Archived: Chasewood

Chasewood 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 accommodates up to 26 people, who may live with dementia, in one adapted building.

There was not a registered manager in post. The registered manager had left 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 new manager had not registered with us and they left the service in May 2018.

We found systemic and widespread failings in the management, monitoring and oversight 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 through planning and delivering care or in how the premises were used. The provider's fire risk management arrangements did not include a register of everyone who lived at the home and their oversight of fire prevention and control measures was inadequate.

The provider had failed to take the actions they said they would take to minimise risks to people’s safety related to the premises. The provider had failed to identify new risks to people’s safety related to the premises and failed to respond to staff’s repeated requests for repair or replacement of the premises and equipment.

The provider’s systems and processes did not ensure people were protected from the risks associated with medicines management, infection prevention and control and food safety and here were not always enough staff on duty to support people safely.

The provider and staff did not understand the principles of the Mental Capacity Act 2005, and one person was unlawfully deprived of their liberty. People were not always supported to receive the healthcare support they needed to minimise risks to their health.

The provider’s oversight, monitoring and auditing of the service failed to identifying risks, trends or patterns that would have enabled to them make changes to the quality of the service. The provider did not challenge staff’s practice when they were less than caring or responsive to people’s health, social and emotional needs. The provider’s failure to ensure people were treated with respect and dignity, did not give the right leadership or support to enable staff to treat people as valued individuals. Care plans contained insufficient detail about people's personal histories and interests to support staff to deliver person centred care and staff did not deliver a person-centred service.

People had limited opportunities to engage in meaningful activities that they enjoyed. 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's care plans were not updated accurately when their needs changed, to give staff the guidance they needed to support people safely and minimise their personal risks. Other 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, or any changes to their abilities and the support they needed.

People's and relatives' views of the service were 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 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.

The service provides accommodation and personal care for up to 26 older people who may live with dementia. Twenty-six people were living at the home on the day of our inspection.

The registered manager had retired from their post in December 2016, but they had not de-registered at the time of this inspection. The provider had already appointed a new manager in the expectation they would register with CQC at the end of their probationary period. We have referred to the new manager as ‘the manager’. Two deputy managers took charge of the day-to-day running and management of the service, because the manager was also the manager of the provider’s other home, which did not have an appointed deputy manager.

People were safe from the risks of harm, because staff understood their responsibilities to protect people from harm and were encouraged and supported to raise concerns under the provider’s safeguarding and whistleblowing policies.

There were enough skilled and experienced staff to support people safely. Staff understood the risks to people’s individual health and wellbeing and knew how to minimise the risks. The manager had already identified that improvements were required in recording staff’s knowledge about how to support people, to ensure their knowledge was available to be shared with new staff.

Medicines were stored, managed and administered safely by staff who were trained in medicines management. People were protected from risks related to essential supplies and equipment, through regular testing and service contracts with professional experts and equipment suppliers.

Accidents, incidents and falls were investigated and actions taken to minimise the risks of a re-occurrence for the individual. The deputy manager analysed accidents, incidents and falls and found they were attributable to each individual person’s needs and dependencies.

People’s needs were met effectively because staff had the necessary skills and experience and received appropriate training and support. The manager had identified a new training supplier to ensure all staff received training in line with the fundamental standards of care to support their induction training.

The manager understood their responsibility to comply with the requirements of the Deprivation of Liberty Safeguards (DoLS). They had applied to the Supervisory Body for the authority to restrict people’s rights, choices or liberty in their best interests. Staff understood and acted within the principles of the Act to support people to make their own decisions.

People were supported to maintain a balanced diet that was suitable for their individual dietary needs and met their preferences. Staff monitored people’s appetites, food intake, general health and moods and referred them to other healthcare professionals when they identified signs that the person was not their usual self.

People were cared for by kind and thoughtful staff who knew their individual preferences for care and their likes and dislikes. People were able to choose how they spent their day and were supported to socialise or spend time alone, according to their preferences. People enjoyed spending time with staff who took an interest in them as individuals.

Staff were guided and supported in their practice by a management team that they liked and respected. Staff shared a common purpose of delivering care that was focused on each individual person’s needs.

Improvements were required in the system for ensuring the premises were safely maintained to minimise risks. The provider had not implemented an effective premises’ maintenance policy and procedure. They had not instructed the manager and staff about their level of responsibility to report maintenance issues, or provided them with a reliable process, risk rating or timescale for taking action to repair and maintain the premises safely.

The provider had not followed their own policy, to ensure the measures they implemented to minimise risks to people’s safety met the latest standards set out by the health and safety executive’s guidance.

People we spoke with told us that the care planning was not discussed with them although staff did 'chat' to them on a daily basis. We saw that people or relatives were not involved with the reviews of people's care.

We found that staff listened to people about their care needs and their wishes. We noted people's independence was promoted within their care plans and on the day of our inspection.

We found that the care plans were person centred and reflected people's individual needs. We saw the members of staff supported people as detailed within their care plans. We observed that staff were compassionate and caring when supporting people.

People we spoke with told us that staff were friendly and supported their needs well. Staff we spoke with knew what people's care needs were and how they needed to be supported.

Staff demonstrated a good understanding of their responsibilities in providing a clean environment for people receiving support.

We spoke with staff who told us they were supported by the management team. They also told us that training was provided which was specific to meet people's support needs.

We found there were systems were in place to monitor the quality of service being provided.

We saw people's bedrooms were clean, warm and well furnished. People had brought some personal items with them into the care home and this made their rooms "homely".

We asked relatives about the care provided to their family and they each told us that the care delivered to people was good. They told us, 'All the staff are friendly and XX is really settled here' and 'Everyone, (staff), is friendly and caring. The manager is very approachable.'

We found staff understood the needs of the people using the service. They told us they had support and guidance through care planning and training to meet the more complex needs, such as dementia.

We read the recruitment records for two staff newly employed to work at Chasewood and found all necessary checks to ensure their fitness to deliver care had taken place, this included Criminal Record Bureau checks, (CRB).