Ann Challis

We found the following examples of good practice.

The home was visibly clean throughout, with regular checks being made by the registered manager and senior care staff. Cleaning schedules were used to ensure all areas of the home were frequently cleaned.

Staff had received training in the use of personal protective equipment (PPE) and hand hygiene. Regular observations of practice were completed. Members of care staff told us they were kept informed of any changes in guidance by the registered manager.

A booking system was used for visitors to ensure there were not too many visitors at any one time. Current government guidance for visiting was being followed.

During the recent COVID-19 outbreak people who had tested positive used one lounge and those that were negative used another to reduce the risk of transmission.

All staff had had their COVID-19 vaccinations and took part in the regular testing programme at the home.

The home was clean and cleaning schedules were in place. The management team had oversight of the cleaning schedules and completed regular audits to ensure cleaning practices were to a high standard.

Staffing had received training in infection, prevention and control and donning and doffing. Staff were aware of the correct personal protective equipment (PPE) they need to use which was in plentiful supply and replenished weekly.

The home was part of regular testing for COVID-19. Procedures were in place to isolate those with positive tests. Additional checks were made on people and staff to assure the provider, they were not showing symptoms.

Regular contact was made with family and friends including window visits, video calls and telephone calls.

Further information is in the detailed findings below.

Ann Challis is a residential care home providing personal care for up to 23 older people. At the time of the inspection there were 23 people using the service all of whom were female.

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

People were happy with the care and support provided and told us they felt safe. Risks identified at the last inspection had been addressed however, other risks had not been fully assessed. We have made a recommendation about risk management.

The home was clean and many areas had been refurbished, however, we found more work was required to make the environment suitable for people living with dementia. We have made a recommendation about making the environment more dementia friendly.

Staff knew people’s needs and how to meet them, although this information was not always fully reflected in their care records. Accidents and incidents were monitored although there was no thorough analysis of themes and trends.

People, relatives and staff felt the home was well run. The provider responded promptly to issues raised during the inspection. However, these had not been identified through the provider’s own quality assurance systems.

Medicines management was safe. There were enough staff to meet people’s needs. Staff were trained and had the required skills to meet people’s needs. Staff told us they felt well supported. Recruitment processes ensured staff were suitable to work in the care service. Staff understood safeguarding procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s nutritional and healthcare needs were met. People and relatives praised the staff for being kind and caring. We saw staff treated people with respect. People enjoyed a range of activities and events, including going out on trips. Systems were in place to manage complaints.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 December 2018). There were four breaches of regulation and we took enforcement action. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

We last inspected Ann Challis on 22 and 23 August 2017 when we rated the service requires improvement overall, and for all key questions other than caring, which was rated good. This will be the third consecutive time that the service has been rated requires improvement overall.

At our last inspection we identified breaches of the regulations in relation to assessing risks to people using the service, accurate completion of care records and systems in place to monitor the quality and safety of the service. Following the inspection, we requested and received an action plan from the provider detailing how they would make the required improvements. This indicated that measures had already been put in place to address the breaches of regulations identified. However, at this inspection, we identified ongoing issues and continued breaches of these regulations. Breaches of the regulations found at this inspection related to; the safe management of medicines, premises and equipment, staff recruitment procedures, acing in accordance with the Mental Capacity Act, and good governance. You can see what action we have told the provider to take at the back of this report. This section will be updated once any actions have been concluded.

Ann Challis is a residential care home for women. The service provides care and support to older people, some of whom are living with dementia. The home has a secure garden area and communal facilities include two lounges and a dining area that are open plan to one another.

Ann Challis 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. Ann Challis accommodates up to 23 people in one adapted building. At the time of our inspection, there were 23 people living at the home.

The service is also registered to provide personal care as a domiciliary care agency (home care) although they had not provided this service since 2012. We have asked the registered manager to submit applications to cancel the registration for this regulated activity.

The former registered manager had left the service in March 2018, and an existing staff member had been promoted to the registered manager position. Their registration with CQC was completed shortly prior to our inspection. However, at the time of the inspection they were on planned leave, with an expected return date in January 2019. Another staff member had been appointed as the acting manager in the interim.

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.

Staff were enthusiastic about making a positive difference to the lives of the people they supported. People told us staff were kind and caring. The interactions we observed between staff and people living at the service showed that staff acted in considerate and caring ways that encouraged people to retain independence.

There were sufficient staff on duty to meet people’s needs, although both staff and people living at the home told us there were times when ‘another pair of hands’ would be useful. We looked at staff rotas and saw levels of care staff on occasions dropped from the expected three, to two staff on duty for an hour or two. The manager told us that domestic staff were fully trained and would provide any additional cover and support needed.

We found ongoing issues in relation to the safe management of medicines. As at our last inspection, the amount of medicines in stock did not always ‘tally’ with the amount staff had recorded that they had administered. Records in relation to the application of cream medicine were not always completed accurately, and we could not be certain that people had received their medicines as prescribed. We also found that staff on duty at night had not all received medication training. This could delay people receiving medicines such as pain relief if they required these medicines outside normal medicine round times.

The provider had acted to make improvements in relation to concerns raised with them about fire safety and window restrictors. However, we found further shortfalls in the way staff identified and controlled risks in relation to the premises and equipment. The provider had not acted on recommendations made by a third party who had carried out a legionella risk assessment on their behalf. There were no robust systems in place to control risks relating to legionella. Legionella is a type of bacteria that can develop in water systems and cause Legionnaire's disease. Legionnaire’s disease can be dangerous, particularly to more vulnerable people such as older adults.

We saw staff had carried out risk assessments and checks in relation to the use of bedrails. However, staff had not fully completed one of these risk assessments. We also found that despite the checks carried out, the bedrails did not conform to expected standards in relation to their safety. Other issues in relation to the safety of the environment included finding that heavy furniture was not secured to prevent it accidentally toppling over, and a radiator in a person’s bedroom was not covered.

Staff recorded any accidents or incidents that occurred. We saw that people’s care plans and risk assessments had been revised following any significant change in a person’s needs. However, it was not always clear what action had been taken to prevent accidents recurring, and the systems in place to track and monitor trends in accidents and incidents needed to be strengthened.

People living at the home and relatives we spoke with were confident that staff had the skills and competence to meet their, or their relative’s needs. We received positive feedback from a visiting health professional in relation to staff knowing the people they cared for, and acting on their advice. Staff received a range of training relevant to their job roles. However, completion rates for some of the training, including safeguarding training, were low. Staff told us they were well supported, and we saw they received regular supervision.

The provider was not able to evidence that they had followed robust procedures when recruiting staff to ensure they were of suitable character. The provider had misunderstood advice given to them in relation to data protection laws. This had resulted in them returning documents they needed to hold in relation to the employment of staff such as proof of their identity. We also found satisfactory evidence of conduct in previous employment had not always been obtained, and a full employment history had not been recorded for one member of staff.

The provider was not always acting in accordance with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The manager had not re-applied for DoLS applications in a timely way, which meant some of these had expired. This meant there was a risk that people could be deprived of their liberty without proper legal authority. We also found shortfalls in relation to procedures followed when deciding to give medicines covertly (without a person’s knowledge).

Care plans had improved since our last inspection. We found people’s care plans accurately reflected their needs and preferences. They also contained information about people’s social history, likes and dislikes, which would help staff get to know them and deliver person-centred care. Staff consulted people and their families about how much they wanted to be involved in reviews of their planned care.

The hours worked by the activity co-ordinator had increased since our last inspection. We saw craft activities and nail painting taking place during the inspection. Staff told us the activity co-ordinator had started supporting people to access the community and visit local shops, lunch clubs and cafés more regularly.

Staff, relatives and people using the service told us the manager and provider (directors of the company) were approachable. There was evidence that the provider was in regular contact with staff and the manager. They had asked for feedback from people living at the home and their relatives in relation to how they could improve the service.

There were a range of checks and audits completed by staff to help monitor the quality and safety of the service. However, these had not always been effective at identifying and addressing risks, such as those in relation to the safety of the premises and equipment and medicines. Sufficient improvements had not been made to improve the overall rating of the service, and we found ongoing breaches of regulations.

At our last inspection we made recommendations in relation to providing a dementia friendly environment, care planning in relation to dementia and strengthening governance processes. We found the provider had acted on these recommendations, but found ongoing shortfalls in the processes to monitor and improve the quality and safety of the service. Improvements had been made to make the home more accessible to people living with dementia and to improve care planning for people living with dementia.

At this inspection we identified three breaches of two of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to keeping accurate records of care, provision of safe care and treatment and good governance. You can see what action we have told the provider to take at the end section of this report. We have also made a recommendation that the provider reviews guidance in relation to implementation of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

Ann Challis is a residential care home for women. The service provides care and support to up to 23 older people some of whom are living with dementia. There were 21 people living at the home at the time of our inspection. The home has a secure garden area and communal facilities include two lounges and a dining area that are open plan to one another.

There was a registered manager in post. 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.

People told us staff treated them with dignity and respected their privacy. We found staff knew the people living at the home well and they were able to talk in depth to us about people’s needs, preferences and social histories. Staff interacted well with people and were quick to act to make sure people were comfy and received the support they needed.

We found records were not always kept up to date and did not always accurately reflect people’s planned care or the care they had received. For example, records relating to the application of cream medicines had not been completed for several days and one person’s records showed they had been administered an antibiotic on one occasion when this was not correct.

Care plans were personalised to people’s needs and had been regularly reviewed. However, they were not always up to date and did not always reflect the care people currently received or needed. We found staff were aware of people’s care needs despite this shortfall. However, this would increase the risk of inconsistent care being provided.

Staff assessed risks to people’s health and wellbeing, and measures were identified to help reduce the risk of harm occurring. However, risk assessments were not always up to date. In one case we found the use of bed-rails had not been risk assessed to help determine they were safe and appropriate to be used for that person.

Staff received a range of training relevant to their job roles. They told us they received adequate training and support to allow them to meet people’s needs effectively. People told us staff supported them to see a health professional such as a GP if they had any health concerns.

Staff had assessed people’s capacity to provide consent to their care plans or in relation to other decisions about their care. We saw examples of documented best interests decisions where these were required. However, we found one person who was subject to potentially restrictive practice did not have a recorded best interest decision and the registered manager had not submitted a Deprivation of Liberty Safeguard (DoLS) application.

Staff had worked in a person-centred way to identify activities that might be of interest to people living at the home based on their previous occupation. Some people living at the home had previously been employed as typists or machinists. The home had purchased a typewriter and sewing machine to allow people to use their skills in these areas if they wished to do so.

The registered manager worked ‘on-rota’ as a member of staff providing direct care and support to people. This meant they had very limited time in which to carry out their management responsibilities, although they told us delegation of tasks helped them manage the service effectively.

A range of audits and quality checks had been undertaken by the registered manager and the provider. However, they had not identified or ensured action was taken in a timely manner to address the concerns we found during the inspection. We found the registered manager took action to make improvements in response to feedback from relevant persons included the Care Quality Commission, local authority and infection control team. However, some of these improvements were not sustained. For example, we found the local authority quality assurance team had identified issues in relation to the completion of cream charts six months prior to our visit and this was an on-going issue at our inspection.

Staff felt well supported by the registered manager. Staff, relatives and people living at the home told us they would feel comfortable approaching the registered manager to raise any concerns they might have.

The provider had a registered manager in place as required by the conditions of their registration with the Care Quality Commission (CQC). 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 registered manager was responsible for all the services delivered by the provider.

The home was previously inspected in September 2014 and was compliant in all the areas we looked at then.

People were cared for by staff who knew how to recognise the signs of possible abuse. Staff were able to identify a range of types of abuse including physical, financial and verbal. Staff were aware of their responsibilities in relation to keeping people safe. They were able to explain the process which would be followed if a concern was raised and said they felt confident using the process should they need to.

Risk assessments were in place and reviewed monthly. Where a person was identified as being at risk actions were identified on how to reduce the risk and referrals were made to health professionals as required.

Safe recruitment practices were in place and records showed appropriate checks had been undertaken before staff began work. There were sufficient numbers of staff on duty to keep people safe and meet their needs.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. We observed medicines being administered and staff doing this safely. The manager completed an observation of staff to ensure they were competent in the administration of medicines.

Consent to care and treatment was sought in line with legislation and guidance. Capacity assessments had been completed appropriately for people and were in their care records. Staff we spoke with understood the principles of the Mental Capacity Act 2005 which meant staff understood the importance of ensuring people’s rights were protected.

Staff had undertaken appropriate training to ensure that they had the skills and competencies to meet people’s needs. New staff undertook a comprehensive induction programme which included essential training and shadowing of experienced care staff.

People were supported to maintain good health and had access to health professionals. Staff worked in collaboration with professionals such as GPs and district nurses to ensure advice was taken when needed and people’s needs were met.

People received enough to eat and drink. People who were at risk were weighed on a monthly basis and referrals or advice were sought where people were identified as being at risk.

Family and friends were able to visit without restriction and relatives told us that staff were always welcoming and happy to spend time speaking with them about their family members. Relatives told us that they felt involved in the care their family member received.

We have made recommendations to ensure people who are living with dementia are supported in an environment which is appropriate to their needs and is clean and tidy, and have person-centred care plans which outline how much support they need in relation to their dementia care.

We also recommend that the provider ensures there are more formal systems in place to ensure the quality of the care people receive is regularly reviewed and monitored.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive to people's needs?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and the Registered Manager. We also spoke by telephone with the district nurse and a representative of Trafford Local Authority Quality Monitoring team. We looked at records relating to people's care and the management of the service. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Ann Challis provides support to people with varying personal care needs which include people who are living with dementia. The premises are located in a quiet residential area of Urmston, Manchester. The building is a detached Victorian house that has been extended to provide accommodation for up to 23 people. The premises had recently had new carpet fitted to all communal areas including the stairs and landings on the upper floors. The home was mainly odour free and was clean, tidy and well presented.

Training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) took place which ensured that people who were not able to make decisions or choices were protected and kept safe. Best interest meetings and any other legal requirements such as applications to DoLS were completed in conjunction with other health care professionals such as social workers. We saw that an application to DoLS had been completed for one person and that a best interest meeting was to take place. We discussed with the manager the possibility of obtaining advocacy or be-friending services for those people who may not have meaningful or consistent support from family or friends.

There were a sufficient number of people in the staff team to ensure that people were supported with their care needs.

Is the service effective?

Recruitment and selection procedures were in place. There was an induction period of 12 weeks to ensure that the people who lived at Ann Challis were cared for by staff that had the skills to meet people's needs.

We saw from looking at the care plans that people had received an assessment and that there was a good understanding of the person's needs and the support they required.

The people we spoke with said that they were happy with the care they received. The majority of people spoke well of the staff team and had no complaints.

Is the service caring?

We spoke with seven people who used the service and two family members. Comments we received were; "I am really happy with the place; there have been times when my relative has been really poorly and they have cared for them over and above; genuine care.' Another person said; 'I think it is generally ok.'

The majority of people we spoke with including both staff and people who used the service said that they would go to the manager if they had any concerns.

People's preferences were recorded in the care plan and they were able to express their views and opinions during resident meetings, assessments and reviews.

Is the service responsive to people's needs?

We saw that people's needs were assessed before they were offered a place at Ann Challis to make sure that the home could provide the care the person required. We also saw that either the person or a family member had signed consent to care and treatment forms.

There was an activities organiser who worked four days a week. The home also had entertainers and representatives of the local church visiting regularly.

We saw that people were referred to other healthcare professionals as and when necessary; these included GP, district nurse and podiatrist.

Is the service well led?

The manager monitored the care plans and daily records to make sure that they were up to date and reflected the care that had been provided that day.

The manager had monitored the number of staff available for night duty. They had observed that an additional member to the staff would be beneficial to the home in order to maintain continuity.

When we arrived we found the home to be warm and well presented. There was a new manager who had recently submitted an application to the Care Quality Commission (CQC) to become the Registered Manager. Our records confirmed this.

We could see the manager had introduced new systems to ensure the care and welfare of people were maintained and to obtain their consent. We spoke with people who used the service and all gave complimentary feedback. They told us they were well looked after and were happy living there.

We spoke with four people who used the service and all gave complimentary feedback. Some comments received were 'I am very happy and satisfied all staff help they are very good, I am looked after properly I feel safe and supported'.

We looked at the home's policies and procedures which included Protection of Vulnerable Adults, Restraint, Abuse Towards Staff, Whistle Blowing, Missing Residents and Dealing with Residents' Finances. All of the policies had been reviewed and updated in October 2011.

We saw evidence that people had received the correct administration and monitoring of their medications.

We looked at two staff records and saw they had evidence of training relevant to their role. We saw in one file the staff member had undertaken an induction programme, had received an induction book and an employee handbook when they commenced at the home.

A visiting family member told us 'X is lovely and very knowledgeable I am able to approach her with any problems. There is no difference in care since the manager left, the girls are very busy'.

We saw that plans contained assessments of risks which included personal care, nutrition, mobility, pressure areas, falls and medication administration.

We did not find any evidence of mental capacity assessments for people who used the service. We saw that as part of care planning there was a statement of mental state and cognition noted but no further assessment.

We spoke with people who used the service. They said: 'I am very happy here', 'I am always looked after well', 'Whenever I use my buzzer the staff come as soon as they can, I don't normally have to wait long' and 'The girls look after me here, I am very happy'.

We also spoke with relatives who were visiting at the time of the inspection. They told us: 'My X has only been here a few weeks but we are very happy with the way she has been treated', 'We have no concerns up to now, I feel X is well looked after'.

During the inspection we carried out a Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. This was carried out over lunch.