Cheddar Grove Nursing Home

Updated 4 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by one inspector.

Service and service type

Cheddar Grove is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Cheddar Grove is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. They were on a period of leave and an interim manager had been redeployed by the Trust to support the home.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with two people who used the service about their experience of the care provided and spent time with others observing interactions with staff. We spoke with three members of staff, the interim manager, a representative from the Trust’s quality assurance team, a representative from the Trust’s human resources team and two health professionals visiting the service.

We spoke with three relatives and contacted a further three health and social care professionals about their experience of the service via email and telephone. We also had a virtual meeting with the nominated individual and the head of operations.

We reviewed a range of records. This included three people's care records, daily records and medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service including training data, staff rotas and quality assurance records.

Updated 4 November 2022

About the service

Cheddar Grove is care home providing personal and nursing care to seven people with a learning disability or autistic people. At the time of our inspection there were six people using the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People’s experience of using this service and what we found

Right Support:

Staff were passionate about providing care that was tailored to the person. Relatives praised the home on the care and support provided to their loved ones. Regular contact was maintained with family and the person’s named representative was involved in reviews of care. Overall, relatives felt communication was good. People continued to be well supported with meaningful activities in their home and the community.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Infection control procedures and measures were in place to protect people from infection control risks associated with COVID-19.

People were supported by enough staff. The home was experiencing workforce pressures and agency staff were being utilised to ensure there were enough staff supporting people.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report safeguarding concerns.

People had access to healthcare professionals when they became unwell or required specialist support. The interim manager was proactively working with professionals to improve communication and ensure people received care that was safe and meeting their individual needs.

Right Care:

People were not always kept safe as the advice of health professionals and risk assessments were not always followed.

Staff interaction with people was warm, caring and respectful. People were involved and staff were observed asking people how they wanted to be supported. Family members told us their relative were cared for and treated well.

Medicines were managed safely. Although during the summer they had experienced some difficulties with the pharmacist not supplying medication in a timely manner. Staff told us they were looking to change to a local pharmacist to aid improvement in this area.

Right Culture:

In the last two years there had been a high turnover of staff. There had also been a change of management. Health and social care professionals had raised concerns in respect of the communication between the team and themselves and as consequence not following their advice. An interim manager had been redeployed to assist with making improvements and providing leadership and direction to the team.

The staff were committed to getting it right for people. Care was person centred and tailored to each individual. Health and social care professionals were regular visitors to the service.

The provider and the manager had implemented a robust system to monitor the quality of the service. However, improvements were needed to ensure records relating to the care of people were consistently completed such as fluid charts, monthly summaries and epilepsy monitoring charts.

Rating at last inspection and update

The last rating for this service was good (published 16 February 2019).

Why we inspected

The inspection was prompted in part by a notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risks to people. This inspection examined those risks.

Since the death the management team had reviewed risks assessments and an interim manager had been brought into work with the staff team.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

For enforcement decisions taken during the period that the ‘COVID-19 – Enforcement principles and decision-making framework’ applies, add the following paragraph: We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have found evidence that the provider needs to make improvements. We have identified breaches in relation to safe care and treatment and in good governance relating to record keeping. Please see the safe and the well led section of this report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cheddar Grove on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.