Chaseley

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.

The home accommodates 55 people. It specialises in the care of people with highly complex needs, including diseases or injuries that affect the brain and nervous system. When inspected, 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 some people living within the home. There were multiple communal areas, including a large dining hall, a bar and a quiet lounge, along with large accessible gardens. The facilities were adapted to suit the needs of the different people and there was an extensive range of individual aids and resources available. Technology was used throughout the home to enhance people’s lives and to improve the care provided.

At the time of the inspection there was a registered manager in place. 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.

The staff were proud of the positive, inclusive culture within the home and we observed caring, empathic interactions between the staff and different people throughout the day. There were numerous activities available which were seen to enhance the quality of people’s lives and promote independence. The activities included art, gardening and exercise clubs. There were activities involving the wider community, for example, a regular disco and garden parties. People were helped to access activities within the community, such as the theatre and enjoying local nightlife. Families and friends were made to feel very welcome and were actively involved, according to the needs and preferences of the different people. The home provided end of life care, as necessary, seeking support from other organisations, including the hospice, as required.

There were good staffing levels and people and relatives felt very supported throughout the day and night. There was a robust system of staff recruitment, which ensured that those employed had appropriate references and the necessary background checks were made, to ensure they could work in the care industry. People felt safe and the staff were knowledgeable about safeguarding and worked within the framework of the Mental Capacity Act. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice. Staff also had an excellent understanding of equality, diversity and human rights and this was seen in practice, with people being respected and enabled to lead the life the way they chose. There was an extensive training schedule in place, with staff receiving both standard training and attending courses which were specific to the people they cared for. Staff had established their own innovative system of peer support and assessment to both maintain and improve standards. There was a robust system of supervision and appraisals to maintain high standards.

Medicines were managed safely and according to good practice and there were systems in place to ensure good infection control. There was an extensive range of audits which maintained standards, ensured the environment was safe and were used to inform practice and continually improve the care given. Any accidents and incidents were thoroughly investigated and there was a comprehensive system in place to analyse trends. This led to a proactive approach with potential trends being identified and any issues addressed.

All the people were treated as individuals and their care plans reflected this. The whole person was central to planning care with the psychological, social, sexual and spiritual needs being reviewed alongside the physical needs. All care reflected this holistic approach. There was extensive evidence of multi-disciplinary working with an in-house GP, physiotherapy staff and occupational therapist. The team also worked closely with other health care professionals, with the aim of achieving the best outcomes, for the people they cared for. There were comprehensive individual risk assessments in place and people were encouraged to take positive risks to enhance the quality of their lives.

Staff considered accessible information for all the different people within the home, although they did not have a formal Accessible Information Standard strategy. Many people had highly complex communication needs and specialist aids were used extensively. Staff were aware of how different people expressed themselves and were skilled in interpreting their needs. There were systems of obtaining feedback and information from the different people and their relatives and this information was used to make changes. One example was a survey which resulted in the gym opening hours being extended.

There was a social dining area and people had access to a healthy and varied diet. People were supported to lead a healthy life and opportunities were taken to improve people’s diets and their levels of physical activity. People were asked to give feedback about the food and could influence what was on the menu.

The management team were very industrious and actively sought ways to improve the service. There was an extensive system of audit and quality assurance in place and the management constantly strove to improve the standards within the home through feedback and networking. The staff worked well as a team and the vision of the home was embedded in their practice. They had productive relationships with other organisations and were actively engaged with the wider community.

Chaseley is registered to provide care for 55 people. At the time of the inspection there were 40 people living at the home, including one person staying at Chaseley for a period of respite care.

At the last inspection 18 and 19 November 2014 we asked the provider to make improvements for notifications after incidents occurred, training for staff around Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), confidentiality of records and assessing and monitoring the quality of service provision. The provider sent us an action plan stating these issues would be addressed. At this inspection we found that actions had been taken to ensure all regulations had been met.

This was an unannounced inspection which took place on the 22 and 25 January 2016.

Chaseley had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The manager was in day to day charge of the home, supported by the deputy and human resources business partner. People and staff spoke highly of the manager and told us that they felt supported by them and knew that there was always someone available to support them when needed. Staff told us that the manager and deputy made a good team and had made a number of positive changes.

Staff felt that training provided was effective. Registered Nurses had received further training to ensure they were able to meet specific nursing needs for people. Care staff felt they received effective training and this ensured they were able to provide the best care for people. Competencies checks and workshops took place to ensure staff training was relevant and up to date. Robust recruitment checks were completed before staff began work, and staff completed a full induction when they commenced employment at Chaseley. There a programme of supervision and appraisals for staff, this meant that staff felt continually supported.

Medicine administration, documentation and policies were in place. These followed best practice guidelines to ensure people received their medicines safely. Regular auditing and checks were carried out to ensure high standards were maintained. People were supported to self-medicate if deemed safe for them to do so and this was regularly reviewed.

There were robust systems in place to assess the quality of the service. Maintenance checks had been completed. Fire evacuation plans and personal evacuation procedure information was in place in event of an emergency evacuation.

Peoples nursing and care dependency levels were assessed and reviewed to ensure appropriate care provision was in place. Staffing levels were reviewed regularly.

Care plans and risk assessments had been completed to ensure people received appropriate care. Care plans identified all nursing and care needs and had been reviewed regularly to ensure information was up to date and relevant. Staff had a good understanding around the principles of MCA and DoLS. People were asked for their consent before care was provided and had their privacy and dignity respected. Feedback was gained from people this included questionnaires and regular meetings with minutes available for people to access.

People were encouraged to remain as independent as possible and supported to participate in daily activities. Regular therapy was provided when appropriate and people had access to the on-site gym.

Staff demonstrated a clear understanding on how to recognise and report abuse. Staff treated people with respect and dignity and involved people and their families in decisions.

People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave positive feedback about the food and visitors told us they had eaten with their relative and found the food to be of a very high standard.

Referrals were made appropriately to outside agencies when required. For example GP and hospital referrals, dentists and speech and language therapists (SALT).

Notifications had been completed to inform CQC and other outside organisations when events occurred.

The service currently has an embargo on admissions implemented by the local authority.

As part of our inspection we spoke with six care and nursing staff, the registered manager, clinical lead and further senior staff member responsible for safeguarding. Throughout the inspection we were able to speak with eight people who lived in the home and one visitor to the service.

Three inspectors carried out this inspection.

The inspector considered the 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?

Is the service safe?

We saw that the home carried out regular maintenance and equipment checks for the service. The home had implemented some quality assurance systems to assess and monitor quality of the service provided, however these were not robust, and actions had not been completed.

We saw that there were unsafe practices in relation to medication administration errors and discrepancies within the medication records. We looked at incident/accident reports and complaints.

Is the service effective?

We spoke with people living at Chaseley. We were told 'It is fine for me I am well looked after.' Another told us 'No issues personally, I am off to the caf', I like it down there.' People told us that the food was 'Nice, plenty of choice for me, I have no complaints.' And 'It is usually very good.'

One person we spoke with told us they did not feel that they were listened to or that staff responded when they raised concerns.

Is the service caring?

We saw staff speaking to people and providing care and support. Staff spoken with were able to tell us about people and their individual needs.

We saw that one person who received one to one care at all times had sticky eyes. However, no information or guidance had been included in their care file regarding this. We also observed a member of staff reading the newspaper whilst providing one to one care to this person in their room. We discussed this with senior staff who told us that this should not be taking place, and staff should use the time spent in the room observing the individual or completing documentation regarding that person.

Is the service responsive?

We looked at accidents and incidents reporting within the service. We saw that the system in use meant that there could be a delay from an incident being reported to a senior staff member responding and taking appropriate action.

Is the service well-led?

The home had a registered manager, clinical lead and one further senior staff member who were responsible for the running of the service, and a second location which also belonged to the provider.

We identified by direct observation that all three senior staff were working long hours and appeared to be very busy throughout the inspection dealing with day to day issues at both locations. We were told that the Nominated Individual provided support for three days a week, this was again over both locations.

We were shown that the service asked people who used the service for their feedback, and the results of these surveys, were used to improve the service.

We saw that staff had attended safeguarding training, and were able to demonstrate a good understanding around how to recognise and report safeguarding concerns.

The organisation had been actively recruiting nursing and care staff. Agency staff had been used to maintain staffing levels. An induction and competencies for agency staff had been introduced.

A number of audits had taken place. However, we saw that some actions identified had not been taken forward and rectified.

People's care documentation did not provide appropriate information in relation to the care and treatment needs of the individual. Gaps were seen in daily charts and care plans had not been reviewed and maintained to an appropriate standard.

We looked at care plans and further care documentation identified in the warning notice. We spoke with staff and people living in the home. We found that concerns identified in the warning notice had been addressed.

During our inspection we found that documentation in people's care files did not detail their care needs. Gaps and inconsistencies were seen. This meant that people were at risk of receiving inappropriate care and treatment.

Staffing levels were being maintained by the regular use of agency staff. Due to the lack of relevant documentation and inadequate daily records it was unclear how the provider had ensured that all staff were aware of people's needs.

The provider had implemented a number of changes to assess and monitor the quality of the service. However actions taken to address concerns raised was not always clear. Time was needed to allow monitoring to become fully embedded.

People living at Chaseley had complex needs which meant that some people were not able to tell us their experiences. Those who could told us they were happy living at Chaseley. One person told us 'Staff do a wonderful job here.'

During our inspection we found that people were involved in decisions made about the care they received. The provider had robust recruitment procedures to follow for new staff. However, not all staff were aware of correct safeguarding procedures. Documentation in people's care files had not been completed correctly, with gaps and inconsistencies seen.

People living at Chaseley had complex needs which meant that some people were not able to tell us their experiences. Those who could told us they liked living at Chaseley. One person told us 'I enjoy the activities, and I really like my room, I have all my own things around me."

During our inspection we found that care plans clearly documented the needs of people, and the general standard of cleanliness was of an appropriate standard.