Archived: Chalkney House

Chalkney House is a residential care home providing personal care and accommodation for people aged 65 and over. The service can support up to 47 people. At the time of the inspection there were 26 people living at the service.

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

There were systemic failings at the service. Concerns raised during the previous inspection had not been effectively addressed. The provider did not have effective systems and processes in place that enabled them to identify, monitor and assess risks to the health, safety and welfare of the people who use the service. Where risks had been identified, measures had not been introduced to remove the risk within a timescale that reflected the level of risk or the impact on people using the service.

The service failed to manage and mitigate fire safety. We referred the service to the local fire authority.

The provider did not always safely maintain the environment to ensure it was safe for people living in the service.

Appropriate checks in place were not completed by competent staff to ensure the environment was safe.

The environment was not always clean and required improvement. We have made a recommendation about the environment of the service.

Further improvements were required in end of life care planning for people to ensure their last wishes were known and followed.

People’s dignity could not always be maintained due to the environment of the home.

Staff were instinctively caring and understood people’s needs.

Information was available in other formats to aid people’s understanding where required.

People received care from staff who understood how to recognise potential abuse.

People's health was well managed, and staff had positive relationships with professionals which promoted people's wellbeing.

People were encouraged to maintain their independence and to make their own choices about how and where they spent their time. People were offered activities which they had the opportunity to join in.

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 practice.

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 requires improvement (Published 8 November 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not, enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the environmental risk and lack of sustained improvement.

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

We will request an action plan and will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Chalkney House 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 service accommodates 47 people in one adapted building. At the time of our inspection there were 37 people using the service.

There is 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 2008 and associated Regulations about how the service is run.

Our previous inspection on 3 February 2018 found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the management of medicines and failure to identify and manage risks to people using the service. Infection prevention and control policies were not always followed by staff and cleaning schedules were not being used effectively to keep the premises clean and odour free. We also found that people’s nutrition and hydration needs were not always being properly managed. People’s care plans were not always person centred, completed or reflective of their current needs. Staff lacked guidance on how to respond to people on end of life care to ensure they were pain free and comfortable when they died. People lacking capacity were not consistently supported in line with the requirements of the Mental Capacity Act (MCA) 2005 legislation. Systems to assess and monitor the service were not being used effectively to identify where improvements were needed. Complaints had been investigated however, the outcome and judgements made were not always open and transparent or used to improve the quality of the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when. At this inspection we discussed the action plan with the registered manager and what progress had been made. Improvements had been made to the management of medicines. However, there continued to be failure to identify and manage risks to people using the service. People’s, Personal Emergency Evacuation Plan (PEEP) were not always correct, which meant staff did not always have accurate information to provide the right level of support to keep people safe. Additionally, assessments to mitigate risks to people were not consistently followed by staff, specifically in relation to prevention of falls. Falls resulting in head or facial injuries were not being well managed.

We found ongoing issues with regards to cleanliness and unpleasant odours in the service. Although there was sufficient staff on duty to meet people’s needs and keep them safe, we found the contracted hours for domestic staff were not sufficient to keep the premises clean. The systems in place to monitor the quality of the service, were largely a tick box process and were not effectively used to identify where improvements were needed. For example, these had failed to identify the lack of cleanliness and poor quality of bedding we continued to find. The quality of bedding had been raised at our previous inspection and whilst immediate action had been taken to purchase more, there was no regular checks taking place to ensure bedding was fit for purpose.

Record keeping had improved. The provider had introduced an electronic care recording system which provided good details about the food and drink people received to ensure their nutrition and hydration needs were being met. A ‘Resident of the week’ initiative had been implemented and was helping to improve care plans and ensured people received person centred care that was specific to them. Documentation in relation to people’s mental health and other conditions such as dementia that affected their wellbeing had improved and staff had a better understanding on how to support people at times of anxiety.

The arrangements for people nearing the end of life care had significantly improved. Measures had been put into place that ensured people received a dignified, comfortable and pain free death. People’s families had confirmed this with positive feedback directly to CQC and via thank you cards to the staff.

One complaint had been received and investigated in full since our last inspection. This had been responded to in a transparent way, involving other agencies to find an appropriate solution to the concerns raised.

Staff demonstrated a good awareness of safeguarding procedures and knew who to inform if they witnessed or had an allegation of abuse reported to them. A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience and were suitable to work with people who used the service.

Where a missing controlled medicine had been identified the registered manager had taken immediate action and reported this to the appropriate authorities. They had investigated, and arranged for a review of medicines by an external pharmacist to learn what went wrong. Following their recommendations, the registered manager had implemented measures to prevent this happening again, including retraining all staff.

Staff received training to meet the specific needs of people using the service and relevant to their roles. New staff were mentored by an experienced member of staff until assessed as competent to work unsupervised. Staff were supported and received regular supervision regarding their performance.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice. People’s care plans clearly documented how decisions about their care or support were made where they lacked capacity. Where decisions were being made on people’s behalf their family representatives and/or professionals were involved in making decisions that were in the best interests of the person.

Mealtimes were a positive experience for people. People were complimentary about the food. Staff were aware of people’s dietary needs, and followed professional advice where people were identified at risk of weight loss or choking. People had access to a range of healthcare services, such as the dietician, Speech and Language Therapist (SALT), district nurse, continence nurse and the community mental health team.

People and their relatives were complimentary about the attitude and capability of the staff. Staff were kind and caring and had developed good relationships with people. People told us they were supported to make choices and decide how they spent their day. People were treated with dignity, respect and kindness. People had access to a range of activities, within the home and via external sources, and chose if they wanted to take part.

People, their relatives and staff spoke positively about the registered manager. Staff felt supported by the registered manager. They described them as approachable, very hands on, supportive and demonstrated good leadership, leading by example.

The registered manager had sought feedback from people using the service, their families, the public and staff about the quality of the service provided. Questioners, resident meetings and reviews of the service on the internet, provided positive feedback.

We found 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 the report.

Chalkney House 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 service accommodates 47 people in one adapted building. At the time of our inspection there were 37 people using the service.

There is 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 2008 and associated Regulations about how the service is run.

Before this inspection we received five complaints, three safeguard alerts and two whistleblowing concerns. These all raised concerns about poor care and hygiene, missing medicines, people not receiving sufficient to drink, a lack of understanding around managing people’s end of life care and negative attitudes of staff. At this inspection we found people were receiving appropriate personal care.

Medicines were not being managed consistently and safely. Medicines, including controlled drugs were not always obtained, stored, administered and disposed of appropriately. People prescribed medicines on an 'as required' basis, such as Lorazepam, (used to treat anxiety and produce a calming effect) were being given these medicines on a regular basis. However, a random sampling of people's routine medicines, against their records confirmed they were receiving these as prescribed by their GP.

Although systems were in place to identify and reduce risks to people using the service, these were not always effective. Infection prevention and control policies were in place, but these were not always followed by staff to ensure essential elements of general cleaning were undertaken. Cleaning schedules were in place but were not being used effectively to keep the premises clean and odour free.

People’s nutrition and hydration needs were not always being properly managed. The service was committed to a local authority scheme, known as Prosper aimed at promoting new ways of reducing preventable harm from falls, urinary tract infections and pressure ulcers. Although, individual risks to people’s health due to incontinence, poor skin integrity and dehydration had been assessed, charts to monitor they were receiving adequate hydration and being repositioned regularly were not always completed properly by staff, which increased the risk of people not receiving the care they needed. We recommended that additional training is provided to ensure staff completed records correctly and to reflect the actual care provided. People’s moving and handling risk assessments and care plans indicated the equipment they needed to move, but did not include specific information about the slings to be used to ensure the fit, comfort and safety of the person being hoisted.

The service was providing end of life care to people, however there were no links with the community palliative care team or hospice. The registered manager was not aware of specific guidance with regards to end of life care, such as the National Institute of Clinical Excellence (NICE) quality standard or the Gold Standard Framework (GSF). These provide good practice guidance to ensure people nearing the end of their lives receive the best care. Staff were provided with training to give them the skills and knowledge to meet people’s specific needs, including end of life care, however, staff were not always using their learning to provide appropriate care that ensured people were pain free and comfortable at the time of their death.

People and their relatives were complimentary about the attitude and capability of the staff. Staff were kind and had developed good relationships with people using the service. Staff had a good knowledge of what people could do for themselves, how they communicated and where they needed help and encouragement. People were supported to make choices and decided how they spent their day.

There was sufficient staff on duty to keep people safe. A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience and were suitable to work with people who used the service. Staff demonstrated a good awareness of safeguarding procedures and knew who to inform if they witnessed or had an allegation of abuse reported to them. The registered manager was aware of their responsibility to liaise with the local authority where safeguarding concerns were raised and such incidents were managed well.

The registered manager and staff had variable understanding of the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People lacking capacity were not consistently supported in line with the requirements of the Mental Capacity Act (MCA) 2005 legislation.

People’s needs were assessed on admission to the service and formed the basis of their care plan. However, we found people’s care plans were not always person centred, complete or reflective of their current needs. Where people were referred to as having challenging behaviour, their care records did not show how this had been assessed. It was difficult to see how their behaviour was challenging and how this was likely to affect the person or others.

‘Sparkle’ events were arranged for people to enable them to follow their interests and take part in activities that they still loved to do. A ‘come dine with me’ experience took place on a regular basis where people had the opportunity to enjoy an evening meal with others from a different service within the organisation. However, there was mixed responses from people regarding activities. Some people told us there was a good choice of activities; whereas other’s felt there was little to do during the day. People using the lounge in the Gables took part in stimulating activities, in contrast people sitting in the front lounge sat for prolonged periods of time with little social interaction or engagement from staff.

People, their relatives and staff spoke positively about the registered manager. Staff felt supported by the registered manager. They described them as approachable, very hands on, supportive and demonstrated good leadership, leading by example.

The registered manager and area manager were completing audits of the service on a regular basis, however these were not used effectively to identify where improvements were needed. Infection control audits had not identified the issues of poor cleanliness, in particular in people’s rooms. An audit carried out by an independent consultant identified issues with medicines management. The last medicines audit carried out by the registered manager identified the same issues with 'as required' medicines, but no action had been taken to make the required improvements, and we found the same issues at this inspection. The falls log was being reviewed each month; however these were not being used as intended, to identify themes or trends. At this inspection we identified a pattern of falls between 10pm and 4am, but the falls monitoring did not identify this and therefore no action had been taken to analyse why there was an increase in falls during this time period. Complaints were investigated in full and were responded to in a timely way. However, the outcome and judgements made were not always open and transparent or used to improve the quality of the service.

The registered manager told us staff were encouraged to share innovation and ideas and had embraced the Prosper project with a view to reducing preventable harm from falls. Staff came up with the idea of ‘No frame the same’ where they helped people to decorate their walking frames to personalise them so they are able to recognise there frame easily and use it. This won a falls prevention award at the Caring UK national awards for innovation.

The registered manager attended regular management meetings with managers from others services owned by the provider to share ideas and best practice. They had developed good working relationships with other agencies such as Hearing Action and attended Prosper community events. However, they had not recognised the importance of partnership working with other agencies, such as hospices or McMillan nurses for people nearing the end of their life.

We found 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 the report.

The inspection took place on the 7 October 2016 and was unannounced. At the last inspection on the 14 September 2015 we rated this service as requires improvement as we identified two breaches in regulations. At this inspection there were no breaches and there were some clear improvements to the service provided.

The service provides accommodation for up to 47 older people some living with dementia. At the time of our inspection there were 39 people using the service. There was 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 2008 and associated Regulations about how the service is run.

We found a cohesive service which was well led and managed in the best interests of people using it. Risks to people’s safety were managed through adequate staffing and by staff trained to deliver safe and effective care.

People received their medicines in the way that was intended and people’s health care needs were monitored to enable staff to take necessary actions if needs changed.

Staff recruitment processes were robust and ensured only suitable staff were employed. Once employed, new staff were supported through a thorough induction process. All staff had access to appropriate training, support and the opportunity to undertake further, more advanced training.

People were supported to eat and drink in sufficient quantities to maintain good health and were protected from the risks of malnutrition. Staff promoted people’s well-being through adequate activities and stimulation whilst promoting people’s choice and independence.

Staff had sufficient understanding of legislation relating to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberties Safeguards (DoLS). The MCA ensures that, where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation. People were supported to make decisions and any restriction on people with carried out lawfully.

Staff knew people’s needs well which mitigated risks of them receiving unsafe care but we found records of people’s care needs and initial assessments did not always reflect people’s current needs well.

The manager supported staff and managed a team of happy, cohesive staff who pulled together to provide the best care they could. There were systems in place to help the manager assess the delivery and effectiveness of the care provided and takes steps to address areas where care might have fallen short.

People were consulted about their care needs and the wider needs of the service.