registered manager had retired from the service in December 2016. 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 manager had worked at the service since June 2017. They had not registered with us. There had not been a registered manager in post for fifteen months.

We found systematic and widespread failings in the oversight, monitoring and management of the service, which meant people did not always receive safe care. There was not an effective system to identify and manage risks to people’s safety in how the premises were used. The provider’s fire risk assessment had not been reviewed since January 2017 and contained out of date information. There were no signs or reference points to support an evacuation in an emergency or to enable people, staff or visitors to find their way around the building. There was not enough mobility equipment to ensure people were supported safely when they needed support.

The system and process of assessing individual risks to people’s health and safety, through personalised care planning, was not effective. People’s care plans did not give staff the guidance they needed to support people safely and minimise their personal risks. People’s care plans were not updated accurately when their needs and abilities changed, which put them at risk of poor care that did not meet their needs.

Improvements were required in the management and administration of medicines to ensure people received their medicines when they needed them and in accordance with their prescriptions.

The oversight, monitoring and auditing of the service failed to identifying risks, trends or patterns that would have enabled to them make changes to minimise the risks of a re-occurrence and make improvements to the quality of service. The provider had not ensured that all allegations of abuse were referred to the local safeguarding authority and had failed to notify us when they did make such referrals. The provider had not always notified us when a person died and had failed to notify us of other important events at the service. Failures to notify us of serious injuries and safeguarding incidents, had prevented us from monitoring the service effectively.

Records related to people’s care, support and treatment were incomplete or not up to date. There was not an effective or auditable system of sharing important information about people’s needs, any incidents they were involved in or any changes to their abilities. Care plans contained insufficient detail about people’s personal histories and interests to support staff to deliver person centred care.

The provider did not operate an effective complaints handling system that would have enabled them to identify trends or areas of risk that they could have addressed to improve people’s experience of the service.

People felt staff had the skills and experience to care for and support them, but staff did not always receive the training they needed to support people effectively. Some staff did not recognise that the way they supported a person who presented behaviour that challenged was uncaring and could amount to a deprivation of the person’s liberty. Staff had variable understanding of the meaning of dignity, respect and promoting independence. People had limited opportunities to engage in meaningful activities that they enjoyed.

People were not consistently offered a choice of meals and the provider had not ensured there were sufficient supplies to provide the meals according to their planned menus. The provider had failed to ensure that people were enabled to find their way around independently, due to a lack of directional signs or points of reference along the corridors.

The provider, manager and staff did not work together to improve the quality of the service. People’s or relatives’ views of the service not sought, heard or responded to. Staff experienced a lack of communication, inconsistent direction and guidance and were not supported to be instrumental in making the required improvements. The provider had not met with the staff to hear their concerns or suggestions for improving the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures. This is the second time the service has been in special measures since November 2015. 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.