Chepstow House

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• 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

People felt safe living in the service. Staff had received training in relevant topics to keep people safe. Complaints procedures and whistleblowing policies were available to staff to safeguard people if needed. We observed some positive and negative interactions between staff and people. Risks to the health and safety of people using the service were assessed. Staff understood their roles and responsibilities in protecting people from abuse and the risk of harm. Staff had received training in how to safeguard people. Safeguarding concerns had been raised with the relevant authority where required. Staff completed moving and handling following best practice guidance. Staffing numbers kept people safe but were not always in place to allow people to go into the community frequently. The home was generally clean apart from 1 fridge, which staff swiftly cleaned.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received generally good feedback from relatives we spoke with. Three relatives told us communication was good and they were kept informed. One relative felt communication and documentation could be improved. A relative said, “Staff always let me know if there has been an incident.” Another relative told us, “Communication is good (between them and the manager). They call me if there’s anything, I can always contact them too.”

The provider had recruited a new manager at the time of our assessment. Staff had recently been introduced to them. Staff spoke positively about the regional manager. One staff member said, “They are very approachable and keen to be open and honest with people.” Staff confirmed they had received induction training and relevant safeguarding training.

Staff had received training in relevant topics such as medicine administration and safeguarding people. The complaints procedures and whistleblowing policies were available to staff to safeguard people if needed. Management were found to be open and honest throughout the assessment and showed a commitment in wanting to further improve the service.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We received mixed feedback from the relatives spoken with. One relative told us staff met their loved ones needs and keep them safe.” Another relative described how there had been some incidents with other people using the service. Another relative told us how their family member had some falls. They had raised these concerns to staff, who had looked into what could be done to try to avoid falls in the future. One relative said, “[Person’s name] is being kept safe at the home and things are slowly improving. There’s rails [to hold onto] now.” Another relative described their family member and told us, “[Person’s name] can become agitated. Staff stick to routines to avoid them becoming agitated. Staff are on the ball and keep [person] safe.” Relatives told us they were informed of any incidents. One relative told us, “Staff always let me know if there has been an incident.”

Staff confirmed they would not hesitate to report any concerns. One staff member said, “Depending on what the situation was I would go to the team leader, deputy manager, registered manager or the local safeguarding hub, and report it on our system.” Staff knew where to access safeguarding policies and demonstrated good knowledge of how to report concerns.

We observed some positive and negative interactions, and 1 person who had very little interaction with staff. Some staff were not always able to identify when a person was showing signs of anxiety. Staff observed but did not intervene or divert the person’s attention to try to calm the situation. This did not always protect people from harm. Later in the observation, a different staff member recognised the person’s anxious behaviour and diverted them to go for a walk into another room.

Staff had received safeguarding training and there were safeguarding and whistleblowing policies and procedures available to support the process of keeping people safe for any issues arising.

We observed a person self-administer their insulin. They checked their blood sugar 4 times a day by doing their own finger pricking. We spoke with a family member who shared with us how their family member was supported to safely manage a risk associated with their health.

The regional manager told us how they had involved people in developing their risk assessments in relation to smoking and vaping. These were sent to us following our onsite visit, which confirmed peoples’ involvement in this process.

We observed one person self-administer their insulin. The person had a good understanding of their health needs and associated risks.

Risks to the health and safety of people using the service were assessed. For example, we identified there were risk assessments in place for a person who self-medicated and for people who chose to smoke or vape.

We found a generally safe environment though in 2 bathrooms and a toilet there was exposed piping which could present a risk to people if they were to come in to contact with it. We addressed this with the management team. The provider acted on this without delay and sent us evidence the piping had been boxed in. We also saw there were toiletries in an unlocked cupboard and toiletries left out in an upstairs bathroom. which included a razor and creams. The senior immediately took action and removed the toiletries and told us they would request a keypad to be fitted to the cupboard. The regional manager said these toiletries had been be moved into people’s own bedrooms and locked away if there was any risk to the person.

There was mixed feedback from the person and relatives. A person told us, “I like it here. I like the staff they are always kind and polite.” A relative said, “It’s completely [person name] home. The staff and residents are [person’s] family.” Other relative’s comments included, “There always seems to be enough staff.” “Staff are very nice.” “[Person’s name] has good care there. Staff know [person] really well. Staff keep on top of everything their loved one needs and they are getting what they need.” However, 2 relatives had negative experiences. One relative said that when their family member had grabbed a member of staff’s shirt, the staff had reacted aggressively. The police had been involved. Another relative told us on one occasion, a staff member had been disrespectful, and argued with them.

We found staff levels were above minimal risk levels and although some shifts have worked with reduced staffing, this has been the result of staff calling in sick at the last minute. There had been lack of activity plans in place. The regional manager stated that as of September 2024, the role of activities co-ordinator will be reintroduced to work alongside keyworkers. This will ensure all people have an activity planner to enhance their quality of life and upskill the staff team. There was mixed feedback from staff. A staff member told us, “I think we have enough staff, its important the senior leads the shifts well, it more about good allocation and good planning.” Another staff member said, “Agency staff are used if needed and they know people well.” A staff member said there were not always enough staff for activities, as more staff were needed for people who used wheelchairs. A number of people who could walk needed to have 1 staff member with them. This meant there was not enough time spent out in the community. They said management were currently reviewing staffing levels, so hopefully this would improve.

We carried out observations in the lounge. There was a mixture of good and poor interactions observed. People did not have to wait for staff support. For example, one person wanted to go out for a cigarette, and staff supported them to do this. People and staff spent time together in the lounge watching a film. We observed a good transfer with a staff member and senior supporting the person from their wheelchair. Although staff did not communicate with the person throughout the transfer, they did ask the person if they were comfortable once seated and raised their footrest and asked them if it was at the correct height. The person gave the thumbs up. One person appeared agitated. Staff were observing but did not intervene or try to divert. Staff seemed unsure what to do when a person grabbed another person. Another staff member came in and recognised the person was agitated and was able to divert them. We observed staff member supporting a person to transfer from a chair to their wheelchair. The staff member was distracted and did not fasten the seat belt. Two minutes later the staff member returned and fastened the seat belt.

The staff training matrix was viewed. Staff had received relevant training such as completion of the care certificate, fire safety, first aid, fluids and nutrition, Infection control, medicine awareness and safeguarding. There was also service specific training in relevant topics such as autism awareness, dementia, learning disabilities and understanding the perspective of the people being supported. We viewed 4 staff files. Staff were recruited safely. Processes ensured necessary checks were completed prior to staff starting employment. This included reference checks, proof of identity as well as Disclosure and Barring Service (DBS) checks. A DBS check is a way for employers to check an employee criminal record, to help decide whether they are suitable person to work for them. This protected people from receiving support from unsuitable staff.

All areas of the home looked clean, apart from the fridge in the kitchen which was not clean and food was not labelled consistently. People's bedrooms were personalised and also looked clean. We observed some areas needed cosmetic improvement, for example, the hallway bannisters were chipped.

We spoke with 4 relatives and 1 person living at Chepstow House. One person told us they knew what medicines they were taking and said, "It (medication) helps sometimes." A relative said, “[person's name] pain management is under control." We observed a person self-administer their own insulin. The person checked their blood sugar levels 4 times a day to ensure their diabetes was managed safely.

All the staff told us they had received training in the administration of peoples’ medicines. One staff member said, “I completed an online course and 2 in house books and 1 assessment to carry out competencies on others.” Another staff member told us, “I completed an E learning course, then had 3 face to face competency tests.”

Policies were in place to ensure people received their medicines on time. Medicine records confirmed people had been supplied with their prescribed medicines. Audits were completed which showed people had been supplied with relevant medicines to manage their health conditions.