Chandlers Ford Care Home

Chandlers Ford Care Home is a residential care home providing personal and nursing care to up to 45 people. The service provides support to older people and younger adults, including those who are living with dementia. At the time of our inspection there were 26 people using the service.

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

We received mixed feedback from people’s relatives about some aspects of the service. Some felt the service could improve in the ways it communicated with them. Some also felt there were sometimes not enough staff available, so that people were left waiting and did not receive support in a timely manner. Some said not enough was being done to provide people with activities for mental and social stimulation.

Positive comments from relatives included, for example, “They are respecting her…and she looks pleased to see them.” Also, “They have made him feel very welcome, all the staff, manager are friendly and easy to talk to” and “Overall feeling is they are kind and caring with her.”

We found there were inconsistencies and a lack of clarity in some of the care records, which meant we were not assured that people always received appropriate care and support. External health and social care professionals had also raised concerns around gaps in records putting people at risk of unsafe care. The service was working in partnership with the local authority and were making improvements as part of an action plan.

A dependency assessment was used to assess and monitor staffing levels and the registered manager was introducing an improved staff allocation system as part of their action plan. Safe recruitment practices were followed before new staff were employed to work with people.

People received their medicines in a safe and effective way from staff who had received appropriate training. The labelling of bottles with opening and expiry dates could be made clearer and the registered manager agreed to action this. We observed staff adhered to the provider’s infection prevention and control policy and procedures.

Staff received training in safeguarding and demonstrated their understanding of procedures for reporting and escalating any concerns. Risks to people’s health and wellbeing were assessed, such as falling, choking, or developing pressure areas on their skin, and actions taken to minimise the risk were recorded. A range of systems and processes were in place to identify and manage environmental risks.

There were systems and processes in place for monitoring the quality and safety of care and used to plan improvements. Monthly meetings were held for the purpose of sharing learning across the organisation. The registered manager was promoting a positive culture that was open and person-centred. Staff told us the registered manager was approachable and was making improvements to the service, such as daily meetings to communicate what needed to be done.

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

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

Rating at last inspection

The last rating for this service was good (published 2 June 2018)

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to staffing, personal care and support to ensure people had enough to drink and were offered baths or showers, and activities to promote mental / social stimulation. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

The provider has taken action to mitigate the risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chandlers Ford Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Chandlers Ford Care Home is a residential care home providing personal and nursing care to up to 45 people. The service provides support to adults who require personal or nursing care and people living with dementia. At the time of our inspection there were 22 people using the service.

We found the following examples of good practice.

The premises were very clean and fresh looking. Works were underway to redecorate areas as they became vacant and to ensure décor in communal areas was in good condition, both for cosmetic and infection control reasons. We identified some areas that required additional maintenance to improve hygiene and the registered manager welcomed our observations.

On arrival we were asked to sanitise our hands, sign in, have our temperature taken and asked if we had symptoms of, or been in contact with anyone who had symptoms of, COVID-19. We were also asked to show our vaccination record and evidence of a lateral flow device test taken that day. Face masks were available at the door should they be needed and visitors were only admitted to the service after following these procedures.

Communal areas in the premises had been arranged to facilitate social distancing to encourage people to participate fully in the life of the service without compromising safety.

The service was compliant with all current government guidelines around infection prevention and control and COVID-19.

In April 2016 the home was rated Good overall with Requires Improvement in the Responsive domain as improvements were required in wound care and pain management in the home. At this inspection we saw these improvements had been made. In September 2017 we carried out a focussed inspection in response to concerns people had raised about the levels of staffing in the home. We were unable to substantiate these concerns at that time and the rating of the home remained Good. At this inspection we found the home remained Good in all domains.

Chandlers Ford Care Home 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 care home provides accommodation, nursing and personal care for up to 45 older people. Accommodation is arranged over two floors with stair and lift access to all areas. At the time of our inspection 25 people lived in the home.

A registered manager had been in place since 12 March 2018 at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

Before the inspection, we had received concerns about the cleanliness and hygiene in the home from members of the public. At this inspection we were unable to substantiate these concerns. The home was clean and odourless and staff had a good understanding of infection control measures which were in place.

Whilst we received mixed feedback at our inspection about staffing levels in the home, there were sufficient staff deployed to meet people’s needs and ensure their safety and welfare. Staff recruited to the home had been assessed as to their suitability to work with people.

People received care which was person centred and individual to their specific nursing needs. Staff had a good understanding of people’s needs and clearly knew people well. The registered provider was taking steps to improve the recording of people’s social and personal histories in their care records.

There were effective systems in place to plan and implement end of life care for people to ensure this met their needs and preferences.

Risks associated with people’s care, including the safe administration of medicines, had been identified and actions identified to mitigate these.

Where people could not consent to their care, staff sought appropriate guidance and followed legislation designed to protect people’s rights and freedom. Staff knew how to keep people safe and understood how to report any concerns they may have about the care people received.

People received nutritious food in line with their needs, likes and preferences.

People were cared for in a kind and compassionate way and were encouraged to interact with each other and participate in a wide variety of stimulating activities and events.

There was a system in place to allow people to express any concerns or complaints they may have, and people and staff had the opportunity to express their views on the quality and effectiveness of the service provided at the home.

The home was well led. There were effective systems and processes in place to review standards of care delivered in the home. The registered manager promoted open and transparent communications and this was reflected in the home. People, their relatives and staff felt supported to express themselves and improve the service for the benefit of all.

At our last inspection in April 2016 we rated the service overall as Good.

The most recent registered manager left in January 2017. Since then the service had been overseen by four managers, some of whom were always expected to be interim. At the time of our visit a new manager had been appointed. They had been in post for one day when we visited but had already applied to become registered with 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 and associated Regulations about how the service is run. The new manager was being supported by an experienced interim manager who had worked at the service for

Chandlers Ford Care Home provides accommodation and nursing care for up to 45 older

people. There were 31 people living in the home on the day of this inspection. The home is in the centre of Chandlers Ford behind the Methodist Church and close to local shops and amenities. The service is located on the ground and basement floors of a large purpose built building. The first and second floors are flats with separate access.

This was a focussed inspection as a result of concerns people raised over staffing levels. This meant during our visit we specifically considered staffing skills, levels and staff deployment. We also looked at management structures to see if there were suitable management arrangements in place to ensure they were appropriate.

We found although there were mainly sufficient staff deployed, the high number of agency staff included in these numbers had impacted in a negative way upon the experience, and at times on the care requirements of people who lived at Chandlers Ford Care Home. The fragmented management arrangements since the last registered manager deregistered in January 2017 had compounded this impact.

During our visit we found current managers were aware of the staffing concerns raised to us and had taken some action to mitigate the situation. They were actively recruiting staff and were not admitting any new service user with high needs until more regular staff had been employed. They, along with senior managers had identified where other improvements were needed. The service had produced a very detailed action plan and had made a copy of the action plan available for all to see (this was located by the signing in book for visitors to the home) This showed the service was being transparent in acknowledging shortfalls and documenting how and when they were going to achieve these objectives.

We have updated the safe and well led part of our published report without amending our previous ratings as we will review these as part of our next comprehensive inspection of the service. This will take place once we have given the service the time to implement and embed the improvements they have identified themselves as being needed.

Chandlers Ford Christian Nursing Home provides accommodation and nursing care for up to 45 older people. There were 30 people living in the home on the days of this inspection. The home is located in the centre of Chandlers Ford behind the Methodist church and close to local shops and amenities. The home is located on the ground and basement floors of a large purpose built building.

The first and second floors are flats with separate access.

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.

A key improvement to the service overall was that the management team were now established which enabled them to demonstrate consistently the values of the service. They lead by example and this helped to enable people who lived at the service, their relatives and staff to express their opinions and to feel they were being listened to. This helped to promote a positive culture which was person centred and inclusive.

Whilst we found some further improvements were needed during our inspection of April 2016, these were mainly responded to and completed during our visits. The management team also agreed to review and improve how they managed people's wound care and to how they assessed people's experience of pain. This could not be completed quickly. We said as a result of this that the service continued to need to improve and to demonstrate they were consistently providing effective care.

Medicines were safely managed. People said they felt safe at the service. Staff understood how to manage risk and took action where they could to reduce the possibility of any identified risk causing people unnecessary harm. There were sufficient numbers of appropriately recruited , well trained staff deployed to meet peoples' needs.

People were supported to have sufficient amounts to eat and drink and people told us they liked the food. People's day to day health needs were met and staff ensured people and, where appropriate, their relatives had information and explanations about their healthcare options.

People told us that staff in the main had positive and caring relationships with them. Staff had a good knowledge and understanding of people's preferences and personal histories which helped them to provide care and support tailored to peoples individual needs. There was a range of activities available which people could choose to take part in, or if they preferred, they could keep their own company Staff respected people's wish for privacy.

There were systems in place to review how effectively the service was running. These helped to drive continuous improvement.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found '

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

Is the service safe?

We found that people's care needs had been assessed, recorded, and risk assessed. However, some people were supported to eat in positions which put them at risk of choking. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting people to eat safely.

The home was clean on the day of our inspection. There were effective systems in place to protect people from the risk of infection.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have been submitted under the safeguards, we have asked the provider to consider whether any applications should be made.

Is the service effective?

The service was not effective. The provider was not complying with the requirements of the Mental Capacity Act 2005 (MCA). We saw that, people's mental capacity had not been assessed, where appropriate. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the MCA.

People told us they were happy with the care they received and it met their needs.

Is the service caring?

The service was caring. We observed care workers who were sensitive in the support they offered people and the way they asked people about their wishes. Many staff had worked in the home for a long period of time and this was reflected in the consistency of care people received.

Is the service responsive?

The service was responsive to people's needs. We found evidence which showed that the service was regularly monitored and that changes were implemented where necessary.

Is the service well led?

The service was well led. We found there was evidence that care plans were reviewed regularly and the registered manager carried out monitoring checks. The registered manager responded to our concerns immediately on the day of the inspection.

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas watching television and interacting with each other in the dining room. During our inspection we observed people spending time in their bedrooms listening to their choice of music and reading. We observed staff spending the majority of their time with people who used the service. They frequently checked on them to ensure they were alright when spending time on their own.

We saw staff supporting people to make their own choices about what they had for lunch and what activities they took part in. Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

People were cared for by staff who were supported to deliver care and deliver treatment safely and to an appropriate standard. During our inspection we reviewed records which showed that all staff had received dignity training and equality and diversity training. 87.5% of staff had received safeguarding training. We also spoke with three members of staff who all confirmed they had received a recent supervision from their line manager. One staff member said 'they are supporting me very well.'