Chorleywood Manor Care Home

Signature at Chorleywood is a residential care home providing personal care and accommodation for up to 100 people. The service provides support to adults including adults living with different forms of dementia. At the time of our inspection there were 68 people using the service.

The home is a purpose-built building over three floors. There is a section of the home specifically for people living with dementia who need additional support, this is called the ‘reminiscent’ community.

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

We found many issues with how oxygen therapy was being managed at the home. There were a lack of processes and checks to ensure additional oxygen was stored and managed safely. Staff had not had training on oxygen therapy and the associated risks. The management and provider were not thoroughly monitoring and assessing this aspect of people’s care to assure themselves and others everyone was safe in relation to the use of oxygen.

The registered manager and provider started taking action to correct these issues as soon as we told them about these safety issues. We asked them to send us an action plan which they did, detailing how they were going to correct these safety issues. The registered manager also talked us through what they had done and would be doing moving forward.

We found some other issues connected to people’s health and wellbeing such as not promoting falls and pressure care safety. These concerns and the safety issues connected to oxygen therapy had not caused any harm to people, but there was a potential risk they could. Improvements were also required around how managers and the provider assessed some aspects of the quality of the care provided.

People and their relatives felt safe at the home. One person said, “I feel that I’m in a safe place. They [staff] are always popping in and out during the day when I’m here in my room.” Another person said, “The staff are extremely co-operative, very nice people. They are here for you.” A person’s relative told us, “Yes, I’m very confident that [relative] is safe and happy. [Relative] has been here for [number of months] and the communication is very good, they [managers] tell me what's going on and they ring me.”

The home was clean, and staff followed safe hygiene practices. There had been a recent COVID-19 outbreak but this was manged in a safe way. One person told us, “The cleanliness is good, they [staff] are forever cleaning.” A person’s relative told us, “It’s immaculate.”

People were supported by enough staff who had been safely recruited. Some people raised delays with requests for support in the mornings which we told the registered manager about. Actions were also being taken to increase the recruitment of permanent staff at the home to provide a better continuity of care for people.

Staff spoke well of the support they received by colleagues and managers to perform well in their jobs. Despite staff views, we found managers were not always supporting staff to maintain their knowledge in their work. We have made a recommendation about this.

Staff and managers sought help for people when they were unwell and supported people to be as healthy as possible.

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

The staff and managers were kind and thoughtful towards the people they supported. One person said, “The staff are lovely, kind and respectful. I think they listen. All my personal care is done well. I like [name of member of staff] especially, we have such a laugh.” A person’s relative told us, “Yes, [relative] is clearly happy. [Name of relative] is happier now than they have ever been. They [staff] encourage all [relative’s] talents, they are less anxious, doesn’t worry and enjoys the company and stimulation.”

There was a social atmosphere to the home with staff spending time with people. Many events took place to help people feel included, happy and at home. One person’s relative told us how staff had supported their relative to make friends when they first moved to the home, “[Name of relative] has made some special friends of their own age which is so good.”

Complaints were processed in an open way and lessons were learnt from these. People were confident about making suggestions and raising issues which were important to them, and they felt improvements took place as a result of doing this.

Although there were some issues with how managers and the provider checked some aspects of the quality of care people received, there were also positive aspects too in terms of the other audits and checks the managers and provider were completing. The managers, provider, and staff had created an open positive culture in the home to benefit the people living at the home.

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

Rating at last inspection

This was the service’s first inspection as the provider had made a change to their legal status. This service was registered with us on 1 December 2021, and this is the first inspection following this change. The last rating for the service Sunrise at Chorleywood, under the previous provider was good, published on 7 August 2018.

Why we inspected

This inspection was prompted by a change in the provider’s registration which meant this service did not have a current rating.

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.

Enforcement and Recommendations

We have identified a breach in relation to ensuring all people were always safe in connection to the use of oxygen therapy at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sunrise of Chorleywood is a ‘care home’ registered to provide accommodation and nursing care for up to 100 people, some of whom may be living with dementia. At the time of this inspection, 56 people were living at the service.

We found the following examples of good practice.

¿ The service was receiving professional visitors with robust infection control procedures in place. Visitors were welcomed into the entrance hallway by a member of staff, where they were provided with guidance, personal protective equipment (PPE) and health screening was completed. Each visitor also had their temperature checked and was prompted to wash their hands.

¿ At the time of our inspection, other visits had been temporarily suspended due to an outbreak of COVID-19 at the service. This suspension was lifted shortly after our visit. Plans were in place to begin face to face visits at the service where one nominated visitor and people could meet and hold hands. Visits were to be pre-arranged, with visitors being provided with a rapid test for COVID-19, guidance and personal protective equipment (PPE). All other visitors were able to continue visiting, with screened visits being facilitated in a designated room. These visits were by appointment only, with times allocated to avoid potential infection transmission with other visitors and to enable the visiting area to be cleaned between visits.

¿ The service had taken steps to alleviate the negative impact of the pandemic on people. People had been provided a wide variety of in-house activities to support wellbeing including celebrations of festivals and events. A newsletter was compiled which was shared with people, family and friends. The service provided telephone lines into people’s bedrooms for private calls and staff had supported videos calls between people and their family and friends.

¿ The service was clean and hygienic. Robust cleaning regimes were in place, which were methodically completed throughout the day. Isolation, cohorting and zoning had been successfully implemented across the service.

¿ The provider had developed policies and procedures in response to the COVID-19 pandemic. They had formed a ‘COVID-19 Taskforce’, who provided regular updates to each service related to the changes in guidance, policy and good practice which were to be adopted. Management oversight and daily checks, alongside regular infection prevention and control audits were in place.

The inspection took place on 7 August 2018 and was unannounced. This was the first inspection for Sunrise Chorleywood since the service was dual registered in August 2017. Dual registration is when an applicant has stated and is able to evidence that at least two providers are jointly managing the regulated activities at a single location. Sunrise of Chorleywood is dually registered under two Sunrise legal entities Sunrise Senior Living Limited and Sunrise UK Operations Limited.

Sunrise Chorleywood 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. They are registered to provide accommodation and nursing care for up to 100 people older people including people who live with dementia. At the time of our inspection there were 73 people accommodated at the service.

The service consists of two units, the residential unit which is spread across three floors and accommodates people with residential and nursing needs and reminiscence, which is a unit for people who live with dementia.

There was a registered manager in post. 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.

People felt safe living at Sunrise Chorleywood. Staff were knowledgeable about how to keep people safe and knew how to report concerns. Peoples individual risks were assessed and kept under regular review. Accidents and incidents were documented and investigated appropriately.

Recruitment processes were Robust with all pre-employment checks completed. There were sufficient staff deployed which helped keep people safe. People received their medicines regularly from staff who had been trained and had their competency checked.

Staff received regular support including one to one supervision from their line managers, and regular team meetings were held which gave staff an opportunity to contribute their views. and made them feel supported and valued.

People were supported to eat a varied and nutritionally balanced diet to help maintain their health and wellbeing. people's health and medical needs were well managed with appropriate referrals made to external health professionals when needed.

People and their relatives were positive about the staff team for being kind and caring. Staff we spoke with demonstrated their knowledge about individuals’ care and support needs and preferences.

People told us they had been involved in the planning of their care where they were able. People's dignity was promoted and their privacy respected.

People were supported and encouraged to participate in a range of activities and hobbies that were of interest to them.

People were confident to raise concerns with staff or management and were satisfied that they would be listened to.

There was an open, inclusive and respectful culture in the home and people, relatives and staff were comfortable to speak with the general or registered manager if they had any concerns.

The provider had a range of quality assurance systems and processes in place to regularly monitored the health, safety and the quality of the care and support people who used the service received. The management team demonstrated an appetite for continual improvement.