This inspection was carried out over four days on the 8, 9, 10 and 30 August 2016. Our visit on 8 and 30 August 2016 was unannounced.We last inspected Chester House Care Home on 2 December 2013. At that inspection we found the service was meeting the regulations we assessed.
Chester House Care Home is located in Hazel Grove, Stockport and can provide care for up to 14 adults with a range of needs and requirements.
Accommodation is provided on three floors, accessible by two chair lifts. There are twelve single bedrooms and two bedrooms that have the capacity to be used as shared rooms. However at the time of this inspection the rooms occupied were all single occupancy. No en-suite faculties are available.
The home has a lounge/dining room and a conservatory which is used as a smoking area as well as an outside garden to the rear of the property.
At the time of our inspection 8, 9 and 10 August 2016 there were nine people living in the home. When we inspected on 30 August 2016 there were ten people living in the home.
A Registered Manager was in post although they were not available during the first three days of inspection due to being on four weeks annual leave but were available on the 30 August 2016. 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.
During this inspection we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 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.
Some medicines were not managed safely. We found there were not always clear, detailed written directions for the use of medicines to enable staff to apply prescribed creams as intended by their GP. This meant there was a risk prescribed creams may not have been applied when required, which could have resulted in unnecessary discomfort to the person.
We had concerns in relation to staff supervision because staff were not receiving supervision on a regular, ongoing basis and there was no evidence that staff had received an annual appraisal. This meant that staff were not being appropriately guided and supported to fulfil their job role effectively.
Recruitment processes required improvements to ensure only suitable staff were employed to work with vulnerable people.
Some of the routine safety checks had not been undertaken for example checks of window restrictors and nurse call bells. This meant the provider could not be sure people using the service were safe at all times.
We saw that some people’s identified care needs did not have a corresponding plan of care to direct care staff on how to meet the individual care need. This meant there was risk that people could receive unsafe and inappropriate care.
There was not a systematic approach to determine the number of staff and range of skills required to meet the needs of the people who used the service. This meant people might be at risk of receiving unsafe and inappropriate care. We saw and staff told us that as part of their paid care hours they were expected to undertake cleaning, laundry and cooking duties. Staff told us they thought due to this they were sometimes too busy to spend time with the people living at Chester House Care Home.
People were not always supported to access regular, meaningful activities within or outside the home. This meant people were not always encouraged to meet their full potential.
Prior to this inspection it came to the attention of CQC that an allegation of abuse had been made of which the CQC had not been notified. During this inspection it was identified that the registered manager had not complied with their duty to notify us of a further notifiable incident which was a Deprivation of Liberty Safeguard authorisation.
We saw evidence that staff had completed a basic, homes own induction training. However from April 2015 all new health and social care workers should be inducted according to the Care Certificate framework. This replaces the Common Induction Standards and National Minimum Training standards. There was no evidence that staff were inducted according to the Care Certificate framework.
From looking at the staff training matrix (record) we found there were gaps in staff training. This meant some staff were not be appropriately trained and skilled to meet the needs of the people living at the home.
We found that systems had not been implemented to monitor the quality and safety of service people received.
The visitors we spoke with told us they thought Chester House Care Home was a safe and caring place to live and they thought people were well looked after. However we found people were at risk of receiving unsafe or inappropriate care. We found the registered manager did not demonstrate a good understanding of potential risk or the appropriate measures needed to be put into place to minimise risk to people.
The complaint policy was out of date because it made reference to outdated regulations. The policy stated that staff should be trained in dealing and responding to complaints but we found no staff had received such training. However the visitors we spoke with told us they had never made a complaint and were happy with the care provided.
Staff spoken with understood the need to obtain consent from people using the service before a task or care was undertaken and staff were seen to obtain consent prior to providing care or support.
We saw staff had good relationships with the people they were caring for.
The healthcare professional we spoke with said they did not have any concerns about this service and staff were always very helpful. During the inspection we found staff were helpful but we had concerns that people were at risk due to the shortfalls we identified.
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.