Chaseley

Updated 5 November 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by a team of four inspectors. There were two inspectors on day one of the inspection and three inspectors on day two. On day two, the third inspector joined the inspection for half a day. The team was based on the size of the service and people’s complex needs.

Service and service type

Chaseley 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection because we inspected at short notice. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with eight people and three relatives. Some people could not verbally share their views of the service. Therefore, we observed people's experiences of living at Chaseley. This included meal-times, activities and interactions with staff. We spoke with the nominated individual who is responsible for supervising the management of the service on behalf of the provider. We also spoke with the registered manager, clinical nurse manager, unit nurse manager, chef manager and seven staff members. We met with a visiting health professional who was happy for their comments to be used in this report. We had feedback from the local authority and clinical commissioning group.

We reviewed a range of records. This included seven people’s care records and medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed. We carried out observations.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at staff rotas and quality assurance records. We also received a wide range of information including records relating to training, lift servicing, supervision tracker, risk assessments and formats to be introduced to record clearer evidence. We received feedback from eight health and social care professionals who were happy for their comments to be quoted.

Updated 5 November 2019

About the service

Chaseley is a residential care home providing nursing and personal care to up to 55 people. At the time of inspection there were 51 people living there. The home specialises in the care of people with complex needs, including diseases or injuries that affect the brain and nervous system. People were living with a variety of conditions, including acquired brain injuries, spinal injuries, strokes and multiple sclerosis. There is a rehabilitation gym, with designated therapy staff, which was available to people who were funded to receive this support. There were multiple communal areas, including a large dining hall, a bar and a quiet lounge, along with large accessible gardens.

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

Since the last inspection the registered manager had left their position. A new manager was appointed and is the registered manager. Some members of the senior management team had been appointed since the last inspection.

The provider had recognised that standards in some areas had slipped and already had an action plan to address this and make improvements. Quality assurance systems were not sufficiently organised or robust enough to identify the concerns found during our inspection. The registered manager had not always recognised when action needed to be taken to improve.

There was a lack of oversight to ensure people’s care plans were up to date and accurate. Care plans included detailed information about how to support people’s health and medical needs but lacked information about how to meet people’s emotional needs.

The systems for reporting safeguarding matters were not always effective. Some safeguarding matters had not been reported to the Care Quality Commission (CQC) as required. During the inspection we found that further incidents had not been recognised as safeguarding incidents, and so had not been reported to the local authority or to CQC.

There were staff vacancies and recruitment of staff was ongoing. In the interim vacant hours were covered through staff working overtime and with the use of agency staff. However, staff were not always suitably deployed to ensure people’s needs were met safely and in a timely manner. The impact of the staff shortages had not been assessed to check that people still had the support they needed.

The oversight of health and safety checks and documentation was not effective, and several records were missing. Although eventually located, the lack of organisation left the potential for important checks to be missed. Record keeping related to complaints lacked detail to demonstrate all aspects of complaints had been investigated thoroughly.

Risk assessments did not always include detailed information. For example, there was no advice in some people’s care plans about how staff should support people who displayed behaviours that challenged. Guidance about giving medicines needed on an ‘as required’ basis was not detailed.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. This was specifically in relation to mental capacity and consent.

Relatives and professionals gave mixed feedback about the service. Three relatives highlighted shortfalls, but all felt the home was on the right track and improvements were being made. One relative talked about a shortage of staff, that communication was not always good and the effect this had on them and their relative’s needs.

Staff were kind and caring in their approach. One person told us, “I love living here, the atmosphere, the kindness of the staff, the residents, the food.” Another said, “They are good and very friendly.” A relative told us, “Chaseley has a warm embrace, warm, accepting and tolerant.”

Appropriate checks had taken place before staff were employed to ensure they were safe to work with people. Revised systems ensured that new staff received additional guidance and support in the early stages of their employment. This had been effective in ensuring greater staff retention. Staff attended regular training to update their knowledge and skills.

People were supported to attend health appointments, such as the GP or dentist and attended appointments for specialist advice and support when needed. People had enough to eat and drink and menus were varied and well balanced. Bi monthly food forums were held to ensure people had a say about the food on offer. People had the equipment they needed.

Bedrooms were personalised to reflect people’s individual tastes and interests. There was a wide range of activities provided in the home and a number of volunteers were used to ensure these activities continued. These included gardening, art, pottery, choir and music and movement. The location of the home meant people and their relatives could make use of the seafront and the local theatres.

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 outstanding (published 24 August 2018).

Why we inspected

The inspection was prompted by concerns received about safeguarding matters not being correctly reported to the local authority. A decision was made to inspect the service and examine those risks. We found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches of regulations. These were in relation to protecting people from abuse, the deployment of staff, person centred care, dealing with complaints, reporting significant events and governance.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.