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Inspection carried out on 22 January 2016

During a routine inspection

Chaseley is a residential nursing home in Eastbourne, providing care for people with severe physical disabilities. Chaseley also provides long and short term respite care. There is an on-site gym with designated therapy staff providing support to people in their rooms and in the gym environment as appropriate. The gym is accessible for use by people in the community who may require specialist equipment for rehabilitation and daily fitness as well as people living at Chaseley.

Chaseley is registered to provide care for 55 people. At the time of the inspection there were 40 people living at the home, including one person staying at Chaseley for a period of respite care.

At the last inspection 18 and 19 November 2014 we asked the provider to make improvements for notifications after incidents occurred, training for staff around Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), confidentiality of records and assessing and monitoring the quality of service provision. The provider sent us an action plan stating these issues would be addressed. At this inspection we found that actions had been taken to ensure all regulations had been met.

This was an unannounced inspection which took place on the 22 and 25 January 2016.

Chaseley had a registered manager. 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.

The manager was in day to day charge of the home, supported by the deputy and human resources business partner. People and staff spoke highly of the manager and told us that they felt supported by them and knew that there was always someone available to support them when needed. Staff told us that the manager and deputy made a good team and had made a number of positive changes.

Staff felt that training provided was effective. Registered Nurses had received further training to ensure they were able to meet specific nursing needs for people. Care staff felt they received effective training and this ensured they were able to provide the best care for people. Competencies checks and workshops took place to ensure staff training was relevant and up to date. Robust recruitment checks were completed before staff began work, and staff completed a full induction when they commenced employment at Chaseley. There a programme of supervision and appraisals for staff, this meant that staff felt continually supported.

Medicine administration, documentation and policies were in place. These followed best practice guidelines to ensure people received their medicines safely. Regular auditing and checks were carried out to ensure high standards were maintained. People were supported to self-medicate if deemed safe for them to do so and this was regularly reviewed.

There were robust systems in place to assess the quality of the service. Maintenance checks had been completed. Fire evacuation plans and personal evacuation procedure information was in place in event of an emergency evacuation.

Peoples nursing and care dependency levels were assessed and reviewed to ensure appropriate care provision was in place. Staffing levels were reviewed regularly.

Care plans and risk assessments had been completed to ensure people received appropriate care. Care plans identified all nursing and care needs and had been reviewed regularly to ensure information was up to date and relevant. Staff had a good understanding around the principles of MCA and DoLS. People were asked for their consent before care was provided and had their privacy and dignity respected. Feedback was gained from people this included questionnaires and regular meetings with minutes available for people to access.

People were encouraged to remain as independent as possible and supported to participate in daily activities. Regular therapy was provided when appropriate and people had access to the on-site gym.

Staff demonstrated a clear understanding on how to recognise and report abuse. Staff treated people with respect and dignity and involved people and their families in decisions.

People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave positive feedback about the food and visitors told us they had eaten with their relative and found the food to be of a very high standard.

Referrals were made appropriately to outside agencies when required. For example GP and hospital referrals, dentists and speech and language therapists (SALT).

Notifications had been completed to inform CQC and other outside organisations when events occurred.

Inspection carried out on 18 & 19 November 2014

During a routine inspection

Chaseley is a residential nursing home in Eastbourne, providing care for people with a range of complex needs including acquired brain injuries, long term medical conditions, complex medical needs and physical disabilities. Chaseley also provides long and short term respite care, with on site occupational and physical therapy department and gym for rehabilitation and on-going therapies. At the time of this inspection the local authority had an embargo on admissions to the home pending the outcome of on-going safeguarding investigations. There were 36 people living at Chaseley.

At the last inspection 10 June 2014 we asked the provider to make improvements for care and welfare of people who use the service, management of medicines and assessing and monitoring the quality of service provision. The provider sent us an action plan stating they would have addressed all of these concerns by October 2014. At this inspection we found that some actions had been taken, however, improvements were required to ensure systems were fully embedded. You can see what action we told the provider to take at the back of the full version of the report.

This was an unannounced inspection which took place on 18 and 19 November 2014.

Chaseley has a registered manager. 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.

Staff had safeguarding adults training and understood their responsibilities to report any concerns if they suspected abuse. However, one incident had not been reported appropriately by the provider to the local authority for review and there had been a delay in reporting other incidents. Some incidents required notification to CQC and this had not taken place in a timely manner, and in one instance no notification had been completed at the time of the inspection. This meant that people had not been protected from the risks of abuse as the provider had not reported accidents and incidents to the relevant authority for investigation and in a timely manner.

Risk assessments had been completed however, these did not always give an accurate picture of people’s needs. There were inconsistencies in care documentation. This meant that staff did not always have up to date guidance on the individual needs of people.

A high number of agency staff were used, and there was an on-going recruitment program. Staff received an induction before commencing work, and all appropriate recruitment checks had been completed. Staffing levels had at times dropped below the designated ratio during night and day shifts. People spoken with raised concerns about the numbers of agency and new staff.

Chaseley had a system in place to record staff training. This was a new computer system and was still in the development stages. The current system was not easy to use and did not allow oversight of each staff member and the training attended.

Policies and procedures were seen. Guidelines for ‘as required’ medicines were not in place in all files and information for staff regarding the administration of ‘as required’ medicines was not always clear. Some assessments had not been reviewed within the timescale stated, this included self-administering medicines.

Staff did not have an understanding or adequate knowledge of the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS). It was unclear how staff had made decisions about people’s capacity to make decisions about their care. No DoLS training had been provided at the time of the inspection. People had been supported to maintain their independence with regards to self-administering medicines when this was appropriate.

Chaseley had support from visiting professionals. This included chiropodists, on-site occupational therapists and GPs.

There was a system in place detailing when staff received supervision. However supervision had not happened every eight weeks as stated in the organisations supervision policy. No staff appraisals had taken place; these were scheduled to commence in January 2015. Currently there was no robust mechanism in place to ensure that management were monitoring staff performance and providing regular feedback. This would help ensure staff performance was safe and encourage continual improvement.

Staff had access to policies and procedures; this included a whistle blowing policy. Providers must have policies in place to inform staff of the correct procedures to follow.

People had their nutritional needs met. Choices were offered and people were asked for their feedback about meals provided.

People told us they thought the staff at Chaseley were caring. Staff knew people well and we saw staff communicating with people in a dignified manner.

Systems were in place to ensure equality and diversity needs were met, people were supported to maintain their independence and staff knew people's preferences and religious needs and ensured these were met. People felt staff cared for them well and supported their choices and decisions.

Care files were kept in people’s rooms with further information stored in the nurse’s office on each floor. When people were not in their rooms we saw doors were left open. This meant that people’s confidential information and documentation was not stored securely. People had care plans, which were called ‘rehabilitation strategies’. However, not all of the information included in them was clear. Inconsistencies were also found in people’s care plans and risk assessments.

There were regular activities and people had access to a variety of art and crafts. Activity information was displayed around the building advertising forthcoming activities and events.

Care files included information about people’s likes and dislikes. We saw that some of this information had been included in ‘pen pictures’. Not all pen pictures had been dated; therefore it was unclear how up to date or relevant the information was.

There was a complaints policy and information regarding the complaints procedure was available. Analysis of complaints did not include completed information to show actions had been taken.

The registered manager was due to leave Chaseley in the near future. A new interim manager had recently been appointed with a view that they would take over from the current registered manager when they left. People told us that there had been a number of staff changes and this had not always impacted positively on the culture within the service. However, we were told a new team leader role had been developed and this had a positive impact on how shifts were allocated.

The provider and management team carried out a number of audits within the service. These had not always been updated to show actions had been taken to evidence lessons learned or that the improvements had been made.

People, staff and relatives were able to feedback their views, experiences and suggested areas for improvement.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 10 June 2014

During an inspection to make sure that the improvements required had been made

We carried out this inspection to look at the care and treatment that people living at the home received. At the last inspection on 21 January 2014 we found that there were concerns with regard to assessing and monitoring the quality of service provision and records.

The service currently has an embargo on admissions implemented by the local authority.

As part of our inspection we spoke with six care and nursing staff, the registered manager, clinical lead and further senior staff member responsible for safeguarding. Throughout the inspection we were able to speak with eight people who lived in the home and one visitor to the service.

Three inspectors carried out this inspection.

The inspector considered the inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We saw that the home carried out regular maintenance and equipment checks for the service. The home had implemented some quality assurance systems to assess and monitor quality of the service provided, however these were not robust, and actions had not been completed.

We saw that there were unsafe practices in relation to medication administration errors and discrepancies within the medication records. We looked at incident/accident reports and complaints.

Is the service effective?

We spoke with people living at Chaseley. We were told “It is fine for me I am well looked after.” Another told us “No issues personally, I am off to the café, I like it down there.” People told us that the food was “Nice, plenty of choice for me, I have no complaints.” And “It is usually very good.”

One person we spoke with told us they did not feel that they were listened to or that staff responded when they raised concerns.

Is the service caring?

We saw staff speaking to people and providing care and support. Staff spoken with were able to tell us about people and their individual needs.

We saw that one person who received one to one care at all times had sticky eyes. However, no information or guidance had been included in their care file regarding this. We also observed a member of staff reading the newspaper whilst providing one to one care to this person in their room. We discussed this with senior staff who told us that this should not be taking place, and staff should use the time spent in the room observing the individual or completing documentation regarding that person.

Is the service responsive?

We looked at accidents and incidents reporting within the service. We saw that the system in use meant that there could be a delay from an incident being reported to a senior staff member responding and taking appropriate action.

Is the service well-led?

The home had a registered manager, clinical lead and one further senior staff member who were responsible for the running of the service, and a second location which also belonged to the provider.

We identified by direct observation that all three senior staff were working long hours and appeared to be very busy throughout the inspection dealing with day to day issues at both locations. We were told that the Nominated Individual provided support for three days a week, this was again over both locations.

We were shown that the service asked people who used the service for their feedback, and the results of these surveys, were used to improve the service.

Inspection carried out on 21 January 2014

During an inspection to make sure that the improvements required had been made

We carried out this inspection to follow up on a number of compliance actions set in previous inspections.

We saw that staff had attended safeguarding training, and were able to demonstrate a good understanding around how to recognise and report safeguarding concerns.

The organisation had been actively recruiting nursing and care staff. Agency staff had been used to maintain staffing levels. An induction and competencies for agency staff had been introduced.

A number of audits had taken place. However, we saw that some actions identified had not been taken forward and rectified.

People’s care documentation did not provide appropriate information in relation to the care and treatment needs of the individual. Gaps were seen in daily charts and care plans had not been reviewed and maintained to an appropriate standard.

Inspection carried out on 28 August 2013

During an inspection to make sure that the improvements required had been made

We carried out this inspection to follow up on a warning notice issued as a result of concerns identified at the last inspection.

We looked at care plans and further care documentation identified in the warning notice. We spoke with staff and people living in the home. We found that concerns identified in the warning notice had been addressed.

Inspection carried out on 26 July 2013

During an inspection in response to concerns

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. We observed care and looked at documents

During our inspection we found that documentation in people’s care files did not detail their care needs. Gaps and inconsistencies were seen. This meant that people were at risk of receiving inappropriate care and treatment.

Staffing levels were being maintained by the regular use of agency staff. Due to the lack of relevant documentation and inadequate daily records it was unclear how the provider had ensured that all staff were aware of people’s needs.

The provider had implemented a number of changes to assess and monitor the quality of the service. However actions taken to address concerns raised was not always clear. Time was needed to allow monitoring to become fully embedded.

Inspection carried out on 24 April 2013

During an inspection in response to concerns

At the time of our inspection there was no registered manager employed at Chaseley. The organisation had informed us that the previous manager had left. However, the previous manager had not deregistered with CQC at the time of the inspection, therefore their name still remains on any reports until such time that this information is received.

People living at Chaseley had complex needs which meant that some people were not able to tell us their experiences. Those who could told us they were happy living at Chaseley. One person told us “Staff do a wonderful job here.”

During our inspection we found that people were involved in decisions made about the care they received. The provider had robust recruitment procedures to follow for new staff. However, not all staff were aware of correct safeguarding procedures. Documentation in people’s care files had not been completed correctly, with gaps and inconsistencies seen.

Inspection carried out on 23 October 2012

During an inspection to make sure that the improvements required had been made

At the time of our inspection there was no registered manager employed at Chaseley. The organisation had informed us that the previous manager had left. However, the previous manager had not deregistered with CQC at the time of the inspection, therefore their name still remains on any reports until such time that this information is received.

People living at Chaseley had complex needs which meant that some people were not able to tell us their experiences. Those who could told us they liked living at Chaseley. One person told us “I enjoy the activities, and I really like my room, I have all my own things around me."

During our inspection we found that care plans clearly documented the needs of people, and the general standard of cleanliness was of an appropriate standard.

Inspection carried out on 25 June 2012

During a routine inspection

People living at Chaseley had complex needs which meant that some people were not able to tell us their experiences. Those who were, told us they liked living at Chaseley. Visitors spoken with were happy with the level of care provided. We were told “staff are very caring and do all they can”. Another visitor spoken with told us “I cannot fault the care staff, but the bedroom, although cleaned regularly, needs attention to detail, I often tidy up myself when I visit”

Inspection carried out on 1 November 2010

During an inspection in response to concerns

All of the people we spoke to said that the home offers the support and care they need, in a flexible way that enables them to be as independent as possible. They said that the staff were kind, patient and always around to talk to. People said the food was good, several choices were offered for each meal and special diets were catered for. They felt they could be involved in decisions about how the home is run if they wanted to, and some changes have been made following suggestions from people using the service and their relatives.