We carried out a comprehensive, unannounced inspection at The Chase Care Centre on 12 September 2018.At the last inspection, on 24 April and 3 May 2018, we asked the provider to make immediate improvements in some areas of the care and support people received. These areas were in relation to risk management for people, safeguarding systems and processes, training, consent to care, personalised care, dignity and governance systems.
The inspection was carried out to follow up the breaches of regulations 9,10,11,12,13,14, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 found at the last inspection and to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2012, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.We found the provider had worked hard to improve the service to people living at the home, with significant improvements to staff training, staff supervision, safeguarding people from harm, staff knowledge and practices in relation to DoLS (Deprivation of Liberty safeguards) and DNACPR (Do Not attempt cardio pulmonary resuscitation) and the standard of meals provided.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
The Chase Care Centre 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.
The Chase Care Centre is registered to provide personal and nursing care for up to 110 people aged 18 and over with a range of complex health and care needs. At the time of our inspection, 67 people were using the service.
The Chase Care Centre is divided over three floors and accommodates people within six separate units, some of which have adapted facilities. The service supports people with complex nursing and residential needs which included supporting young people with brain acquired injuries, people with mental health needs, physical needs and people who are living with dementia. At the time of this inspection one unit (Churchill) was closed for renovation work to be completed.
A new manager had been appointed since the last inspection took place in April 2018 and was in the process of applying to become registered with the Commission. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.
At this inspection we found that improvements had been made, however we found some areas were still developing and required improving to ensure people safety was maintained and protected from the risk of harm.
Risks to people`s well-being and health were identified and assessed but not always mitigated in a way that maintained their safety.
People's end of life care needs and people`s wishes, likes and dislikes had not always been assessed or considered when staff developed or reviewed care plans.
We have made a recommendation about an adjustment to the current care plans in place.
Staff demonstrated they had the knowledge to identify potential abuse and the process for reporting concerns. Notices and information was displayed throughout the service informing people, staff and visitors how to report concerns and relevant contact numbers for external safeguarding authorities. Referrals to local safeguarding authorities and CQC were done in a timely manner.
Where people were assessed as requiring a fortified diet to help reduce the risk of malnutrition we found that staff were knowledgeable and the kitchen staff who were aware of people’s individual dietary needs. However, we found that records relating to the amount of fluids people had consumed were not accurately recorded.
Where people had pressure relieving equipment in place to help prevent the development of pressure ulcers, we found that all the necessary checks and records were up to date and accurate.
Infection control measures were in place. Staff were observed to use personal protective equipment, including the use of gloves and aprons while supporting people with personal care. People’s medicines were managed safely. Medicines were stored safely and administered by trained staff.
People who had complex health care needs had been assessed and care plans developed to provide guidance to staff but we found that these were not always implemented to ensure people`s health and welfare was maintained at all times.
People had mixed views with regard to being involved with developing their care. Some care plans contained inaccurate and out of date information which required updating to reflect people`s current needs.
People were asked for their consent to the day to day care and support they received from staff. We observed staff assisting people and communicating with them and asking for their involvement in the task.
We found that staff failed to respect and maintain people's dignity and privacy.
The principles of the Mental Capacity Act 2005 (MCA) were followed by staff and where Deprivation of Liberty Safeguards (DoLS) authorisations were in place, with conditions listed on the restrictions to people`s freedom, plans were in place to meet these and keep people safe.
Staff received support through induction and a training programme with a mixture of distance learning and face to face training. We found the training provided had improved since the last inspection was carried out in relation to both specialist training and mandatory training had also been updated.
Recruitment processes were robust and ensured that the staff employed were suitable to work in this type of care setting.
We found the standard and choices of meals provided had improved and where necessary staff had referred people to specialist support in cases where they were at risk of malnutrition.
The atmosphere at The Chase Care Centre had improved since the last inspection and felt more welcoming and calm. However, on the day of this inspection there was only one activity staff member to provide activities to 67 people. People who spent time in their bedrooms were at risk of social isolation. This is an area that requires improvement.
People told us that they felt more confident in raising any concerns they may have since the new manager started at the home.
We found the systems now in place to provide an overview of the service and monitor the quality of care and support provided had improved.