Archived: Chardwood Rest Home

Chardwood Rest Home is converted property located in Pevensey Bay providing care and support for up to 15 older people including some people living with mild dementia and memory loss. There were 12 people living at the home, one person was in hospital at the time of the inspection,

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

Risks to people were not always assessed and reviewed effectively. Care plans and risk assessments had not been reviewed and updated when changes had occurred. One person’s PEEPs had both of their names written incorrectly, this had not been identified by management or staff. This would put them at risk in the event of an emergency evacuation. Care folders had not been maintained to ensure information was easily accessible clear and up to date.

Medicine processes had not been safely maintained. People were not receiving their medicines in accordance with their prescriptions. PRN medicines did not have protocols in place to ensure they were administered, monitored and reviewed regularly. Rationales behind decisions had not been recorded.

Governance systems needed to be improved. Quality assurance systems were not robust and had not identified the issues and concerns found during the inspection. The provider confirmed that audits had not been effective, and improvements were needed.

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. People had the opportunity to feedback their views and opinions of the service.

The service had a relaxed, homely feel. People’s rooms were personalised and staff told us they knew people well. Feedback from people and relatives was positive. One told us, “The owner is lovely; she looks after us all.” Daily records were written at the end of each shift and relevant information handed over verbally to staff coming on duty. The provider was also one of the registered managers. They spent a lot of time at the home providing care and supporting staff. Both managers covered care duties and also cooked meals when no cook was available.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection The last rating for this service was good (published 19 May 2018).

Why we inspected

We received concerns in relation to staffing, training, infection control, documentation management and leadership of the service. A decision was made for us to inspect and examine these risks.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

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 identified breaches in relation to safe care and treatment, risk management, medicines and the management and governance at the service.

Please see the action we have told the provider to take at the end of this report.

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.

Chardwood Rest Home was a small service and not purpose built. People were reminded to social distance when at all possible. During an outbreak at the home, people were supported to isolate in their rooms when they tested positive for Covid-19.

The provider was completing regular testing in line with current government guidance. There had not been any new admissions to the home for some time. However, the registered manager was aware of current admission procedures to be followed.

The provider had an infection control policy in place and a monthly Infection Prevention and Control (IPC) audit had been completed.

Chardwood Rest Home is a detached property close to the seafront in Pevensey Bay. It provides care and support for up to 15 older people with care needs associated with age. This includes people with low physical and health needs and people with mild dementia and memory loss. Chardwood Rest Home provides respite care that includes supporting people while family members are on a break, or to provide additional support to cover an illness.

At the time of this inspection twelve people were living in the service. This inspection took place on 15 and 20 March 2018 and was unannounced.

There is a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

At the last inspection in January 2017 the provider was rated requires improvement with a breach of regulation 12. This was because the provider had not ensured that appropriate staffing had been maintained in order to ensure people's safety at all times. The provider had not ensured people were handled and moved in a safe way at all times and had not ensured all medicines were stored safely.

At this inspection we found this regulation had been met and the service was rated ‘Good’ overall.

However we found the management arrangements did not ensure effective leadership was in place at all times. When the registered and deputy manager were on annual leave together suitable management arrangements had not been assured. During their absence no one had been designated day to day management responsibility. This meant there was no one able to deal with important management issues quickly. This would include effective responses to safeguarding and emergency situations including fire. We also found some records were not completed in a consistent way. This included consent records, recruitment and medicine records. There was no evidence that the inconsistent records had impacted on care. This lack of management oversight and consistent record keeping was identified to the registered manager as an area for improvement.

People were looked after by staff who knew them well and understood their individual needs. Staff treated people with kindness, they were polite and considerate in their contact with people. People's dignity was protected and staff were respectful. People and their relatives gave us positive feedback about the care, and the atmosphere in the service. One relative said, “Easy going, homely atmosphere, everyone knows their role and they are all competent, It is a lovely little place.” Visiting professionals were confident that staff were kind and caring and responded to people’s health and welfare needs appropriately.

Medicines were stored and handled safely. People were protected from the risk of abuse because staff had a good understanding of safeguarding procedures and knew what they should do if they believed people were at risk of abuse. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager had an understanding of DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people's rights.

Staff were provided with a full induction and training programme which supported them to meet the needs of people. Staffing arrangements ensured staff worked in such numbers, with the appropriate skills that people's needs could be met in a timely and safe way.

People were given information on how to make a complaint and said they were comfortable to raise a concern or give feedback. A complaints procedure and comment cards were readily available for people to use.

Staff monitored people's nutritional needs and responded to them ensuring they had enough to eat and drink. People's preferences and specific dietary needs were met. People were supported to maintain their own friendships and relationships. Staff related to people as individuals and took an interest in what was important to them.

Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis and satisfaction surveys had been completed. The registered manager was readily available and led by example.

There is a registered manager at the home who is also one of the owners and the provider. 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.

Chardwood Rest Home was inspected in March 2015. A number of breaches of the regulations were identified. Improvements were required in relation to the safe management of medicines, recruitment practices, staff training and supervision, the assessment and planning of care to meet people's individual needs and the quality monitoring systems. The provider sent us an action plan and told us they would address these issues by July 2015.

We completed a further comprehensive inspection in January 2016 to check that the provider had made improvements and to confirm that legal requirements had been met. We found improvements had not been made. A number of continuing breaches were identified and the service was rated as inadequate. The CQC took enforcement action and the service was placed into special measures. Warning notices were served along with a condition being placed on the registration of the service which required the provider to give us regular updates against their action plan.

After our inspection in January, the provider wrote to us to say what they would do to ensure all regulations would be met. This inspection took place on 11 November 2016 and was a fully comprehensive inspection to see what improvements the provider had made to ensure they had met regulatory requirements. At this inspection four people were living at the service one person was on respite and a further person was being admitted. We found the Warning Notices had been met and significant improvements had been made. However, these will need to be embedded into everyday practice to ensure they are consistently met and maintained when the occupancy of the home increases. We found one breach of a regulation at this inspection.

The staffing arrangements did not ensure two staff were working in the service at all times as recorded on the duty rota during the day and it was unclear who was providing staff cover at night when the registered manager was not available. This meant a suitable number of staff were not available at all times to respond to emergency situations including fire. People were not always safe because moving and handling practices at the service were not always appropriate. When people fell and were unable to get up from the floor staff lifted them manually as suitable equipment was not available. This was a safety risk to people and staff. Medicines that required specific storage arrangements had not been stored appropriately in accordance with required legislation. Staffing arrangements the way staff were moving people and the storage of medicines impacted on how the service was maintaining a safe service and represented a breach to regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found the provider had established some quality monitoring systems. They provided reports to CQC as required, in accordance with a condition of registration. However, these systems needed further improvement to ensure robust and effective arrangements were in place to ensure legal requirements were met and ensure safe and effective care in all areas. For example, we found records that were not accurate or complete. This could impact on the care and support provided to people as staff were not provided with the most up to date information on people’s needs.

People did not have a full range of activity and entertainment to meet all their individual needs. However people who were able to follow their individual hobbies independently were supported by staff to do this. Some visiting entertainment and activities were provided in the service.

People were looked after by staff who knew and understood their individual needs well. Staff treated people with kindness and were polite at all times. People’s dignity was protected and staff were respectful. People gave us positive feedback and their relative’s also positive feedback about the care, the atmosphere in the service and the approach of the staff and registered manager. One relative said; “We like the home as it is small and friendly.” Feedback from visiting professionals was also positive. They told us staff worked with them to meet people’s health care needs.

People were protected from the risk of abuse because staff had a good understanding of safeguarding procedures and knew what they should do if they believed people were at risk of abuse. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager had an understanding of DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people’s rights.

New staff undertook an induction and an established training programme supported all staff to meet the needs of people. Recruitment records showed there were systems in place to ensure as far as possible staff were suitable to work at the service.

People were given information on how to make a complaint and said they were comfortable to raise a concern or give feedback. A complaints procedure and comment cards were readily available for people to use.

Staff monitored people’s nutritional needs and responded to them ensuring they had enough to eat and drink. People’s preferences and specific dietary needs were met. People were supported to maintain their own friendships and relationships. Staff related to people as individuals and took an interest in what was important to them.

Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis and satisfaction surveys had been completed.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. At the last inspection the service was place in Special Measures. The provider has made enough improvement for us to take the service out of special measures and we will inspect again within a year to ensure their progress in maintained.

There is a registered manager at the home who is also one of the owners and the provider. 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.

We carried out an unannounced comprehensive inspection at Chardwood Rest Home on the 26 February and 3 March 2015 where we found improvements were required in relation to the safe management of medicines, recruitment practice, staff training and supervision, the assessment and planning of care to meet people’s individual needs and the quality monitoring systems. The

provider sent us an action plan and told us they would address these issues by July 2015.

We undertook this inspection on 27 and 29 January 2016 to check that the provider had made improvements and to confirm that legal requirements had been met. We found improvements had not been made and the provider was not meeting a number of the regulations.

Medicines were not always managed safely. Records were not accurate and systems did not ensure that variable dosage medicines and other prescribed medicines were given as required.

Recruitment records did not confirm the provider had assured themselves that staff working had relevant checks undertaken to ensure they were suitable to work with people at risk.

Suitable environmental risk assessments and measures put in place to ensure people’s safety within the home had not been established.

Suitable training had not been provided to all staff to ensure they had the knowledge, skills and competence to undertake their designated responsibilities within the home.

People did not have clear and accurate person centred care plans to reflect all their care needs. We could not be assured that staff knew and understood people’s individual care needs.

The registered manager had not established quality monitoring systems across the service. Ways of reviewing the care and improving the care and quality of the service were not in place. She had not addressed breaches of regulations identified at the last inspection and remained in breach of five regulations.

Feedback received from people and their representatives was positive about the care, the approach of the staff and atmosphere in the home. Staff were kind, friendly and patient with people. Staff were mindful to people’s privacy and dignity, taking account their individuality.

People had a variety of food available at mealtimes. Meals were unrushed and people were encouraged and supported to eat independently. There were systems to monitor people’s diet and to support them in maintaining good nutrition.

Systems for sharing information between staff were established. Staff understood their responsibilities to identify and respond to any safeguarding issue. Regular and appropriate contact with health care professionals took place, to ensure people’s health care needs were responded to.

People had their choices and preferences responded to by staff who understood their responsibilities in ensuring they gained consent to care. The registered manager had a working knowledge of the Mental Capacity Act 2005.

The registered manager had a high profile in the home and managed by regular contact with staff people and relatives. She lived on the premises and staff knew where she was if they needed her.

We found 5 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. We are considering further additional enforcement action in relation to Regulation 17.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

CQC are taking enforcement action to ensure that the provider provides safe and effective care.