Archived: Chaplin Lodge

Chaplin Lodge is a residential care home providing personal and nursing care to 29 people aged 65 and over at the time of the inspection. The service can support up to 66 people in one adapted building. People are accommodated within two units, Beeches and Parkview. The latter provides care and support, primarily for people living with dementia.

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

Not all risks to people’s safety and wellbeing were assessed, recorded or followed by staff. Improvements were still required to ensure people received their medication as they should. People told us they were safe. Suitable arrangements were in place to protect people from abuse and avoidable harm. Staff understood how to raise concerns and knew what to do to safeguard people. Enough numbers of staff were available to support people living at Chaplin Lodge and to meet their needs. Recruitment practices were robust to make sure the right staff were recruited. People were protected by the prevention and control of infection. Findings from this inspection showed some lessons were being learned and improvements made when things went wrong.

Suitable arrangements were now in place to ensure staff were appropriately trained and newly appointed staff received a robust induction. The dining experience for people using the service was good. People received enough food and drink to meet their needs. People were supported to access healthcare services and receive ongoing healthcare support. The service worked with other organisations to enable people to receive effective care and support. People were in general 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. At the time of inspection, the service was undergoing redecoration and refurbishment.

People and those acting on their behalf told us they were treated with care, kindness, respect and dignity. Staff had a good rapport and relationship with the people they supported, and observations demonstrated what people told us. However, on Parkview, interactions were more task orientated and not always person-centred.

Improvements were still required to ensure information recorded clearly detailed people’s care and support needs and was followed by staff. People were supported to participate in social activities, both ‘in house’ and within the local community. The service is not fully compliant with the Accessible Information Standard to ensure it meets people’s communication needs. People and those acting on their behalf were confident to raise issues and concerns and felt listened to, though not all complaints had been responded to in a timely manner. People’s Preferred Priorities of Care [PPC] had been discussed with them and their relatives. Referrals had been made to the end of life register to ensure people’s wishes were adhered to.

Governance arrangements were much improved, but progress was still required to make sure improvements made were sustained in the longer term.

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

The rating at last inspection was requires improvement (published March 2019). There were three breaches of regulation. These related to breaches of Regulation 12 [Safe care and treatment], 17 [Good governance] and 18 [Staffing].

Conditions were imposed on the registered provider’s registration. The registered provider was requested to complete and submit a monthly report to show what they would do and by when to improve the service and to demonstrate they had oversight of the service.

At this inspection we found improvements had been made and the provider was no longer in breach of two out of three regulations. The service still remains in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Chaplin Lodge is a residential care home that provides personal and nursing care to for up to 66 people aged 65 and over. At the time of the inspection there were 36 people living at the service.

People’s experience of using this service:

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service, as not all risks to people had been identified and assessed.

People were at risk of having their safety compromised. This was because equipment such as people’s call alarms to enable people to summon staff assistance was either not accessible or not working. The arrangements for notifying relevant staff and managing equipment-related risk was not robust.

Staff did not have sufficient time to give people the care and support they needed. The provider did not regularly review its staffing levels or ensure there were sufficient numbers of staff at all times available to meet people’s needs.

Staff regularly felt under pressure and this meant care provided by staff was not ‘person-centred’ care and support. Staff did not sit and talk with people for a meaningful length of time and people’s distress or discomfort was not always responded to promptly or consistently.

The provider did not have effective systems in place to monitor the quality of the service they provided or to drive improvements where needed. The lack of managerial oversight had impacted on people, staff and the quality of care provided. Improvements were not always made when things went wrong.

People did not always receive their medicines as prescribed and accurate medicines records were not maintained.

Staff training was not up-to-date. Not all staff had completed a comprehensive induction and staff supervision and support was inconsistent.

Care planning arrangements did not ensure all of a person’s care needs were recorded. Staff were aware of people’s end of life care needs but these were not recorded.

Recruitment arrangements were robust to ensure the right staff were recruited.

People were protected by the provider’s prevention and control of infection procedures.

Sufficient food and drink was available to people throughout the day. Regular monitoring and review was carried out for people at nutritional risk to ensure their dietary needs could be met.

People experienced positive outcomes regarding their health and wellbeing and had access to healthcare services. The service worked collaboratively with other services and agencies.

People’s capacity to make day-to-day decisions had been considered and assessed and the provider was working within the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People enjoyed the activities provided but stated there were occasions when they were bored and there was nothing for them to do.

Rating at last inspection:

The rating of the service was ‘Requires Improvement’ (Last report published 9 November 2017)

Why we inspected:

This was a planned inspection based on the rating at the last inspection of ‘Requires Improvement’.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found during this inspection is added to reports after any representations and appeals have been concluded.

Follow up:

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.

Chaplin Lodge provides accommodation and personal care for up to 66 older people. Some people also have dementia related needs.

This inspection was completed on 2 and 3 August 2017 and there were 34 people living at the service when we inspected.

A registered manager was in post but on maternity leave at the time of this inspection. The service was being managed by a peripatetic manager to cover the registered manager’s maternity leave and to address the shortfalls identified at the last inspection. 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.

Quality assurance checks and audits carried out by the provider and the management team of the service were in place and had been completed at regular intervals in line with the provider’s schedule of completion. The provider and management team of the service were able to demonstrate a better understanding and awareness of the importance of having good quality assurance processes in place. This was a significant improvement and this had resulted in better outcomes for people using the service. Feedback from people using the service, those acting on their behalf and staff were positive and spoke of the improvements made by the provider and management team following our last inspection in November 2016. This referred specifically to better visible management presence within the service and there now being confidence that the provider and management team were doing their best to make the required improvements to the service. Nonetheless, some improvements were still required to ensure that where issues were highlighted as part of the management teams auditing arrangements, information was available to show actions required had been addressed. Additionally not all areas of concern found at this inspection, namely induction processes for newly employed staff, infection control practices and improvements to the premises had been identified.

People told us the service was a safe place to live and that their safety was maintained. Staff understood the risks and signs of potential abuse; however improvements were required to ensure staff followed relevant safeguarding processes by alerting the management team at the earliest opportunity where concerns were highlighted.

Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed to ensure their safety. Although environmental risks were highlighted, where actions were required, not all of these had been addressed in a timely manner. This referred specifically to the service’s Legionella risk. Additionally improvements were needed in respect of some aspects relating to infection control practices and procedures at the service and ensuring the premises were suitable for people using the service. The latter referred specifically to improvements required to Parkview Unit so as to make it suitable for people living with dementia and many items of furniture, fixtures and fittings within the service required repair or replacement. Some areas of the home environment also required redecoration.

Sufficient staff were now available to meet people’s care and support needs. Our observations showed that the deployment of staff was suitable to meet people’s needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure theirs’ and others’ safety. Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

Improvements were needed to ensure where appropriate newly employed staff completed the ‘Care Certificate’ or an equivalent induction, particularly where newly employed staff had limited experience within a care setting or had not attained a National Vocational Qualification. Improvements were also required to ensure that staff received an appropriate induction for their role. Staff received suitable opportunities for training and where refresher training was required; this was scheduled for the coming months. This ensured that staff employed at the service had the right skills and competencies to meet people’s needs. Staff now felt supported and received appropriate formal supervision at regular intervals. Staff told us this was now a two-way process and they felt able to express their views openly. Staff commented that this process was no longer an opportunity to solely receive negative feedback.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The peripatetic manager was working with the Local Authority to make sure people’s legal rights were being protected. People who used the service and their relatives were involved in making decisions about their care and support.

The dining experience for people was positive and people were very complimentary about the quality of meals provided. Where people were at risk of poor nutrition or hydration, this was monitored and appropriate healthcare professionals sought for advice and interventions.

Care plans accurately reflected people’s care and support needs and people received appropriate support to have their social care needs met. Care plans also reflected people’s choices and preferences and included information relating to people’s life history and experiences. However, minor improvements were still required to ensure that care plans for people who could be anxious or distressed, considered the reasons for people becoming anxious and the steps staff should take to comfort and reassure them. People told us that their healthcare needs were well managed. Staff were friendly, kind and caring towards the people they supported and care provided met people’s individual care and support needs. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

Arrangements had been made following our last inspection in November 2016 to protect people from the risk of social isolation and loneliness. Additional staff had been employed so as to provide and undertake a programme of social activities for people living at the service. People and those acting on their behalf confirmed that social activities were readily available and relatives told us that the arrangements were much improved.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

The inspection was completed on 27 October 2016, 16 and 18 November 2016 and was unannounced. There were 56 people living at the service when we inspected. Chaplin Lodge provides accommodation and personal care for up to 66 older people. Some people also have dementia related needs.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by the Care Quality Commission. 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.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

A registered manager was 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.

There was a lack of provider and managerial oversight of the service. Quality assurance checks and audits carried out by the registered manager were not robust as they did not identify the issues we identified during our inspection and had not identified where people were placed at risk of harm or where their health and wellbeing was compromised.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered and risk assessments had not been developed for all areas of identified risk.

People did not think that there were sufficient numbers of staff available to meet their needs. Staff did not always have time to spend with the people they supported to meet their needs and the majority of interactions by staff were routine and task orientated.

Suitable arrangements were needed to ensure that staff received regular formal supervision and an annual appraisal of their overall performance. Improvements were required to ensure that where subjects and topics were raised by staff, this was followed up and there was a clear audit trail to demonstrate actions taken.

People and their relatives were not fully involved in the assessment and planning of people’s care.

Not all of a person’s care and support needs had been identified and documented. Improvements were required to ensure that the care plans for people who could be anxious or distressed, considered the reasons for people becoming anxious and the steps staff should take to comfort and reassure them. Care plans for people who were at the end of their life were inadequate. Improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for people living with dementia.

People and their relatives felt confident that people were safe. Staff knew how to identify potential abuse and report concerns. Suitable arrangements were in place to ensure that people were supported to take and receive their medicines safely.

The registered manager and some members of staff understood the requirements of the Mental Capacity Act 2005 (MCA) and demonstrated how to apply the principles of this legislation to their everyday practice. Staff obtained people’s consent before providing any support.

The dining experience was positive and people were supported to have enough to eat and drink. Consideration by staff was evident to demonstrate that the dining experience was an important part of people’s daily life and treated as a social occasion. People were supported to maintain good health and have access to healthcare services as and when required.

Suitable arrangements were in place to ensure that the right staff were employed at the service. Arrangements were in place for staff to receive appropriate training opportunities for their role and area of responsibility.

Where appropriate people were enabled and supported to be independent. People were also treated with dignity and respect. Staff knew the care needs of the people they supported and people told us that staff were kind and caring.

The inspection was completed on 19 August 2016, 25 August 2016 and 26 August 2016 and was unannounced. There were 56 people living at the service when we inspected.

A registered manager was 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.

There was a lack of provider and managerial oversight of the service. Quality assurance checks and audits carried out by the registered manager were not robust as they did not identify the issues we identified during our inspection and had not identified where people were placed at risk of harm or where their health and wellbeing was compromised.

Arrangements were not in place to make sure that peoples medication records were completed to a good standard or that they received their prescribed medication as they should.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered. Risk assessments had not been developed for all areas of identified risk and bedrail assessments had not always been completed to determine that these were suitable for the individual person so that any risks identified were balanced against the anticipated benefits.

People did not think that there were sufficient numbers of staff available to meet their needs. Staff did not always have time to spend with the people they supported to meet their needs and the majority of interactions by staff were routine and task orientated. This had a significant impact on the delivery of care to people using the service.

Improvements were required to ensure that all staffs training were up-to-date and staff received a robust induction so that they had the skills and confidence to carry out their role and responsibilities effectively. Not all staff understood the relevant requirements of the Mental Capacity Act [MCA] 2005. Additionally, suitable arrangements were needed to ensure that staff received regular formal supervision and an annual appraisal of their overall performance. Improvements were required to ensure that where subjects and topics were raised by staff, this was followed up and there was a clear audit trail to demonstrate actions taken.

Not all of a person’s care and support needs has been identified and documented. Improvements were required to ensure that the care plans for people who could be anxious or distressed, considered the reasons for people becoming anxious and the steps staff should take to comfort and reassure them. Improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for people living with dementia.

Although there was a complaints system in place, not all complaints evidenced fully how conclusions had been reached and actions followed up.

The dining experience was positive and people were supported to have enough to eat and drink. Consideration by staff was evident to demonstrate that the dining experience was an important part of people’s daily life and treated as a social occasion. People were supported to maintain good health and have access to healthcare services as and when required.

Suitable arrangements were in place to ensure that the right staff were employed at the service.

Where appropriate people were enabled and supported to be independent. People were also treated with dignity and respect. Staff knew the care needs of the people they supported and people told us that staff were kind and caring.

You can see what actions we told the provider to take at the back of the full version of the report.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff checked our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service. They also told us that they would feel able to speak up if they had concerns or worries and felt that they would be listened to.

Since our last inspection to the service in September 2013, we found that there had been eight safeguarding concerns. Records showed that the outcome of three safeguarding concerns was known and remaining outcomes had yet to be provided to the manager by the local authority. We saw that all staff had received training in safeguarding of vulnerable adults from abuse. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We found that people who used the service were protected against the risks associated with the unsafe use and management of medicines.

We found that people who used the service lived in premises that promoted their safety and wellbeing. Many areas of the home environment had been re-decorated since our last inspection to the service. In line with regulatory requirements the manager had forwarded to us two statutory notifications advising of events which stop the provider from running the service as well as they should. This referred specifically to the service's boiler and passenger lift.

The provider was able to demonstrate that they had an effective recruitment procedure in place.

Is the service effective?

Our observations and discussions with the manager demonstrated that people who used the service received regular support and access from a variety of health and social care services and professionals as their conditions and circumstances required.

Records showed that no member's of staff had received Mental Capacity Act [MCA] 2005 and Deprivation of Liberty Safeguards [DoLS] training. Staff spoken with were able to demonstrate a basic understanding and awareness of MCA and DoLS. We found that people who used the service had not had their capacity to make day-to-day decisions formally assessed. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to having suitable arrangements in place for the consent to care and treatment and; in line with the Mental Capacity Act 2005.

We found that the majority of staff working at the service required core and specialist training for the needs of older people, formal supervision and appraisal. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to having suitable arrangements in place for staff employed to receive appropriate training, supervision and appraisal.

Is the service caring?

People told us that they received the care they needed. People living in the service told us that they were happy living there. Our observations showed that care and support was provided in a timely manner.

People who used the service had a care plan in place detailing their specific care needs and the support to be provided by staff.

Our observations showed that people who used the service were respected and treated with dignity by staff.

Is the service responsive?

People's preferences and diverse needs had been recorded in accordance with people's wishes.

Our observations during the inspection showed that visiting times were flexible.

We found that there were appropriate arrangements in place pertaining to complaints management.

Is the service well-led?

The provider was able to demonstrate that there were systems in place to assess and monitor the quality of the service provided. The views of the people who used the service and staff had been sought. People's views about the service were noted to be positive.

As part of this inspection we spoke with the manager, deputy manager and four members of staff.

We found that appropriate systems were in place to ensure that documentation relating to people's manual handling needs were clearly documented and provided sufficient guidance to staff on how this should be carried out. There was no evidence to indicate that people's mobility needs were not being met and/or that poor manual handling practices were being carried out by staff.

Records showed that appropriate arrangements were in place to ensure that an adequate supply of incontinence pads were available for people's use throughout the day and night.

We found that staffing levels at Chaplin Lodge were determined by the assessment of people's dependency levels and completion of a 'staffing level calculator'. Records showed that appropriate staffing levels were maintained at the service each day. Where staffing levels were reduced as a result of unforeseen circumstances additional measures were put in place to staff the service.

Our findings found that the atmosphere within Chaplin Lodge was observed to be calm and relaxed. Staff working within the service were seen to be responsive to people's individual support needs and assistance was provided in a timely manner. Comments from people who used the service and visitors was noted to be very positive and included, "The staff look after my relative very well", "I'm very happy with everything. The best thing is the atmosphere", "The staff are very kind. Sometimes they are (staff) a bit short but are usually good at responding in a timely manner" and "Staff are friendly. Just ask them and they'll do it."

Whilst improvements were noted in relation to the care and welfare of people who use the service, the management of medicines and quality assurance, further improvements are required to ensure the provider attains compliance.

We directly observed care within the service so as to help us determine what it was like for people living at Chaplin Lodge. We found that people using the service could not always be assured that they would experience care, treatment and support that met their needs and protected their rights. We found that improvements were needed to ensure that the deployment of staff working at the service was appropriate to meet people's needs. We found that staff's training was not embedded within their everyday practice and in some cases this had impacted on peoples health and wellbeing. We found that management of medicines was poor and did not safeguard people using the service.

It was apparent from our findings at this inspection that the absence of robust quality monitoring by the provider has been a contributory factor to the failure of the service to identify non-compliance, or any risk of non-compliance sooner.

Concerns raised related to people's nutritional needs not being met; poor staff practices in relation to manual handling procedures and poor medication practices. We found no evidence to suggest at this inspection that people who use the service were placed at risk as a result of poor manual handling practices by staff. However we found that records relating to people's food and hydration needs required significant improvement. Shortfalls were identified with medication practices and this related specifically to discrepancies with records and not having appropriate arrangements in place for ensuring that some people received their prescribed medication. We found during the inspection that some people's dignity was compromised.

We found that people were protected against the risks associated with medicines as appropriate arrangements were in place to manage medicines, however improvements were needed in the way that medicines that were prescribed in variable doses were recorded.