Chamberlaine Court

On this page

• 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 told us they felt safe living at Chamberlaine Court, and relatives spoke of good communication if their family member was unwell or involved in an accident or incident. Processes were in place to support safe and effective risk management and people had the equipment they needed to reduce risks and keep them safe. People benefited from living in a safe and clean environment and staff understood their role in mitigating risk and reporting their concerns. People and relatives described staff as being very busy; staff told us it could be challenging to meet people’s needs at busier times of the day. The registered manager reviewed the deployment of staff during our assessment. Some aspects of medicines management and staff practice needed to be improved to ensure people received their medicines as prescribed.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us there was open and good communication if their family member was unwell or was involved in an accident or incident. One relative told us, “If anything happens, we always have a phone call, we have never had any problems with that at all.” Another relative commented, “If something happens, they let me know. If [Name] had a fall or was not well, they always ring. 10 out of 10 for that one, they do a good job on that side.”

Staff told us any changes in people’s needs or learning from adverse incidents was shared with them in staff meetings or during the handover of information between shifts.

Accident and incident forms were completed in detail by staff and reviewed by the registered manager to ensure all appropriate action has been taken to mitigate future risks. Where necessary, care plans were reviewed to ensure they reflected any changes in the person’s support needs. The registered manager carried out a monthly audit of accidents and incidents to identify any patterns or trends and ensure healthcare professionals were involved in reviews to improve people’s outcomes.

People and their relatives did not share any concerns about their, or their family member’s move to Chamberlaine Court. One relative told us good communication had supported a person’s transition to the home from hospital. They explained, “It was all arranged by the social worker, communication was fantastic, they made sure we knew everything we needed to know. Communication has been brilliant from the start, the slightest thing and they (staff) let us know.”

The registered manager explained the process for ensuring people were admitted to the home safely. This included carrying out baseline observations so they could identify any deterioration in people’s health. The registered manager told us they had recently introduced more detailed documentation to be shared with healthcare professionals when people were admitted to hospital. Senior staff described a robust process to ensure people were reviewed by other healthcare professionals when their needs changed.

Healthcare professionals did not share any concerns in relation to this quality statement. One healthcare professional told us, “The transition (from hospital) appears to be smooth and from my experience information is shared appropriately.” Another healthcare professional commented, “Based on the people I have supported to be discharged from hospital to Chamberlaine Court, Chamberlaine Court has always shared information appropriately.”

When people were admitted to hospital, a document detailing their health needs and risks associated with their care was sent with them. This meant hospital staff had important information about people to ensure a safe transition into their care. When people were discharged from hospital, discharge records were added to people’s care records, so staff had information about the person’s hospital stay and any changes in their needs. Processes were in place to ensure people had the support they needed to attend routine medical appointments if family were unable to accompany them.

People told us they felt safe living at Chamberlaine Court. Some people told us they felt safe because the building was secure. Other people told us they felt safe because of the support they received from staff. Comments included: “I do feel safe, no one can get in or go out”, ‘I’ve never felt not safe. If I didn’t, I’d press the emergency button, but it’s never happened”, “I’m safe, the staff are very reassuring” and “I’m safe, there’s also lots of staff here and they keep popping their heads in.” Relatives did not raise any concerns about how staff cared for and interacted with their family members.

Staff understood their role in speaking up for people and reporting any concerns to the registered manager. One staff member told us, “I would go straight down to the manager, and it would be documented, and safeguarding would be brought in." Staff told us they would escalate their concerns within the provider group if they felt appropriate action had not been taken to safeguard people. Comments included: “You would just keep going up and up until something was done. We come to work for these residents at the end of the day." The registered manager understood their responsibility to respond to safeguarding concerns and report them to the local authority safeguarding team and CQC. However, one new member of staff was unclear about local safeguarding processes if they needed to escalate concerns externally.

There was a calm and relaxed atmosphere in the home, and we observed positive interactions between people and staff.

Processes were in place to identify safeguarding issues to ensure they were referred to the local authority and CQC as required. For example, staff documented any injuries sustained on body maps. Where the cause was not known, this was reviewed by the registered manager as a potential safeguarding referral. Staff received regular training to reinforce their confidence in recognising and responding to safeguarding issues.

Where possible people were involved in managing risks to their health and wellbeing. One person told us how staff promoted their independence with the management of their catheter. They explained how they independently managed some aspects of their catheter care but how staff would support them where needed. This person went on to say, “The staff are good though. They keep me topped up with water. It is important I drink because of this (catheter).” Another person told us, “When staff come in, they have to move me. It is always 2 staff, and they make sure I don’t get red sore skin. I have that blow up mattress as well. If I need anything then I just press that (call bell) and someone is soon here. The staff always leave it where I can reach.” A third person told us, “They need a hoist to move me. It’s done quite well. They never hurt me and there’s always two of them.”

Staff understood their role in risk mitigation and described good communication when risks to people’s health and wellbeing changed. Staff explained they could refer to their ‘priority needs sheet’ which gave a snapshot of each person’s individual risks, and the care required to manage those risks. This ensured a consistent approach to risk management.

Where people needed equipment to mitigate their risks, we saw this was in place. For example, people at risk of falls had sensor mats to alert staff if they stood up unaided. People at risk of falls from bed had crash mats and sensor mats by the side of their beds. We saw one person being transferred using a wheelchair. This was done safely, and the footplates were in place. People who used walking frames when mobilising, had them near to hand. Where people were seen to be sat in ‘in situ’ slings, these had been appropriately risk assessed. One person’s blood sugar level was elevated. We observed staff following the person’s risk management strategies to mitigate the risks. People’s call bells were in reach.

Improvements had been made to records to support safe and effective risk management. Risk assessments were completed, and care plans contained detailed information to support staff in managing risks to people’s health. For example, catheter care plans contained information on how to mitigate risk of infection and what action staff should take if they had any concerns. One person’s care plan directed staff to encourage them to drink over 1200mls of fluid per day. Records showed this was being done. At our last inspection we identified concerns in relation to the safe management of people’s moving and handling needs. Improvements had been made and records now contained detailed information about the use of equipment to transfer people safely. Where people were at risk of losing weight, people’s nutritional intake and weight was monitored. Some people were at risk of aspiration or choking and required adaptations to be made to the consistency of their food. Records clearly recorded this risk and how food must be offered to people including whether they required any thickener to be added to their fluids.

People and their relatives told us people had the equipment they needed to keep them safe. One person told us, “I have a call bell on the wall, but I haven’t needed to use it. They did a little practice with me to make sure I could reach it.” A relative told us, “Yes she’s safe, she has been bedridden since being there; she has a crash pad by her bed.”

Staff understood the process to report and record any maintenance issues with equipment or in the environment of the home. Staff told us maintenance issues were addressed and shared no concerns about the condition of the home or the safety of equipment. One staff member told us, “We have to report it [maintenance issues] to the office. There is a maintenance book in the office where it is written down and whenever the maintenance people are in the building, they will come and do the jobs. The equipment is checked on a regular basis, the hoists, the stand aids and the beds are all checked."

Corridors and communal areas were free from clutter which helped to reduce the likelihood of trips and falls. We observed two maintenance issues and saw these had been recorded and reported for action in the manager’s daily checks. Equipment appeared well-maintained and in good order.

Systems were in place to ensure the safety of equipment and the environment. Compliance certificates in relation to gas, electricity and fire safety equipment were maintained.

People told us they sometimes had to wait for support, but nobody said it had any real impact on them. Comments included: “Not enough staff no, but I always get by, it doesn’t affect me at all”, “They struggle for staff sometimes, but it doesn’t affect me. I use my bell when I need them, they come in about ten minutes”, “I’ve not seen a staff problem, I think they are fine” and “I feel sorry for the girls there aren’t enough of them. They all moan about the paperwork, but my care is still good.” Relatives told us staff were very busy but were happy with the standards of care. Comments included: “They seem to be a bit short staffed at times”, “I believe there is enough staff. [Name] is more than happy to pop his head round the door and shout, he has never had a problem getting help”, “Staff are always so busy, always rushed off their feet” and “They are very busy and always running around like headless chickens, but I feel there is enough staff. Sometimes it can be frustrating as you have to wait a while for the front door to be opened if they are busy.”

Most staff told us they were very busy ensuring people’s needs were met and completing paperwork. This meant they did not have time to spend with people outside delivering care tasks. Staff particularly spoke of the challenges on the first floor where 12 of the 24 people needed support from 2 staff members to transfer and with personal care needs. They explained it became particularly challenging after 3.00pm when staffing numbers on that floor reduced to 3 members of care staff. One staff member told us, “It is hard going, not so much down here but upstairs it is much heavier. We have got a lot of doubles up there. In the afternoon we end up with 3 staff which is hard going with all the paperwork we have to do.” The registered manager acknowledged that staff were very busy but told us they were satisfied staffing levels were safe. However, they recognised there needed to be more flexibility in the deployment of staff to ensure they were available at busier times of the day. The registered manager told us they would inform the regional manager if they felt staffing levels were unsafe and seek guidance.

There were enough staff to ensure people received safe care, and this was evidenced by risk management records being completed. However, there were periods of time on the first day of our assessment when there was a minimal staff presence in communal areas. Following a change in the deployment of staff, this had improved on the second day of our assessment.

The provider used a dependency tool to identify safe staffing levels. Duty rotas showed expected staffing levels were maintained across the home. They also demonstrated a good skill mix with fire wardens, medicators and first aiders identified on the rota. Staff completed regular training to update their skills and knowledge to help support people safely. The provider had a recruitment policy to ensure newly appointed staff were suitable for their role. However, further safeguards were required when new staff were working on a risk assessment prior to receipt of all their employment checks.

People and their relatives told us the home was clean. Typical comments were: “My room is beautiful and marvelously clean”, “The home is always warm and exceptionally clean” and “The home is nice and clean; and the cleaner is great with the residents.”

Staff told us they had received training in food hygiene and infection control practices. A member of the housekeeping team demonstrated a good understanding of national guidance relating to the correct cleaning equipment to be used in different areas of the home. They told us they were always informed of any infections so they could use appropriate personal protective equipment and adapt their cleaning schedule to minimise the risks of the infection spreading.

Throughout our visit we observed the home to be clean and there were no obvious odours. The cleaning trolley was tidy and contained all the appropriate cleaning equipment. The room where cleaning chemicals were stored was locked, organised and well-equipped. Personal protective equipment and hand sanitiser was available. Clinical waste was observed to be managed well.

Systems ensured infection control processes were managed well. For example, cleaning schedules were in place to ensure all areas of the home had been cleaned. The cleanliness of the home was checked during the registered manager’s daily walkaround of the home. Staff had received training in infection prevention and personal protective equipment was available to them. The home had been awarded the bronze accreditation to ‘Say No to Infection’ in March 2023.

People told us they got their medicines when they needed them. One person told us, “They bring my medication into me. I've got no problems with them.” Another person commented, “I take medication twice a day and sometimes only slight delays in an emergency. They always wait while I take them. If the pain gets too much, I tell them, and the seniors deal with it.” However, 3 people told us staff did not always observe them taking their medicines. One person told us, “I have my medication, they let me take it by myself. They wait sometimes.” This practice was not safe because staff could not be assured people were taking their medicines as prescribed. This practice posed further risks as other people living with dementia could enter the person’s bedroom and take the medicines themselves.

Staff confirmed only staff members who had completed medicines management training and had their competency assessed, were able to give people their medicines. One staff member told us, “You have to complete an external (medicines) course as well as online training.” This staff member explained they also had their competency to administer medicines regularly re-assessed. We found a number of stock discrepancies in people’s medicines. We discussed this with the registered manager who told us they would complete a full stock check. On the second day of our assessment the registered manager confirmed they too had identified some discrepancies.

Medicines were not always managed safely. We checked 3 people’s medicines and found stock discrepancies in all. We could therefore not be assured people received their medicines as prescribed. When people were given ‘as required’ medicines to support their emotional well-being, the medicine administration record (MAR) and daily records did not evidence a clear rationale for why this had been administered. The provider had carried out a compliance visit 2 weeks prior to our assessment and identified documentation in relation to people’s emotional wellbeing was an area for improvement. Following our feedback, the registered manager implemented a robust process for daily stock checks to ensure any errors were identified in a timely way.