Chatsworth Grange

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked at all quality statements in this domain. People were supported to receive their medicines safely. However, protocols for as when required medicines (PRN) for some people needed more detail to guide staff when to administer. The use of thickeners to reduce the risk of choking were also not consistently recorded. Action was taken by the registered manager to address the issues raised. We shared some feedback about the recruitment procedures at the service. The registered manager took immediate action in response to the feedback. There were enough staff available to meet people's needs and staffing levels were reviewed regularly by the registered manager. However, some relatives felt that at times staff were stretched. We also noted at busier times of the day such as mealtimes that people experienced extended wait times for support. This had already been identified by the senior team and a trial of staggered mealtimes was to be introduced on units where more people needed assistance with their meals. People were safeguarded from abuse and avoidable harm. Staff were able to recognise possible signs of abuse and knew how to report such concerns promptly. Staff told us they felt supported and felt confident to raise any concerns and that concerns raised would be acted upon. People were protected from the risk of infection, as staff followed safe infection prevention and control practices. The home environment and equipment were kept clean and safe. Staff knew people’s needs and how to support them and staff took action to manage risks. Staff received regular training to ensure their skills and knowledge were up to date and enable them to provide safe care. People were supported to have choice and control of their lives and staff knew to support them in the least restrictive way possible. People’s capacity to make decisions was assessed and best interest decisions recorded.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives said people were safe living at Chatsworth Grange. They said there was good communication with the home and any changes that need to be made are dealt with quickly. One commented, “The care home includes me in everything and keeps me well informed.”

Staff understood their roles and responsibilities to record and report incidents. One staff member said, “Report to the manager. Fill in accident/incident form if needed.” The senior team were proactive and shared lessons learned with staff through supervisions and team meetings.

We visited the service partly in response to information we received about incidents that had occurred at the service and to assess if there was any ongoing risk. We found that investigations had been completed and lessons learned implemented. We also saw evidence of learning lessons from incidents that had happened in the wider social care sector. The registered manager had already implemented new systems to mitigate the risk for people living at Chatsworth Grange from a recent incident in an unrelated care home.

Assessments were completed before admission and staff gathered information about people's needs prior to them receiving support. One relative told us, “[Name] went in for an assessment. When we wanted [person] to stay on, they did a care plan with us. They asked us what [person] liked and didn’t like; they were thorough.” However, some relatives were unsure whether they had been involved or not in the care planning process. One told us, “I don’t really remember a care plan”. People and relatives told us they were happy with their support. One relative said, “GP comes in regularly. [Person] had trouble with his teeth and the staff picked up on it and [person] saw the dentist.”

The registered manager informed us they undertook a comprehensive assessment before people moved into the home. This involved obtaining information from the person and those close to them regarding their routines and preferences. This also included discussions with partners about their care and where appropriate referrals made to health professionals to ensure safe systems of care. Staff were aware of their role in supporting a person to transition from one service to another and in the continuity of care and we saw evidence of positive joint working with professionals involved at the service.

Overall, we received positive feedback from professionals involved at the service. One told us, “Whenever I have arranged a visit, the staff are always informed that I am attending and wherever possible have the records available for me.” Another commented, “[Name of registered manager] always ensured that a thorough assessment takes place prior to agreeing their care. [Person] is careful to ensure that the person is placed on the appropriate unit, where there are the resources to support them and their needs. The team have successfully supported several people whose behaviours were particularly complex and challenging. [Name of registered manager] and the team always ensure that the transition to Chatsworth is as smooth as possible.”

The provider had processes in place to ensure safe systems, pathways and transitions were maintained. Records showed staff communicated with other professionals and services and made sure people experienced smooth transitions when using or moving between healthcare and other care services. New admissions and people’s changing needs were discussed within the staff team during regular meetings. At the time of our visit, we spoke to professionals who were visiting and they were positive of the team and of partnership working.

People and relatives told us they felt safe while living at Chatsworth Grange and could speak to staff if they had any concerns. One person when asked if they felt safe told us, “I do feel safe. Safe and being looked after.” A relative told us, “[Name] is safe. I am very happy with it, I liked it straight away, it’s homely and has first class staff and atmosphere.”

Staff knew how to report any safeguarding concerns and what they needed to report. They said the registered manager would listen and respond to their concerns. One staff told us, “Report it to my line manager as soon as I see the abuse.” Staff explained how they sought people’s consent before providing any support through explaining what they were doing. One said, “Approach, the resident and tell them of my intentions and then ask them if they want me to proceed with my intentions. I can only proceed after I have gained consent.”

We observed staff giving people everyday choices and seeking their consent. We saw respectful interactions and staff speaking to people at eye level. The atmosphere in the home felt warm and friendly. Best interest decisions were in place where appropriate for people who had restrictive practices in place. We asked the registered manager to keep under regular review the use of gates in the home and to always ensure the least restrictive option was in place.

Staff had completed safeguarding training and the provider’s safeguarding policy guided staff about different types of abuse and how to raise a concern to ensure people were protected. Any safeguarding concerns were recorded appropriately and reviewed to ensure the relevant professionals were notified. There were monitoring systems in place to ensure that lessons were learnt from incidents.

Relatives said they were involved in agreeing people’s support needs when they first moved in and were kept up to date with any changes in their relative’s needs. One relative told us that another relative had shared information with them about incident involving their family member. They told us, “I already knew because they [the home] are so good with communication. They moved [Name] and dealt with it straight away.”

Staff were aware of potential risks people may face and how to support them. People’s care plans were regularly reviewed and in response to any change in needs.

We saw that staff were vigilant when people were moving around or undertaking activities and made sure people remained safe. Safe moving and handling techniques were observed during our assessment. We noted some people would benefit from a review of the wheeled comfy chairs in use to ensure they were suitable. The registered manager actioned this immediately.

Risk assessments were completed and regularly reviewed for a range of areas, including weight loss, moving and handling and skin integrity. We recommended a review of the recording of planned care to allow easier management oversight and for best interest meetings to be completed for people who may regularly refuse some elements of support.

People were cared for in a safe environment that was designed to meet their needs. People had a range of equipment available to use. One relative told us, “It’s always clean in there.” Another said, “It’s very clean always and never any smells and it’s not always tidy but maybe that’s a good thing as it’s home.

We did not receive any concerns from staff about the environment or equipment within the service. Staff had received training in health and safety and were aware of their role in keeping people safe. One told us, “Make sure that there is nothing around that is going to cause harm to them. Assist if need assistance.”

The environment was tidy, clean and well maintained. Signs were available to help people to navigate around the service and pictorial information available. Rooms were personalised and individually numbered to resemble front doors. The provision of photos or memory boxes for bedrooms would assist people with dementia to locate their own room.

The provider monitored and reduced any risks in relation to safe environments and a range of training was available for staff to support them keep people safe. Checks on the environment were completed at identified intervals, and equipment serviced in line with legal requirements. However, we noted that cover was not in place for when the maintainer was on leave which meant some planned checks were not always completed. When we highlighted this to the registered manager new arrangements for cover were implemented immediately.

Overall people and their relatives told us staff were available when they needed help or support. One person told us, “They do come straight away. Sometimes they are just there. Knowing that they are there is the biggest thing of all. Done in such a way you don’t feel you are being nursed.” However, some relatives mentioned times when staffing levels appeared lower, or agency staff being used. One commented, “I do think they are short of staff sometimes not a lot, but they do have to get in agency staff.”

Staff told us they felt well supported in their role and received relevant training. Staff told us there were safe staffing levels at the service.

We found staffing levels were sufficient to meet people’s needs. However, at the time of our visit we noted that on units where several people needed 1:1 support at mealtimes this resulted in long wait times for some people. This was discussed with the provider and a staggered lunch time was to be trialled on units where this was impacting on the lunchtime experience for people.

Recruitment procedures were in place, so people were cared for by suitably qualified staff who had been assessed as safe to work with people. However, it was noted that some areas of the process needed closer scrutiny and was failing to meet the policy of the provider. For example, to ensure gaps in a staff member's work history were explained and sufficient number of references were in place. We shared this information with the registered manager who took immediate action. There were enough staff to meet the needs of people using the service. However, some concerns were raised by families about staffing levels and agency usage and improved deployment at mealtimes would reduce wait times for people. Staff underwent an induction and shadowing period prior to commencing work. They had regular updates to their training to ensure they had the skills and knowledge to carry out their roles. Staff had undertaken specialist training to meet the individual needs of people using the service. For example, dementia awareness and positive behaviour support.

Feedback from people and relatives did not highlight any concerns about cleanliness and hygiene at the service or how staff minimised the risk of infection. One relative commented, ”They have a cleaner there every day and they do make it clean.”

Staff had received appropriate training in infection prevention and control and were aware of safe hygiene practices. No concerns were raised about the availability of personal protective equipment (PPE).

We observed housekeeping staff operating throughout the site visit. The home was clean, tidy and well cared for. We saw staff follow current practice when supporting people and that they used personal protective equipment (PPE) appropriately. PPE was available throughout the building and easily accessible for staff.

The provider had policies and procedures in place regarding IPC (Infection, Prevention and Control) and had systems in place to monitor practices. The home knew how to respond to risks and signs of infection and how to make sure infection outbreaks at the service would be effectively prevented or managed. There were arrangements in place to make sure the environment was cleaned by staff at regular intervals.

People that were prescribed their medicines ‘covertly’, to be hidden in food or drink, had detailed plans in place which were reviewed by a GP, pharmacist and care home staff. This ensured that residents were getting their medicines safely and appropriately. Patch rotation charts were used and completed to show staff where patches had previously been applied. This ensured the patches were being rotated and therefore maximising benefit of the drug and to avoid skin irritation. People that had medicines prescribed ‘PRN’, as and when required, had detailed documentation in place to show why and when these medicines were to be administered. They were also reviewed by the GP in case they were no longer required. However, when people were prescribed numerous laxatives PRN, it wasn’t always clear for staff to know which one to use and when. The PRN protocols could be more detailed to help staff identify when to use these medicines to maximise effectiveness for the residents’ health and wellbeing. People that were prescribed thickener to help with swallowing difficulties did not always have this given regularly. The records were inconsistent, and we could not guarantee it was being given appropriately. People and their relatives said they received their prescribed medicines as planned. One relative told us, “They are good, they sort out all [persons] tablets, there haven’t been any problems, but they keep me up to date.” Another said, “They keep me well informed on any medication.”

The registered manager was pro-active in trying to improve systems that would streamline patient care. Currently, the home has some medicines which are ordered in ‘bulk’, including commonly prescribed items such as laxatives and creams. The registered manager is trying to individualise these items, so that they are readily available for residents that need them. This would ensure each item is dispensed for that particular resident with their name on the label. This system is already in place on one unit and appears to work well. Monthly medicines audits were carried out to identify anything that can be improved upon. The home has also shown evidence of regularly reviewing residents that are prescribed antipsychotics and anxiolytics. The GP has regular input into these reviews and is clearly documented in the patient’s care notes. They have recently managed to de-prescribe antipsychotics for 3 residents.

Medicines stock levels that were checked on the day of inspection were all correct and the medication administration records (MARS) reflected this. Controlled drugs stock levels were checked twice a day by staff and once a week by managers. Two random stock levels were checked and correct during the inspection. Where people were prescribed liquid medicines, eye drops or creams, the date of opening was documented on the label to ensure they were being used safely within their expiry dates. However, on the day of inspection we did witness one bottle of medicine which should be stored in the fridge being kept at room temperature. Oxygen was stored appropriately with signage to state where it was kept. The controlled drugs cupboard wasn’t large enough to cater for all the medicines needed to be stored in there. Staff acknowledged this and stated they would investigate ordering a bigger one to ensure the safe custody of controlled drugs. The registered manager confirmed a new cupboard had been ordered.