Archived: Chalfont Court

Chalfont Court is registered to provide accommodation and nursing care for up to 46 people, some of whom may have dementia.

The service had 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm. People’s medicines had been managed safely.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who they felt knew them well. Staff also felt that they knew the people they supported well. Relatives we spoke with described the staff as very good and caring. We observed that staff were not always able to support people in a timely manner and focused on the task at hand rather than the person. This had resulted in a person becoming distressed during our inspection.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. The service supported people with health care visits such as GP appointments, optician appointments, chiropodists and hospital visits.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service. The provider also had effective quality monitoring processes in place to ensure that they were meeting the required standards of care.

We found the provider was in breach of a regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Two inspectors from the Care Quality Commission (CQC) conducted this inspection. We gathered evidence against the standards we inspected to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on what we found at the inspection by looking at records and what people told us about their experiences of the service. We spoke with two people using the service, relatives of two other people, some care staff, the manager, the deputy manager and the service's regional director.

At the time of our inspection, Chalfont Court provided care and treatment to 38 older people, some of whom were living with dementia. Some of the people had complex needs which meant that they were unable to tell us their experiences of the care provided by the service. We used observations to help us understand their experiences.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

People who used the service told us they felt safe. We found people's needs had been assessed, and care plans and risk assessments were in place to ensure that they were provided with appropriate and safe care. However, these did not always accurately reflect people's needs.

We found that people's care had not not always been managed in accordance with the requirements of the Mental Capacity Act 2005 (MCA) because mental capacity assessments were not completed appropriately to determine people's ability to consent to their care and treatment. We also found that the provider did not have an effective system to safeguard people from abuse or harm.

However, we found the provider had made recent improvements to ensure that people were supported by a consistent group of staff to ensure continuity of care. A number of new care staff had been recruited in order to reduce the use of irregular agency staff. A relative we spoke with commented on the positive effect this had on their relatives' care.

Is the service effective?

Detailed care plans were in place to provide guidance to staff on how to deliver appropriate and effective care. However, the service did not always identify changes to people's health needs to ensure that appropriate referrals were made to other health and social care professionals. This did not ensure prompt and effective care and treatment for people who used the service.

Is the service caring?

We observed that people appeared happy and well looked after. People we spoke with told us that the staff were caring and met their care needs. We also observed respectful interactions between people who used the service and the staff that supported them.

Is the service responsive?

We found the service was not responsive because they did not always act promptly on the information from their audits to address areas identified as requiring action. Some of the concerns we found during our previous inspection had not been fully rectified and this presented continuing risk of people not being provided with care that was safe and appropriate.

Is the service well-led?

The service had no registered manager in place and therefore had lacked consistent leadership until a new manager and deputy manager were appointed recently. We found that this lack of consistent leadership meant that not all improvements had been made or consistently maintained to meet the seven standards they did not meet in May 2014. However, we saw that some progress had been made in the short period the manager and the deputy manager had been in post. In recognition of these improvements, we found it appropriate to allow the service a further short period of time to make the necessary improvements.

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 16 and 20 May 2014. This included speaking with four people who used the service, three people's relatives and five members of staff who supported them. We looked at five people's care records.

Is it safe?

During our inspection we saw that people who lived at the home were treated with care and respect. Staff provided care and support in a way that promoted people's dignity, privacy and independence particularly when assisting people to eat their meals.

We noted that call bells were within people's reach so they were able to request help and support if needed.

The home had up to date policies in place relating to safeguarding vulnerable adults and whistleblowing. Staff demonstrated a good awareness of these policies.

However there was no information available in an accessible format for people who may have found it difficult to read or for residents who lived with dementia.

Senior staff had not received training about how to manage potential safeguarding issues. Senior staff told us they were not able to use management tools to audit accidents, create incident reports and monitor care effectively.

People told us that they felt safe at the home and that staff were kind and attentive. People said that they would feel able to raise their concerns. One person told us 'I feel safe and worry free when I close my eyes at night; the staff are really caring people.'

The requirements of the Mental Capacity Act 2005 had not always been followed or implemented. This meant that consent may not always have been obtained in accordance with the relevant legal requirements. Staff had not all received training in relation to this, and were not aware of the basic principles of consent. One staff member told us, "This is a dementia unit so people don't have capacity, but sometimes we allow them to do things."

During our inspection we toured the home and found the environment was clean and free from malodour. However we also found that the kitchenette areas in both units and found that the worktops were scorched and scalded. Areas behind each of the sinks which had been sealed were damaged and in places required replacing.

We asked the staff we spoke with if people shared slings and they told us they did. This meant that where people required hoisting and assistance with personal care, where they shared a sling there was is a risk of cross infection.

People's records were not stored in a safe manner to protect people's personal and confidential information.

Is the service effective?

We saw that assessments had been completed and reviewed in relation to a wide range of issues relevant to people's care needs. These included assessments relating to the management of people's medicines, skin integrity and risks associated with pressure care, nutrition and hydration, mobility and the risk of falls.

We found that where people lacked mental capacity to make their own decisions the requirements of the Mental Capacity Act 2005 had not always been followed.

People were provided with a choice of suitable and nutritious food and drink. We noted that throughout the day staff ensured that people had access to a range of snacks. We noted that the information in people's care records relating to food and nutrition was consistent. We saw that weights were monitored and recorded and where people's needs had been assessed by dieticians or other health professionals, their recommendations had been followed.

Staff we spoke with told us they felt supported by the temporary manager. One staff member told us, '[Interim Temporary manager] is brilliant, they have brought this place up, we feel as if we are listened to and have a power.'

We found however that not all staff had received a review of their personal development through supervision and appraisal. Furthermore, staff had not all received up to date training to enable them to perform their role effectively.

Is the service caring?

We observed the breakfast and lunchtime meal and saw that staff provided appropriate levels of support where necessary to help people to eat and drink in a calm, patient and dignified manner that promoted their independence.

People told us they were happy living at Chalfont Court. However, they told us the constant changing of staff was a concern. One person who used the service told us, '[Carer] is so attentive and kind and listens to me as a person and not like an object. I have no complaints about the care from the permanent staff. On the other hand the agency staff rarely get it right, they chop and change and we have to tell them what to do. I don't know what happens downstairs because they can't really speak up for themselves.'

Is the service responsive?

We saw that people's views, experiences and choices were taken into account in the way that care, support and treatment was delivered. The provider used an external company to collate people's views and experiences for an unbiased response. We noted that people were satisfied generally with the care they received.

Where people were at risk of dehydration or malnutrition, they were referred appropriately for specialist support from health professionals such as doctors or dieticians. We saw the recommendations were then followed, and regular checks of people's weights, nutrition, fluid intake, skin integrity and general wellbeing were carried out.

Where people were at risk of developing pressure sores, staff ensured the appropriate pressure relieving devices were used, such as mattresses and cushions.

People told us they were unhappy with the agency staff used at Chalfont Court. On the day of our inspection we observed numerous people attending the home for a recruitment open day. The manager told us this had been very successful and by using permanent staff things would settle down in the home. They told us it was their intention not to use temporary cover such as agency staff.

Is the service well led?

During our inspection of Chalfont Court on 16 and 20 May 2014 the registered manager had been absent for a period of two months. In the interim period the provider had arranged for managerial support to be provided by two temporary managers who were based at the home.

We saw that people had access to relevant health care professionals where necessary including GPs, dieticians and occupational therapists.

People were not cared for by staff who were supported to deliver care safely and to an appropriate standard.

Effective systems had not been put in place to assess and monitor the quality of services provided or to identify, assess and manage risks posed to the health, welfare and safety of people who lived at the home. This meant that people had not been protected against the risks of inappropriate or unsafe care.

We found that people did not always experience effective, safe and appropriate care, treatment and support that met their needs and protected their rights. People were not protected from the risks of receiving care that was unsafe. Care plans did not reflect people's individual needs and preferences. The provider did not have adequate arrangements in place to identify and manage risks to people who used the service. People's dignity and privacy was not being maintained and in some cases people had the wrong names displayed on their bedroom door. People may have been at risk of receiving care that was not appropriate to meet their needs. We noted that people in one unit did not have access to water throughout the night.

The provider did not have appropriate and adequate arrangements in place to ensure that people who used the services were protected from abuse or the risk of abuse. We found that potential safeguarding concerns were not appropriately referred through the safeguarding process and were therefore not properly investigated, as per the multi-agency safeguarding policy and procedure. People were not protected from the risk of abuse and did not have "protection plans" in place where there was a substantial risk of harm.

Care plans were detailed and covered people's health and care needs. The plans were supported by risk assessments and guidance in relation to aspects of care such as falls, nutrition, hydration and pressure sore prevention.

People had a sufficient amount of food and drink which was of a good quality and which looked appealing. Most people received good support at mealtimes. However, we did observe one person who was rushed to eat when they had just awoken. Another person did not receive adequate support at lunchtime. We checked their care record and found that it contained conflicting information regarding their mealtime support needs. This did not protect them from the risk of malnutrition.

Staff had good opportunities to develop their skills through training. Supervision and practice observations were conducted regularly.

The home had robust systems in place to gather and act on the views of people, their relatives and staff. Quality was effectively monitored through regular provider audits.

We found people were treated with respect and dignity. People had been encouraged to participate in decisions related to their care. People's relatives had been regularly consulted. There were systems in place to ensure medication was managed appropriately. There was a robust recruitment process to ensure suitable staff were employed at the home. There were systems in place to effectively deal with concerns and complaints.