This inspection was carried out on 18 and 27 September 2017. Both visits to the service were unannounced. Chester Lodge care home is a privately owned service providing residential and nursing care for up to 40 people. It is located close to Chester city centre. At the time of our inspection there were 35 people living at the home.The service had a registered manager. 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.
At the last inspection December 2016, we asked the provider to take action to make improvements in regards to safe care and treatment, capacity and consent and overall governance. These actions had not been completed.
During our visit we found a number of new and repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
People we spoke with said that they felt safe at the home and relatives felt that staff did their outmost to support people and protect them from harm. However, we found that the risks to people’s health and safety were not always identified, assessed or managed.
There was a safeguarding concern prior to the inspection in relation to the management and assessment of pressure ulcers. Care plans did not always include accurate information for the prevention and management of pressure ulcers.
A number of people were at risk of malnutrition or dehydration. However, food and fluid charts were not always completed in detail to reflect what people had eaten and drunk over a 24 period and to inform assessment of the person’s nutritional status.
Referrals to health professionals were made when concerns regarding people’s health were identified, but this was not always done in a timely manner. We found that advice and guidance provided by health professionals was not always implemented to ensure that risks to people’s health and wellbeing were minimised
People did not always receive their medication as prescribed as there were delays in administration. Medication was not always stored in a safe and secure way.
Accident and incidents were not effectively monitored. Review of these did not always identify causation, risk or patterns. Management plans to reduce the occurrence of accidents were not always followed or their effectiveness reviewed.
Some call bells were out of reach and inaccessible. When people were unable to use a call bell, robust plans had been put in place to ensure the person received the attention they needed.
The premises were not clean and we detected unpleasant smells in parts of the building. The management of infection control required improvement .
Staff showed limited understanding of their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Supporting documentation did not reflect how specific decisions for people who may lack capacity had been made in their best interest. Decisions were made by people without any legal delegation to do so. However, staff practice showed that people’s consent was considered before care or support was provided.
Staff did not always respect people’s opinions and choices in regards to how they wanted their support to be provided. People were not always kept comfortable and were not always treated with dignity and respect. People informed us that the staff were caring and did the best that they could to look after them.
Care plans did not always record people’s needs accurately. Records were not personalised to reflect people’s individual preferences about how they would like their care and support to be provided.
The quality assurance system in place was not effective and did not monitor the quality and safety of care. The service has now been non-compliant with the regulations since October 2015. Improvements had not been made or sustained.
Staff attended annual training sessions in areas such as moving and handling, first aid and safeguarding adults to update their knowledge and skills. There was adequate fire safety management and evidence to support effective evacuation in the event of a fire.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.